Tuesday, July 09, 2013

Teething Troubles



As a Pediatric Dentist, I see patients from birth to age twenty-one.  In one chair there may be a college age teen who needs his wisdom teeth removed, and in the next, an eight month old with new teeth just coming in.  Yes, we see such young babies.  It is important to have the first visit to the dentist by age one or within six months after the first tooth erupts to establish preventive strategies and make sure dental development is progressing normally.
What concerns many parents are the teething problems associated with the erupting baby teeth.  As the new tooth gets closer to the surface, the gum thins out and you often can see the new tooth bulging right under the thin gum tissue.  Eventually, the gum opens up and the gentile eruptive force of the new tooth moves the tooth up into the mouth. 
When do the teeth come in?  Well, that varies a lot from child to child.  Typically, you might expect the first baby tooth to come in around 6 months of age.*  I see as early as three months and many who are one year of age who don’t yet have their first tooth.  There are actually some kids who are born with a tooth already in place!  The first tooth to come in is typically the lower front incisor.  After that, the order varies with the front four upper and lower teeth coming in first, then the first molars in the back around one year of age or so.  Again, there is a lot of variability.  If you are concerned about any delay, see your Pediatric Dentist.
Does teething usually cause discomfort?  Most of the time babies do not complain much at all when getting their new teeth.  There are, however, times when there are the typical symptoms of teething discomfort.  Many children will begin to drool more than usual.  It’s normal for babies to put things in their mouth exploring textures, but they may want to chew objects a little more than usual to massage the sore gum areas.  They may be grumpy, become more agitated than usual, or even run a slight fever. Mild diarrhea the day the tooth comes in is not unusual.  Constant or severe diarrhea is not normal and should be evaluated by the pediatrician.
Is fever normal with teething?  Now I caution parents to not be too quick to blame a high fever on teething.  New teeth erupting can cause a slightly elevated temperature.  A fever of one hundred or higher should always be looked at with concern as young children are also susceptible to a myriad of conditions that can also cause a fever.  Ear infections are a very common cause of high fevers in babies.  I occasionally see young children with a high fever, multiple oral ulcers who are not eating and are pretty much miserable.  This is not teething, this is an infection caused by the same virus that causes cold sores.  There are many other infections and conditions that can cause a baby to drool, complain and have a high fever, so consult your pediatrician if the fever gets high, or if you are just not sure.
What can you do to relieve any discomfort?  I suggest using cold teething rings or something soft (and safe) so they can chew and help them to feel better.  There is some concern recently about the liberal use of Baby Oragel.  This is the cream with benzocaine, a topical anesthetic that numbs the immediate area when placed on the gums.  I have not seen any definitive study that would cause any concern so long as you use it in a limited manner.  Place a small amount on the gums where the tooth is erupting to provide temporary relief.  Tylenol is ok in appropriate dosages if the child is particularly grumpy or has a low-grade fever; but again, do not dismiss a high fever as just teething.

26 comments:

Kanwar Sidharth said...

Very Nice Post! As a doctor myself i must say Good job doctor! I am chandigarh based doctor specializes for root treatments.

Anonymous said...

Doctor, you seem to be highly intelligent and in fact I'm in need of some intelligence! I know this is an article for teething troubles but my concern is a cavity. I'm not quite sure how to reach out to you in any other way. so please accept my appolgy. my daughter is now 25 months. she has one cavity (left front next to the 2 front teeth) the color is not black. in fact its behind the tooth and is yellowish. is that worse then a black cavity? also the pediatric dentist said "it needs to be pulled" are there any alternatives to placing a crown there or does that normally not happen in the front for baby teeth? and would you say that in the long run it would just be bet to remove the tooth and have her toothless until the adult tooth comes in? thank you. Ashley

Dr. Dean Brandon said...

There are a lot of answer to your questions in my other posts I link over there under general topics like Fillings, etc. There really is a lot of stuff there that I could not link to everything, but I will link to this one:

Bad decay on a two year old--

Forehead Thermometer Accuracy said...

Thanks for posting. Sometimes, kids teething can cause problems like fever. Thanks for sharing the information here.

Dr. Joe Tagliarini said...

No parent like to see their child in pain, and teething can be a scary time, especially for 1st time parents. Just remember that billions upon billions of children have survived teething and so will yours!

Anonymous said...

Hi. My one-year-old son has enamel hypoplasia in one spot on his two bottom front teeth - light yellow discoloration. Our dentist said that it was nothing to worry about. I don't know if it was a glitch in enamel development in utero or maybe due to a lot of antibiotics early in life (8 ear infections/antibiotics in first 8 months of life). Since the appointment this morning I've been reading all sorts of horror stories about enamel hypoplasia. My questions are: does having enamel hypoplasia definitely mean that those teeth are weaker and more susceptible to cavities? If this is due to the antibiotics, are his adult teeth likely to be affected? I've also read that enamel hypoplasia is more common in molars. My son doesn't have those yet. Should I expect more of the same problem on those teeth when they come in? His top three front teeth look fine. Thanks for your help. I haven't been able to find non-horror stories on the Internet, and my dentist (who I really like) will be out of the office for the next several days. - E

Dr. Dean Brandon said...

