Smile: It's time for teething

When your baby's 20 primary teeth start to break through the gums, it's teething time, a totally normal occurrence in every child's life. You can expect the process to start when baby is approximately six months old, but every child is different, says Michael A. Koumaras, D.M.D., of Best Dentist 4 Kids, located in Philadelphia and Hatboro.

"Teething can start as early as three months and as late as 12 months, and may take up to two-and-a-half years to complete," says Dr. Koumaras. "Some babies are born with teeth whose roots may not be fully formed."

In general, look for the two bottom front teeth to arrive first, usually followed by the two top front teeth, he says. Here's what else parents need to know about teeth and teething, from Dr. Koumaras.

1. Recognize signs of teething: Your baby may drool more than usual, so be sure to wipe drool to prevent a skin rash. "It may seem like they want to put anything in their mouth," he says. "They may cry more or be fussy and need to 'chomp' down on objects or fingers to relieve discomfort. Cheeks may also be redder than usual and the child could run a slight fever of 98° to 99°. They may also be less eager to eat or drink and have trouble sleeping. However, luckily, some babies show no signs of teething."

2. Help ease discomfort: To help baby be more comfortable, choose a softer teething toy or ring. A cold, but never frozen toy works best to temporarily "numb" a baby's gums.

Those gums can actually harden if baby chews a tough toy, making it more difficult for teeth to break through to the surface. "Perhaps one out of 100 teeth need a little help to expose a new tooth," he says. “Most teeth erupt on their own but there are times when the process can be helped along by the dentist if teeth have a hard time erupting.”

Avoid any type of topical anesthetic, including a teething powder, tablet or gel. The U.S. Food and Drug Administration (FDA) warns parents that tablets or gels may numb a child's throat, which could impede swallowing. Babies can also swallow these products that can contain unsafe ingredients for infants. In general, do not use any drug, herbal or homeopathic remedy to treat your baby's teething. You do have safe options, so ask your dentist or pediatrician about use of a nonsteroidal anti-inflammatory drug to treat fever or pain. Never give aspirin.

3. Know when to see the dentist: Yes, babies need dental care, too, and that first important visit for an exam should take place around baby's first birthday or six months after the eruption of the first tooth. Parents can begin brushing with an infant-sized brush or wiping teeth with a cloth and water immediately, says Dr. Koumaras. Use a tiny amount of fluoride toothpaste to do this, no more than a grain of rice.

Babies really can get cavities and they may have longer-term implications, he says. A tooth that decays and produces a cavity can get infected and harm the nerve, resulting in an extraction.

"Adult teeth begin forming at birth, and baby teeth actually 'guide' future placement of adult teeth," he says. "That's why extracting them is not helpful, when that procedure leaves an open space."

The first exam is also a great time to talk about a balanced diet that limits sugar and starch consumption to reduce risk of future tooth decay, he says. If baby gets a bottle at night to help encourage sleep, it should only contain water and never juice, which should only be given at meal time or as a snack.