The emergence of the first teeth for a child is often associated with an array of symptoms that are referred to as teething.

Symptoms

The symptoms of teething are: sore gums, increased chewing, increased drooling, restlessness, irritability, disruption of eating and sleeping habits, loose stools, and perhaps even a low grade fever. However, high fever and/or serious illness are not a result of teething and if a child appears to be very ill, then they should see a physician immediately, as it is likely something else.

Treatment

Treatment of teething is largely supportive and symptomatic – meaning that we can only treat the symptoms, not actually provide a cure. This is because teething is perfectly natural and needs to simply run its course.

Treatment consists of:

• chewing on a chilled teething ring or washcloth

• Tylenol (not aspirin or advil) for pain and/or fever

• plenty of fluid consumption (not sugary drinks like juice though)

What about teething gels?

Teething rings are simple plastic appliances that can be purchased for your child to chew on. Chewing often helps calm the teething sensation and calms the child. Choose these over teething gels.

Beware of the commercially available teething gels. Many gels contain Benzocaine as the active ingredient. If too much is applied to the gums, the majority will be swallowed and metabolized or “broken down” inside the child. One of the things that it breaks down into is met-hemoglobin that can produce cyanosis in your child. In addition, teething gels may anesthetize the throat region and make breathing difficult for the child. These gels are not recommended.

Teething pattern – order of teeth that appear

For anxious parents who are counting the teeth as they appear and are concerned that the child is developing slowly, remember: it is not the speed at which teeth come out, but the order, which is most important.

Lower teeth come out before upper teeth (usually), and the same teeth on either sides of the mouth should come out at relatively the same time.

Your child will have most of their baby or primary teeth by the age of 3. During the ages of 6 to 12, the child will have “mixed dentition” – this means that some teeth will be primary teeth, and others will the permanent teeth that are beginning to replace the baby teeth.

In the years that follow, most children will lose their remaining primary teeth and have all of their permanent teeth in place – with the exception of the wisdom tooth that begins coming out through the ages 18 to 21.

Here is a simple breakdown regarding how the first teeth are likely to appear in your child’s mouth:

Segmented, elevated gums are part of the teething process. Far too often, patients are concerned with the appearance as it is new for them.

• Birth: Your child’s gum pads will appear segmented by 5 months of age. They are generally segmented to correspond with the underlying primary teeth.
  
  All primary (baby) teeth are at various stages of calcification at birth, however, there is still considerable deposition of enamel that has yet to occur.
   

• Birth to 2 years: The upper and lower front central incisors usually erupt between 8 to 10 months of age, respectively. The lateral teeth beside those central teeth, come out between 11 to 13 months of age. The first lower primary molar comes out at around 16 months of age, followed by the corresponding upper molar. Primary canines (cuspids) come out by about 19 months, and by 2 years of age, the second and final primary molars begin to come out.
  
  Therefore, your child’s dentition is usually complete by two and one-half years of age. A child will have 20 teeth in total, versus an adult’s 32.Most children will have spaces between certain teeth – this is perfectly normal! The spaces will close as permanent teeth come in since they take up more space. In fact, if there are no spaces at age 2, your child has a higher chance of requiring orthodontics at a later age.
   

• 6-12 years: The lower front or central permanent teeth will start coming out by between the age of 6-7 to replace the primary teeth. The upper central incisors can be expected anywhere from 7-8 years of age.
  
  In most cases, they will be separated by 2-3 mm of space. This is normal, as the other permanent teeth will push them in as they come out.
  
  With time, the remaining permanent teeth will come out in their own sequence to replace childhood teeth. Your child will go from having 20 teeth, to 28 by age 12. The final wisdom teeth can be expected in adulthood, making a total of 32 teeth.