See my post on Hypoplasia here:

White spots on teeth (Hypoplasia)

Ali Y. Ghatri said...

Thank you doctor your blog was very helpful for me.When a kid accidentally looses her half front tooth can the tooth be replaced for kid below 18months old?

Dr. Dean Brandon said...

If you have a chipped tooth, sometimes you just smoothen it, sometimes you can do a filling. If there is a lof missing like into the pulp, might need removal. See my posts on restorative dentistry, including this one:

Broken tooth

Ther ei s a lot more over there in the side bar...

Dr. Dean Brandon said...

Oh, and here:

Fake Baby teeth pediatric partial

jeannat said...

Hi,

This article is very useful and gives very good information.
I would like to read some more article on Pediatric dentistry.

Dr.Nimri said...

Being a dentist i realize that Pediatric dentistry is complicated with respect to the complexities involved in educating parents about the dental care of their kids.
I must say this is an impressive blog post to clear many ambiguities related to pediatric dentistry.

Rajita Gupta said...

Nice blog

Ross Rubino said...

Great tip about giving them cool teething rings. It has also been brought to my attention too that there is concern about the orajel usage. As a Park Ridge dentist I have a lot of youth patients.

Heng Yi Goh said...

I fell of a bicycle 3 months ago and knock on 3 of my permanent tooth. Until now, there is still no sign of vitality. Does that mean that the 3 tooth are comfirm dead?

Dr. Dean Brandon said...

I'd get a dentist to take a look. Trauma can certainly cause loss of vitality that needs treatment.

dentist Redondo Beach said...

This article is very informative. I am going to bookmark it.

best of best said...

i am 14 and will be 15 soon . i lack several permanent teeth . i follow a treatment with my or-tho dentist since 2011. some of my milk teeth have not already fall because of the lack of permanent teeth .i don't know how long it will take to make implants . the dentist told me that the implants will be made once adult and the mouth fully formed. i am a teen now and feel uncomfortable about it . i want to have a rapid treatment that will be successful . i don't want to wait till 21 years to have a 'normal' mouth . can u help please ?

Dr. Dean Brandon said...

Best,
It is true that in many cases it is best to wait till growth is complete before doing implants. In the intervening years prosthetic teeth, such as a retainer like appliance with artificial teeth for appearances can be fabricated. Cases can be complex and each is different. There is no one way that all are treated. Read more on the blog here about congenitally missing teeth. I know it is a difficult situation.

Dr. Dean Brandon said...

Best,
--or if some teeth are unusually small, crowns or composite filling buildups can make their shape more natural.

Pediatric dentist Danville  said...

It is best to wait till till growth is complete before doing implants

Anonymous said...

I have a 5 year 5 month old son. He has cavity on one of his front tooth. We suspect that the cavity was caused by the multivitamin drops that we used to give him upto 2 year as per the recommendation given by our pediatrician. Because of the cavity that tooth was chipped diagonally ( around 25 -40 % of the visible area) when he was 3 year old. But he never complained of any pain. Last week the remaining part of that tooth was also chipped. We visited the pediatrician Dentist 3 weeks back and she asked as to get it removed as it can cause infection in the permanent tooth that is underneath. But we didn't want to get it removed so she asked as to wait and watch, if he complains of any pain or if there is any redness or pimple near that tooth we should immediately see the Dr. But now since the remaining part of the tooth is also broken I am worried and confused, whether to get it removed or just wait and watch. When I saw the X-Ray, Dr said there is still around 1.5 -2 year left before my son can get his permanent tooth. What shall I do now? Shall I get it removed or wait and watch. I have seen a few kids with similar problems but they didn't have problem with their permanent tooth. My son is not complaining about pain or cold/hot sensation. Please advise.

Dr. Dean Brandon said...

Well, I really can't advise as he is not my patient, but I can say that yes, upper front baby teeth do not usually fall out till about age 7. Decayed teeth do get worse and worse and may eventually need to be removed. If your pediatric dentist suggested that you have the tooth removed, you may want to take her recommendation.

dentist in Whitchurch said...

Good evidence now exists that teething is associated with, at most, minor and relatively infrequent symptoms. Most medical professionals now agree that teething does not cause life-threatening illness.

Teething appears to be linked with:

1) Daytime restlessness
2) Thumb-sucking
3) Gum-rubbing
4) Drooling
5) Loss of appetite.

Thanks for sharing additional details about this.

bryan flake said...

My son has some teeth that are growing in sort of funny. Is there anything that the dentist can do to move his teeth around at his age? he is seven.


bryanflake1984| http://www.drserfaty.ca/en/about_us.html

Dentistry & Cosmetic Dentist Tucson said...

Well Explained!!!