Teething

A baby's first teeth (known as milk or deciduous teeth) usually develop while the child is growing in the womb. These teeth then start to emerge through the gums when a child is six to nine months old. This is known as teething.

When teeth emerge through the gums they do not cut through the flesh. Instead, special chemicals are released within the body that cause some cells in the gums to die and separate, allowing the teeth to come through.

How long does the teething process take?

A baby's bottom front teeth usually come through first, followed by their top front teeth (central incisors) and then the top and bottom incisors either side (lateral incisors).

The first molars (back teeth) then start to come through at approximately 12-14 months of age, followed by the canines (next to the lateral incisors) at 16-18 months, and finally the second molars at 18-30 months. A child will normally have a full set of first teeth by the time they are two-and-a-half to three years of age.

In a small number of cases, some children may be born with one or two teeth that have already come through, or will have a tooth emerge within the first few weeks of birth. This should not cause a child any problems, unless it affects their feeding.

Some babies show very few signs or symptoms of teething, while others find it a more painful experience. However, there are lots of ways you can help make teething easier for your child (see the treatment section).

Some babies do not experience any pain during teething, while others are more severely affected. The pain is caused by movement within the developing jaw bone, as teeth start to make their way through the gums.

Some teeth may come through easily, whilst others cause pain and discomfort. Once the teeth have emerged, the discomfort will normally stop.

Your baby may experience a number of different symptoms while they are teething, some of which are listed below.

• A raised temperature - but not a fever, which is a temperature of 38C (100.4F) or above.
• Reddened cheeks - your baby's cheeks may also be warm to the touch.
• Reddened gums.
• Excessive dribbling - this may cause a red rash to develop on their chin.
• Poor appetite - your baby may be more reluctant to eat as a result of the pain in their gums.
• Chewing - you may find your baby starts chewing more - it may be toys or objects, or their fingers.
• Restlessness and irritability - the pain caused by teething can make your baby restless and irritable.

Other symptoms

Some people attribute a wide range of symptoms to teething, such as diarrhoea and fever. However, there is no research to prove this, and it is important to be aware that not all symptoms are the result of teething.

You know your baby best - if their behaviour seems unusual, or their symptoms are severe or causing you concern, then you should seek medical advice. You can call NHS Direct on 0845 46 47, or alternatively contact your GP.

There are several ways you can help make the teething process easier for your baby. Every child is different, and you may have to try several treatments until you find one that works for your baby. Some of the most common treatments are outlined below.

Teething gels

Teething gels often contain a mild local anaesthetic which helps to numb any pain or discomfort caused by teething. They may also contain antiseptic ingredients, which help prevent any sore or broken skin in your baby's mouth becoming infected.

You should make sure that you use a teething gel specifically designed for young children and not a general oral pain relief gel, as those sorts of gels are not suitable for children. Your pharamcist will be able to advise you.

You will need to gently rub the gel onto your baby's gums using a clean finger. Always follow the instructions which come with the gel.

Teething rings

Teething rings give your baby something to safely chew on, which may help to ease their discomfort, as well as providing a distraction from any pain.

Some teething rings can be cooled first in the fridge, which may help to soothe your baby's gums. You should follow the instructions which come with the ring so you know how long to chill it for. You should never put a teething ring in the freezer, as if the teething ring becomes very hard or cold, it could damage your baby's gums.

You should also never tie a teething ring round your baby's neck, as it may be a choking hazard.

Chewing

One of the signs that your baby is teething is that they start to chew on their fingers, toys, or other objects they can get hold of.

Try and give healthy things for your baby to chew, such as raw fruit and vegetables. For example, pieces of apple and carrot are often ideal. Unsweetened rusk biscuits are also a good option. Make sure you always supervise your child when they are eating.

Painkilling medicine

If your baby is in pain, or has a raised temperature, you may want to give them a painkilling medicine which has been specifically designed for children. These medicines normally contain a small dose of analgesic (painkilling medication), such as paracetamol, to help ease any discomfort. The medicine should also be sugar-free.

You must always follow the dosage instructions which come with the medicine. If you are unsure, please ask the pharmacist.

Cool drinks

Cool, sugar-free drinks will help to soothe your baby's gums, and may also help if they are dribbling excessively. The best option is to give them cool water - just make sure it is not too cold.

Comfort

Comforting or playing with your baby can sometimes help to distract them from the pain in their gums. It may be that your baby is feeling too irritable or restless to play, but at other times, it may be a good way of getting them to concentrate on something other than their teething pain.

Preventing rashes

If teething is making your baby dribble more than usual, make sure you frequently wipe your baby's chin and rest of their face. This will help to prevent them developing a rash.

When should I start brushing my baby's teeth?

You should start cleaning your baby's teeth as soon as they start to appear. Your baby's teeth can still be affected by harmful decay, even at a very young age.

You should be cleaning your baby's teeth twice a day. At first you may find it easier to use a piece of clean gauze or cloth wrapped around your finger.

As more teeth appear you should use a toothbrush specifically designed for babies. These toothbrushes have soft, small heads, which will help prevent any damage to the gums. Make sure you gently massage around the teeth and gums with the toothbrush.

You only need to use a tiny amount of fluoride toothpaste when your child is a baby. There are several toothpastes specifically designed for babies and children.

Dummies, teething rings and bottles

Never dip your baby's dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars. These can expose your baby's teeth to harmful acids, which can attack the newly formed teeth and cause decay.

You should also never add sugar to bottle feeds or use sugary drinks. Milk and water are the best drinks for teeth.

Bottle-feeding with drinks containing sugar can lead to 'bottle caries' (tooth decay). Your baby will not be born with a sweet tooth and will only have a taste for sugar if it is given at an early age.

Dental check-ups

Your dentist will be able to advise you about when to take your baby for their first dental appointment. Most babies visit the dentist for the first time at around six months of age. Your child will then have check-up appointments every 3-12 months.

BRITISH DENTAL HEALTH FOUNDATION (2005) Dental care for mother and baby. Available from: http://www.dentalhealth.org.uk/faqs/leafletdetail.php?LeafletID=23 [Accessed August 2008]

GRINSTED, P. (2005) Children's teeth and teething, Net Doctor. Available from: http://www.netdoctor.co.uk/health_advice/facts/teething.htm [Accessed August 2008]

LYONS, G.B. AND GOSS, L. (2005) Teething Tots, Kids Health. Available from:

http://kidshealth.org/parent/general/teeth/teething.html [Accessed August 2008]

MACNAIR, T. (2008) Teething Trouble, BBC Ask the Doctor. Available from: http://www.bbc.co.uk/health/ask_the_doctor/teethingtrouble.shtml [Accessed August 2008]

NHS CHOICES (2007) Practical tips on teething. Available from:

http://www.nhs.uk/Livewell/childhealth1-5/Pages/Teethingtips.aspx [Accessed August 2008]

WELFORD, H. Teething, BBC Parenting. Available from: http://www.bbc.co.uk/parenting/your_kids/babies_teething.shtml [Accessed August 2008]