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.

66 comments:

Unknown 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.

Unknown said...

Nice blog

Unknown 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.

Unknown 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.

Unknown 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.

Unknown 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!!!

Unknown said...

My nephew had his full set of teeth by the time he was one and a half. It was pretty surprising. Luckily he didn't have any complications or had any teeth out of place. I just hope that my kid will have the same luck when he get's his teeth in. I'll make sure to see a children's dentist when they come in.
-Seamus | Grimball Pediatric Dentistry

Baby dentist said...

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

Unknown said...

My cousin is a Toronto dentist, and I remember babysitting his kids once. His daughter had started teething rather unexpectedly and they didn't have any teething rings for her. She grabbed my forefinger, pulled it into her mouth and started gumming it to relieve the pain! Young mouths can exert a surprising amount of pressure! But at least she was all smiles after that.

Roxanne Rook | Walk-In Dental Clinic

Unknown said...

Dealing with a teething toddler is not fun, in any way. However, there are things to help them through the process, and as a result help you as well. I have found that homemade Popsicles work wonders. Making them at home allows you to control the size and amount of sugar. When a teething toy just won't do, try a Popsicle.

Elisa Jed | http://www.bonniedoondentist.com/general-dentistry-edmonton-alberta.html

Jas DAvis said...

You are right doctor, visit to a dentist at a child's early ages is a must to avoid future dental problems, thanks for sharing such a informative blog I loved the ways u have explained things, really gone read more on it.

Puerto Vallarta dentist said...

Thanks for sharing such a nice blog

Syed Mehdi said...

The stem cells replace or repair the damaged cells and restore normal function. Umbilical cord Mesenchymal stem cell is better than dental stem cells.

Anonymous said...

My son has grinded his front teeth down one is practically gone down to the gum I feel bad because he is in pain and the orthodontist told us to not worry but now he is feeling it I'm afraid it maybe tooth decay what should I do should I go to another dentist he is only 2 1/2

Dr. Dean Brandon said...

I see decay in 2 year old children every week. Grinding can wear down teeth quite a bit but it takes time for it to get noticeable. An orthodontist usually does not deal with decay and the things a pediatric dentist sees, so I would recommend an opinion by a pediatric dentist. If it's just grinding, it is usually not as big of a concern.

Unknown said...

What is the difference between a family dentist and a pediatric dentist? I want to find one that is good for my family and my children. I just want to make sure that the children are comfortable seeing the dentist. http://www.brantolsondds.com/

Dr. Dean Brandon said...

William---from the American Academy of Pediatric Dentistry:
What is the difference between a pediatric dentist and a family dentist?
Pediatric dentists are the pediatricians of dentistry. A pediatric dentist has two to three years specialty training following dental school and limits his/her practice to treating children only. Pediatric dentists are primary and specialty oral care providers for infants and children through adolescence, including those with special health needs.

Pediatric Dentistry is a Recognized Dental Specialty.
Pediatric dentistry is one of the nine recognized dental specialties of the American Dental Association. Pediatric dentists complete two to three years of additional specialized training (after the required four years of dental school) to prepare them for treating a wide variety of children's dental problems. They are also trained and qualified to care for patients with medical, physical or mental disabilities.

varsha rajan said...

Doctor,am 22 years girl.My problem is that one day when am having my dinner suddenly one of my tooth started paining and i felt that am almost to loose it because my mom said may be it is a baby tooth so its paining.my doubt is that at 22 yrs age can we lose our baby tooth.if we loose our tooth is there any chance for a new tooth to come in place of baby tooth??..please doctor help me by giving your valuable rply.
Thanks in Advance.

Dr. Dean Brandon said...

Well, there are moe people than you might think that have retained baby teeth as an adult. The permanent one never formed, so the baby one remains for quite some time. However, if pain or discomfort is involved, it could be many other things like a cavity or worse, so get it checked by your dentist.

