• Dealing With the Drool: A Teething Guide for Parents

    IMAGE By the time your baby is three, he or she should have a full set of primary teeth. The process of getting those twenty little pearly whites, though, can be quite an ordeal. Some kids get all their teeth without batting an eye, while others (and their families) agonize over every tooth.

    The Teething Process

    The primary teeth begin to form in the womb when the fetus is about four months old, explains Winifred Booker, DDS, a Baltimore, Maryland pediatric dentist. The actual eruption of teeth through the gums—teething—begins when a baby is between four and seven months old. This can vary, though, as some children are born with teeth (called "natal teeth"), while other kids do not show a toothy grin until after their first birthday.
    The first teeth to show are typically the incisors: first the lower front ones and then the upper ones. While eruption charts are available, Brian Lee, DDS, a Foster City, California pediatric dentist, says each child is different and eruption of primary teeth does not really follow a pattern.
    When your child is teething, he or she may be irritable or salivate more than usual or might chew on everything within reach. These are all normal teething symptoms. However, if your child has a fever and diarrhea, call the pediatrician.
    "Parents will say, 'my child has a fever because she's teething.' That's not true," says Andrew Kapust, DDS, an Olympia, Washington pediatric dentist. "If the child has a fever, it's due to something else and not teething...teething is a normal physical process."

    Tips and Techniques for Coping

    Provide your child with safe things to chew on. Dr. Booker's top picks are a one-piece teething ring (smooth or with bumps), a pacifier, or plain or flavored ice chips. (To make flavored ice chips, freeze fruit juice in an ice cube tray and when frozen, crush the cubes.) Whatever you select, make sure little teeth will not be able to chip off bits that might present a choking hazard.
    A wet washcloth, wrung out and frozen also works great, as do teething biscuits. Though he does not advocate fluid-filled teething rings, Dr. Kapust does suggest letting your child gnaw on a big tablespoon chilled in the refrigerator, or rubbing your baby's gums with a clean finger.
    Dr. Lee doesn't recommend topical anesthetics. "Some people get sensitized and develop an allergic reaction to benzocaine," says Dr. Lee. And according to Dr. Booker, teething gels "can numb the swallowing reflex, and the baby can choke." The United States Food and Drug Administration (FDA) also recommends that teething medicines containing benzocaine should not be used in children under two years old.
    Rubbing whiskey or other alcohol on the gums is an old remedy, but pediatric dentists do not recommend it. Instead, Dr. Lee suggests a non-aspirin type of analgesic, for example, Baby Tylenol (acetaminophen for children). Check the label carefully, as dosages differ between drops and elixir.

    Care of Baby Teeth

    Though your child will eventually replace her primary teeth with permanent teeth, they are still essential right now, and not just for appearance. Primary teeth enable children to chew and speak properly, and these "baby" teeth reserve space in the jaw for permanent teeth.
    To properly care for primary teeth, Dr. Booker recommends wiping your child's gums and teeth with a damp gauze pad or washcloth after every feeding, beginning a few days after birth.
    For older children, use a small, soft toothbrush, and "brush very gently," says Dr. Lee. "Some parents remove gum tissue with scrubbing."
    Toothpaste is not necessary. Young children have not mastered the art of spitting it out, and strongly flavored toothpastes may induce an irritating burning sensation, cautions Dr. Kapust.
    Fluoride is essential for the development of strong and healthy teeth. Many communities have added fluoride to their water supplies, so Dr. Lee recommends that parents have drinking water tested before they give their children fluoride supplements.

    Baby Bottle Tooth Decay

    Whether a baby is bottle-fed or nursed, she is vulnerable to baby bottle tooth decay, one of the most common and serious dental problems associated with young children. Such decay occurs when little teeth are exposed to liquids containing sugars (basically, anything other than water) for long periods of time. Bacteria in the mouth thrive on these sugars and produce acids, which attack the tooth enamel.
    The result is damage to the teeth, which is evident by black or brown spots. One of Dr. Booker's patients, a little girl, lost all of her top primary teeth to baby bottle tooth decay: "I had to make her a partial," says Dr. Booker. "She wanted teeth like other children in the first grade had."
    The best treatment for baby bottle tooth decay is prevention. Do not let your child use a bottle or spill-proof cup as a pacifier, or fall asleep with a bottle or spill-proof cup containing anything but water. And be sure to gently clean her teeth and gums after each feeding.

    It is Here! Now What?

    The American Academy of Pediatric Dentistry recommends that kids see a dentist as soon as their first tooth appears, usually before their first birthday. The dentist will check your child's teeth and gums for healthy development, and will show you how best to clean them.

    RESOURCES

    American Dental Association http://www.ada.org/

    American Academy of Pediatric Dentistry (AAPD) http://www.aapd.org

    CANADIAN RESOURCES

    Canadian Dental Association http://www.cda-adc.ca/

    Primary Care Pediatrics Ontario Association of Pediatricians http://www.utoronto.ca/kids

    References

    Benzocaine topical products: sprays, gels and liquids - risk of methemoglobinemia. U. S. Food and Drug Administration website. Available at: http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm250264.htm. Updated April 7, 2011. Accessed November 17, 2011.

    Berenstain S, Berenstain J. The Berenstain Bears Visit the Dentist . Random House; 1981.

    Civardi A. Going to the Dentist . EDC Publications; 1993.

    Craig L. My Dentist Makes Me Smile . First Books Library; 1998.

    Dowdy LC, et al. Barney Goes to the Dentist . Barney Publications; 1997.

    Keller L. Open Wide: Tooth School Inside . Henry Holt and Company, Inc.; 2000.

    Mayer M (Illustrator). Just Going to the Dentist: Golden Look-Look Book . Golden Books Publishing Company, Inc.; 1998.

    Schoberle C. Open Wide: A Visit to the Dentist . (Rugrats, No. 14). Simon Spotlight; 2000.

    Smee N. Freddie Visits the Dentist . Barrons Educational Series; 2000.

    Teething tots. KisHealth website. Available at: http://kidshealth.org/parent/general/teeth/teething.html. Updated October 2008. Accessed November 17, 2011.

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