Teeth - development and teething

tooth; teeth; teething; development; baby; permanent; deciduous; primary; grinding; cyst; blister; decay; wisdom; molar; inciser; jaw; enamel; lemon; acid; juice; bruise;

Contents

• Tooth development
• When teeth come through
• Tooth eruption chart
• Teething
• Other health problems
• What parents can try
• Teething blisters (eruption cysts)
• Teeth grinding
• Resources
• References

Teeth are some of your children's most important possessions. How you look after their teeth from the time they are babies will make a difference to how they grow and how healthy they are. This means not only how you clean them but also how you protect tham from things that can harm teeth. Tooth decay is preventable.

There are several other topics on this site about teeth and teeth care:

• Teeth - dental care for children
• Teeth – fluoride
• Teeth – when a tooth is knocked out
• Teeth - decay and erosion

Tooth development

• Primary teeth (baby teeth or deciduous teeth) begin to form about 6 weeks after a baby is conceived.
• By the time your baby is born, all 20 primary teeth are present in the jawbones.
• The permanent teeth also begin to develop before birth.

When teeth come through

• The time when teeth appear varies from child to child.
• Occasionally babies are born with a tooth, but these early teeth are usually lost soon after birth.
• Usually the first tooth appears between 6 to 10 months, but a few babies have no teeth until 12 months or more.
• The lower two front teeth usually come through before the upper ones.
• The teeth usually come through in pairs - one on the right, one on the left side.
• By about 2½ to 3 years, all 20 baby teeth have come through.
• The first permanent teeth (molars in both jaws and the central (incisor) teeth in the lower jaw) begin to come through when a child is about 6.
• By 12 to 13 years, most children have 28 permanent teeth. The last 4 molars ('wisdom teeth') usually come through between 17 and 21 years.

Tooth eruption chart

First teeth chart

Permanent teeth chart

Teething

• Teething is natural. A lot of research has been done which shows that babies are not more irritable or unwell when teeth come through.
• Despite this, many people, including parents and doctors, believe babies are in pain, irritable, have sleep problems, and get snuffly around the time they get new teeth.
• If your baby seems to have the problems that are often called "teething problems", the problems are real, but may not be caused by teething.
• When a new tooth is moving up through the jaw into the mouth, the gums might look red and swollen. We might think this causes pain, but it might not cause pain.
• Teething gels, biting on something hard (such as a teething ring), paracetamol or ibuprofen seem to help some babies. If your baby seems distressed you could try them. 
  •  Work out the correct dose of paracetamol or ibuprofen for your baby, using information on the bottle.
  • Teething gels which do not contain salicylates are recommended as there is a theoretical risk of a serious illness called Reyes syndrome if children are given gels which contain salicylates, however no case of this illness has occured due to teething gels.
• Do not use lemon juice on your baby's gums. Lemon juice has a lot of acid and can harm new teeth by dissolving the tooth enamel.

Other health problems

Other health problems when babies are at the age that teeth come through may include:

• waking a lot at night
• being restless and irritable in the daytime
• colds or other infections
• a temperature (fever)
• a rash, especially a nappy rash
• diarrhoea.

These are not likely to be caused by teething. If your baby seems unwell, see your doctor.

What parents can try

If your baby seems to be in pain, the following suggestions may help.

• Give the baby something firm to bite on, such as a cold teething ring, a toothbrush or a dummy.
• Some babies prefer mushy food for a while because it needs less chewing, while others like something firm to chew on. Rusks can be good.
• If there is a lot of pain, some dentists or doctors may suggest using paracetamol or teething gels (see the topic Using paracetamol or ibuprofen).

Teething blisters (eruption cysts)

• Sometimes when teeth start to come through, a little bleeding happens under the skin, which causes a small blood blister (cyst) or bruise on the gum.
• This is a bluish colour and is likely to come where a tooth is about to come through.
• It goes away when the tooth comes through.
• The tooth will still come through in the usual way.
• Usually no treatment is necessary.
• The blister should not be pricked or cut as this may cause an infection.
• See your dentist if your baby has had one of these blisters for a month or so and the tooth has still not come through.

Teeth grinding

• Babies can sometimes rub their gums together or "grind their teeth" when new teeth are growing and starting to come through.
• The baby teeth at the back (molars) usually begin to grow through at around 12 months of age.
• When these new teeth appear, it seems that this can be uncomfortable for the baby. It can also make the baby's mouth feel unbalanced if the molars do not come in on each side at the same time.
• Babies like to explore new things, and the grinding action can be the child's way of feeling the new changes happening inside the mouth.
• Rubbing the gums together seems as if it relieves some of the discomfort caused by the new teeth coming through the gums.
• This is normal in babies and will probably subside by 2 years of age, when all the teeth have come through.

It is best to monitor your baby and watch for any other signs of discomfort - if you are worried, please contact your local dentist.

Resources

South Australia

• South Australian Dental Service for children.
  Office hours - phone 8222 8222
  After hours emergency dental service - phone 8232 2651
  (Mon-Fri 4.30pm - 9pm; weekends 9am-9pm)
  Health Promotion, SA Dental Service (08) 8222 9016
  http://www.sadental.sa.gov.au
• South Australian parents can consult the Dental Department at the Women's and Children's Hospital (Ph: 8161 7379 - 8am to 4.30pm Monday to Friday) or their own dentist for more detailed information.

Books for parents

• Pamphlet 'Zero to Six'. Obtainable from the South Australian Dental Service, Dental Health Education Unit and Child and Youth Health Centres.

References

South Australian Dental Service, Health Promotion Unit - phone (08) 8222 9016:
http://www.sadental.sa.gov.au

Aligne et al. 'Association of Pediatric Dental Caries with Passive Smoking'. Journal of the American Medical Association (JAMA) 2003, 289: 1258-1264.

American Dental Association. 'Tooth eruption charts'.
http://www.ada.org/public/topics/tooth_eruption.asp

National Center for Education in Maternal and Child Health (USA). 'Knowledge Path re oral health for children'.
http://www.mchlibrary.info/KnowledgePaths/kp_oralhealth.html

Sank, Lindy and Hadi, Hayfa. 'Baby Tooth Tales' in Heinz Sight, May 1999 (51).
SIGN 'Preventing dental caries in children at high caries risk: information for non-dental professionals'.
http://www.sign.ac.uk/guidelines/fulltext/47/section5.html

Wake M, Hesketh K. 'Teething symptoms: cross sectional survey of five groups of child health professionals'. BMJ vol 325, 12 October 2002, p1258.
http://bmj.com

The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.