The Tooth Group - Dentist Hamilton said...

Nice Post! Improved my knowledge in Pediatric Dentistry. Thanks for sharing

Kheb said...

Hi! My daughter is teething. Her two upper front teeth are about to come thru... You can see a little bit of white at the gums. She also has recently learned to crawl and is getting into things. She crawled to a toy and was really excited and bumped her open mouth on the toy. So there is now swelling and there was some bleeding that stopped quickly. How Long before the swelling goes down? Do you think the teeth in this area could be damaged under the gums due to trauma... Like erupt discolored or have mere damage? Just wondering if the tooth is protected in the gum?

Dr. Dean Brandon said...

Minor bumps rarely cause any problems with teeth that have already formed (i.e. about to erupt). See your pediatric dentist for followup.

Estetico Manila said...

Thanks for this post. This will be a good help as a guide on how to overcome this kind of situation.

Anonymous said...

Love your.blog!. My son is 9 months and started getting his teeth at 3 months. He has 8 teeth currently. Now the bottom tooth (the first place tooth in the line of three) is just erupting now and is comint through in two separate pieces. So far there doesn't seem to ve any pain but I am not sure if it is fully broken through. I have a dentist appt for him but am wondering what to expect? There was never any trauma or any falls so what would have caused this? Im baffled!! Thank you for any advice!!

Dr. Dean Brandon said...

Well, I usually wait till a tooth comes in more, but sometimes it is a different shape which usually falls under the category of partial gemination. See my post on that.
Gemination and Fusion

Natalie said...

All the information on here is a Godsend and I really can't thank you enough for creating this blog. My problem is that my son is 12 and continues to suck his thumb and I have tried everything to remedy it. It has altered all of his upper teeth which have twisted as a result. Today we have found out that he doesn't have any teeth under his premolars (bottom 1 on each side) What do you think the prognosis is on this. Whenever we have open discussions about his teeth which don't show so much when he smiles... he ends up in floods of tears but continues to suck his thumb as part of a comfort thing. It is almost like a tick...he suffers from attention deficit and tends to always have a finger or thumb in his mouth. I am so worried about the final outcome and don't know what to expect. I would like to note he has inherited quite small teeth from my side of the family. His two front teeth are straight but slightly goofy and the two teeth next to them appear to be growing sideways...um on an angle so look a little like vampire teeth. The name calling has not resulted in him sucking his thumb less but probably more when he returns home from a day of harassment. I am sorry for my rambling but would like to be more informed before I make the wrong decisions on the future outcome. Will he ever be able to have straight teeth? Thank you in advance and wishing you all the very best! Natalie

Dr. Dean Brandon said...

Natalie,

"Will he ever have straight teeth?"

Well, sounds like he will --after proper orthodontic treatment. Two things: first, thumb or other habits are difficult to stop, especially if they have lasted into the permanent dentition. Orthodontic treatment and/or a habit appliance might be helpful for such cases. Secondly, sounds like he might have crowding or the classic Class II division II occlusion. That's where there is an overbite, but the two middle teeth are back and the lateral incisors kind of stick out or are rotated. All this a good pediatric dentist or orthodontist can evaluate and give you a good idea of the possible treatment needed. I encourage you to get an orthodontic consultation. Twelve years old is not too young for most cases.

Monika Harriott said...

Hello, I recently moved back to the United States from Germany due to military affiliation. I am very much interested in the services provided at your facility. My daughter had baby bottle tooth decay in which required us to extract her two front teeth and put white crowns on the teeth on each side of her front teeth. Since we have been in the states rone of the two crowns have can off and I can't find a local dentist that is willing to place a white crown plus replace the two front teeth with a bridge. She is 3 years old.I feel that it is affecting her speech. Im looking for help to find a dentist near the Savannah, Georgia area, can you recommend another near by dentist office that does. If not is this a procedure in which your facility can complete in one visit, I don't mind coming to your facility but it is almost 8 hours away from where I'm located.Thank you for your time.

