One of the big developmental stages of childhood is teething.  And in the same way that other developmental achievements are very individual,  teething happens at different times for every child.  Generally, teeth start to appear in the gums at around 8 months of age.  However, any time between 3 and 12 months is normal for teething to start.   

What is teething?

Teething is the name for when teeth are erupting through the gums.  Just before they can be seen, the teeth often cause swelling underneath the gum line. Contrary to public opinion, teeth don’t actually move up and down, or move around in the gums.  As the crown of the tooth is close to emerging, there is often localised gum redness and swelling. As this swelling subsides, more of the tooth can be seen. 

Baby teeth, also known as milk, primary or first teeth, are formally called deciduous teeth. And in the same way that deciduous trees lose their leaves over time and seasons, children lose their deciduous teeth as they get older.

When do babies start to get their teeth?

Teeth actually start their development during pregnancy.  As early as 5 week’s gestation, the first tiny buds of the baby teeth start developing.  At birth, all 20 deciduous teeth are sitting in the baby’s upper and lower jaw, waiting to erupt.

On average, teething starts at around 8 months of age. Sometimes a little earlier and sometimes later. Most children have all 20 deciduous teeth by the age of 3 years. Once they’re between the ages of 6-7 years, the deciduous teeth start coming out as the permanent teeth begin to erupt.

Rarely, and for reasons we don’t fully understand, babies can be born with teeth, called ‘natal’ teeth. These tend to be small and loose and are often discoloured.  If the tooth is loose, this may be because the root is not fully developed. The general dental advise is to remove loose natal teeth, as they can pose a breathing risk if they are inhaled by the baby.

Although teething ages can vary, the order of tooth development tends to be pretty much the same between all babies.  The first ones to come through are generally the lower, central incisors, followed by the upper incisors, then the lateral incisors, canines and molars . 

What are the symptoms of teething?

Some babies don’t seem bothered at all when they’re teething. One day, a little tooth can just appear in their mouth, often to their parent’s surprise.  However, it’s not unusual for little people to have some physical and behavioural changes during teething, most commonly:

• Dribbling/drooling
• Flushed, red cheeks and perhaps a rash around their mouth
• Wanting to chew and suck more than usual
• Pulling at their ears
• Being cranky and a little irritable
• A nappy rash.

Typically, teething symptoms settle in a day or two.  

An elevated temperature is not generally a sign of teething, especially if a baby also has changes in their feeding, sleep and behaviour. Have your baby checked by a doctor if you’re worried about them, or they appear unwell.

Is teething painful?

The truth is that we don’t really know. But any adult who has had wisdom teeth come through can certainly appreciate that it’s not a comfortable process. Many babies seem happier once their teeth have erupted through the gums, especially if they’ve been miserable for a few days. If there’s been lots of gum swelling and redness which settles as the tooth erupts, it makes sense that they’re likely to be happier.

Some babies seem to show more teething symptoms when the bigger, molar teeth are erupting.  These start at around 12 months of age though again, there’s a big age range depending on individual differences.

Sometimes a blue/grey coloured ‘bubble’ appears on the gum where the tooth is about to erupt.  This is called an eruption cyst, or teething blister. There is no special treatment for an eruption cyst. Once the tooth comes through, the cyst disappears. 

What can I do to help my baby when they’re teething?

There’s nothing you can do to help the tooth erupt through the gums more quickly.  Only time makes a difference in teething ages and stages.

However, you could try these strategies to help your baby feel a little better:

• Lots of cuddles and reassurance.
• Offer your baby cool, wet washers to suck on.
• Teething rings and soft toys often help to relieve the urge to suck and bite down.
• Offer solid foods which are cool and soothing to sore gums. Pureed fruits are often popular.
• Offer teething rusks, or sugar-free teething biscuits.
• Massage your baby’s gums with a clean, soft thumb or finger.
• Dry the skin around your baby’s mouth if they’re drooling a lot.
• Use a good quality nappy rash cream to protect your baby’s skin from nappy rash.
• Give analgesia, such as Paracetamol or Ibuprofen in the recommended dose for your baby’s weight. Speak with a pharmacist or your doctor if you’re unsure about the correct dose and frequency.

What not to use when your baby is teething

Teething gels which contain choline salicylate are not safe to use. This is an ingredient which is related to aspirin.  In some children, this can cause a condition called Reye’s syndrome. 

Teething gels which contain numbing medication like lignocaine and benzocaine.  This is because their dose is difficult to measure, which can potentially lead to overdosing. 

Teething necklaces – these are often made from amber beads, which are believed by some people, to have anti-inflammatory properties.  There is no clear evidence to support the claim that amber bead necklaces help to relive teething symptoms. They are also unsafe because they pose a strangulation risk.

How can I care for my baby’s teeth?

Right from birth, you can start cleaning your baby’s mouth and gums by wiping them with a soft cloth. This helps babies to become used to having their mouth cleaned.  When their first tooth appears, wipe it with a soft, wet cloth or use a soft, small headed toothbrush with plain water to gently clean each surface of the tooth.

Take your baby for their first dental visit when their first teeth appear inside their mouth, or by 12 months of age, whichever comes first.

From 18 months, start using a small, pea sized amount of children’s toothpaste on their toothbrush.  Encourage your child to spit out the toothpaste and not swallow – this can be easier said than done!. 

From 1.5 years of age, start flossing between any teeth which are touching. Flossettes, (which are shaped like a small harp), may be easier for you to use on your child than dental floss.

From 4-5 years of age, switch to adult fluoridated toothpaste and continue to encourage your child to spit the toothpaste out and not swallow. There’s no need for your child to rinse their mouth, the fluoride in the toothpaste then has a chance to stay on the teeth and harden the enamel.

Continue brushing your child’s teeth until they’re at least 8 years old. Until then, children don’t have the manual dexterity to do a thorough  job of brushing.

Offer your baby healthy, nutritious foods which are low in sugar.  Avoid offering juice and/or cordial.

Aim to cease all bottles from 12 months of age and offer your baby milk and water from a cup.

Written for Tooshies by Jane Barry, Midwife and Child Health Nurse, January 2024.