Dr. Dean Brandon said...

Monika,

Young children with "baby bottle tooth decay" often have complicated treatment needs. Crowns are often needed, or even removal of severely decayed teeth. I suggest you read more here on the blog about these issues. There is a lot of info on the right column under general topics. There is often not a simple easy answer. We (Alabama Pediatric Dental Associates and Orthodontics) are accepting new patients, but I am sure there are several good Pediatric Dentists in your area. Look for specialists in Pediatric Dentistry. or, consult the aapd.org website to locate one near you.
-When we see new patients, we evaluate their current status and any treatment needs. If there is something that would be helpful, we find the best way to go about doing that to manage behavioral issues (usually due to age) and still get the best result. Call our office to make a new patient appointment if you wish.
-Keep in mind extensive treatment usually cannot be accomplished in one treatment visit. With General anesthesia cases, we can do all treatment at one time. Cooperative patients with limited needs can be seen in the office setting, in the normal way, and depending on the procedure, be seen in a timely manner.
--Just as an aside, missing front baby teeth do not adversely affect speech and no replacement is necessary unless it is for appearance.

Nurse mommy said...

This is a great blog and great post!

If like to say, that so many parents needlessly worry about their babies teething.

Im sure there is some genetic component to the timing of tooth eruption. I had ALL my primary teeth (including second molars) by my 1st birthday. My oldest son in turn had all his primary teeth by his 1st birthday. And my youngest son had them all by 20months old. My step daughter kn the other hand has been on the late end of tooth eruption.

There are pros and cons of both. Yes its great to have a toothy toddler who can actually chew their food....but its more difficult to brush there teeth.

Meanwhile, my step daughter was sad that her friends were all losing teeth in kindergarten and she didnt lose any until 6 1/2.

No need to stress parents! There are controllable and uncontrollable factors regarding oral health. Tooth eruption/developement/color and shape is not something you can really control much, however you CAN control how you teach oral care.

Anonymous said...

My son i has this flopy skin going all the way across his top gum it got four teath that you can see clear as day u can see white it looks like there are trying to burst through but this skin looks like it is not ganna let them go through his cheaks are allway bright red with rashes on then the same as his bum i carnt get rid of his redness his got shape bits coming through the bottom gums at the back they arnt given him eny truble im not braging when i say this but he is the srongest baby iv ever seen in my life he can go through a lot of pain and he wont cry he gives a little windge like no joke 5 to 10 seconds when he gets needle because his a verry happy eserly distracted baby but i can see his in pain rub that flap on his chin bits like his ganna eat his lip of and chew on his fingers till they go purple sofo i can not tell how bad it is and how much pain his in his been teathing since he was 2 months old and now his 5 months and it just been making me go mad caz i dont now what to because he doesnt cry to let me now his hurting who new as esey as he is his teath are like a nightmare please please help me!!!!!....

Dr. Dean Brandon said...

Most babies do not cry or have pain with erupting teeth. If they do, they are usually just a little grumpy, drooling and like to chew not things. Yes, sometimes kids are pretty miserable with teething. I'd get a pediatric dentist to look, but usually the first tooth does not erupt till about 6-8 months. --Although it varies a lot. If there is a lot of pain or fever get you pediatrician or d=pediatric dentist to look. Sometimes viral infections can cause ulcers in the mouth.

Anonymous said...

My daughter had to get her tooth pulled because she had a in growing tooth. She is scared that she might need braces because of how big the space is. By the way she is 17 years old and I want to say she had one more baby tooth in her mouth. I don't know what to do.

Dr. Dean Brandon said...

Well, braces might seem scary, but they are easy. I would consult an orthodontia to see what your options might be.

Trish Chavez said...

Great read, and great recommendation. I've stuck with Sleeping Baby Trendy Teether's, and my little girl LOVES IT. For moms, they're wearable necklaces (and clip-on teethers, pacifier clips) and they are sooo convenient when your holding your little one and they keep trying to throw it on the floor, but won't be able to since you're wearing the necklace that they love to chew up! I recommend everyone gives it a try!

Unknown said...

And can you please give me your office address? Thank you so much.
My email: nguyencamtien@ gmail.com

Dr. Dean Brandon said...

practice located in Huntsville and Madison Alabama. Office phone: 256-539-7447 Main Office address: 4001 Balmoral Drive, Huntsville, Alabama 35801

Anonymous said...

My daughter has really short teeth. They broke through at 10 months n four months later they look like they grew 1/2 way and stopped. Is this normal

Vane said...

My 15 Months baby has a very bad cavity and his dentist put on this liquid that a couple days later made some of his teeth black specially the one that has the cavity but I feel bad can I do anything to make the black stops go away please help

Vane said...

I took my 15 months toddler to his dentist because he had a very bad cavity on one of is top front teeth and they told me they need to either take the tooth out or they were going to put a liquid to protect the took until he was 2 years old but a couple a day later the liquid the put turned his top part of his front teeth black and when he smile you can tell his teeth are black what can I do isn't there another way to correct his cavity that won't make his smile look bad please help I feel so bad see my baby's teeth like this

Dr. Dean Brandon said...

Vane--
I am sorry to hear of your child's problem. If it is decay, it will slowly get worse with time unless it is treated. Sometimes in very young children, fluoride varnish is applied which slows the process buying a little time till they child is old enough to cooperate or circumstances change. It is only a minimal treatment, but can help. The varnish I know of is clear/white in color and pretty much washes off by the next day. Darkness in cavities is usually caused by the decay absorbing stain from foods. I do zoo young children iwht what i call "iron stain" which is a stain from foods or formula as well. It can be cleaned off and is not decay. It sort of looks like a dusty gray to black color and is usually on several teeth. Seems like you need to see the dentist again. Beware early childhood caries can progress rapidly.

Dr.Aditi Aggarwal said...

Thanks for writing such an informative article stating facts and busting misconceptions about teething. I'm sure it will help many first-timer parents and also those who have certain doubts regarding teething.

TerryC said...

Dr Brandon, thank you for taking the time to write this hugely informative blog. I came across it while trying to find reputable respources on baby's first teeth eruption and growth. I am concerned about the size of my baby daughter's first teeth. She is 10 month old and her first teeth appear too small. They broke through over 2 months ago and are either growing very, very very slowly or have stopped growing completely. It strikes me as odd that it should be taking over two months for them to grow to their full size. She is my second child and I know her brother's teeth did not take this long to grow, nor were they ever this tiny (her teeth are very short but I think their width is normal, or at least close to normal). Could you please advise if this indicates any underlying health issues at all? I came across a comment on a mothering forum that tiny teeth may be a symptom of Ehler Danlos syndrome...? Many thanks!

Dr. Dean Brandon said...

Well, as you probably know, teeth, once formed, do not grow any bigger, but they can be slow to come in compared to their friends of similar age. Once they come in, most are "normal" size, that is, in proportion, and some are smaller. So, I do see small teeth sometimes. Although yes, it could mean some syndrome, most of the time, it's just small baby teeth. Syndromes are rare. Just because the baby teeth are small, that does not necessarily mean the permanent dentition will have the same thing. Once there is cooperation enough to take x-rays (usually three or four years old) you can see the permanent teeth. Have a pediatric dentist take a look and give his/her opinion.

Concerned Mom said...

Hi Dr. can a baby chip their tooth by teething or something hard or is a chipped tooth always caused by a fall or injury? Thanks!

Dr. Dean Brandon said...

It's not always a fall. Kids are putting things in their mouth all the time. Biting a hard object (or ice or hard candy) can chip a tooth. In addition, previously filled or damaged teeth can also chip more easily.