Caring for your child's teeth
A baby’s first teeth (known as milk or deciduous teeth) usually develop while the child is growing in the womb.
In most babies, these teeth start to emerge through the gums when they are around six months old. This process is known as teething.
The teething process
Most babies start teething at around six months. However, all babies are different and the timing of teething varies.
Some babies are born with their first teeth. Others start teething before they are four months old, and some after 12 months. Early teething should not cause a child any problems, unless it affects their feeding.
A rough guide to the different stages of teething is:
- bottom front teeth (incisors) – these are the first to come through, at around five to seven months
- top front teeth (incisors) – these come through at around six to eight months
- top lateral incisors (either side of the top front teeth) – these come through at around nine to 11 months
- bottom lateral incisors (either side of the bottom front teeth) – these come through at around 10-12 months
- molars (back teeth) – these come through at around 12-16 months
- canines (towards the back of the mouth) – these come through at around 16-20 months
- second molars – these come through at around 20-30 months
Most children will have all of their milk teeth by the time they are two and a half years old.
Some teeth grow with no pain or discomfort at all. At other times you may notice that the gum is sore and red where the tooth is coming through, or that one cheek is flushed. Your baby may dribble, gnaw and chew a lot, or just be fretful.
Some people attribute a wide range of symptoms to teething, such as diarrhoea and fever. However, there is no research to prove that these other symptoms are linked.
You know your baby best. If their behaviour seems unusual, or their symptoms are severe or causing you concern, then seek medical advice. You can call NHS Direct on 0845 4647 or contact your GP.
Read more about spotting the signs of serious illness.
There are several ways you can help make teething easier for your baby. Every child is different, and you may have to try several different things until you find something that works for your baby.
Teething rings give your baby something to safely chew on, which may ease their discomfort and provide a distraction from any pain.
Some teething rings can be cooled first in the fridge, which may help to soothe your baby's gums. Follow the instructions that come with the ring so you know how long to chill it for. Never put a teething ring in the freezer as it could damage your baby's gums if it becomes very hard or cold.
Also, never tie a teething ring around your baby's neck, as it may be a choking hazard.
A useful alternative to a teething ring is a cold, wet flannel.
For babies over four months old, you can rub sugar-free teething gel on their gums. You can get teething gel from your local pharmacy.
Teething gels often contain a mild local anaesthetic, which helps to numb any pain or discomfort caused by teething. The gels may also contain antiseptic ingredients, which help to prevent infection in any sore or broken skin in your baby's mouth.
Make sure you use a teething gel specifically designed for young children and not a general oral pain relief gel, which is not suitable for children. Your pharmacist can advise you.
You should discuss with your GP the teething gel options for babies under four months old.
One of the signs that your baby is teething is that they start to chew on their fingers, toys or other objects they 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. You could also try giving your baby a crust of bread or a breadstick. Always stay close in case they choke.
It is best to avoid rusks because nearly all brands contain some sugar. Avoid any items that contain lots of sugar as this can cause tooth decay even if your child only has a few teeth.
Make sure you always supervise your child when they are eating.
If your baby is in pain or has a raised temperature, you may want to give them a painkilling medicine that has been specifically designed for children. These medicines contain a small dose of paracetamol or ibuprofen to ease any discomfort. The medicine should also be sugar-free.
Always follow the dosage instructions that come with the medicine. If you are not sure, ask your GP or pharmacist.
Aspirin should not be given to children under 16 years old.
Cool, sugar-free drinks will help to soothe your baby's gums and may help if they are dribbling excessively. The best option is to give them cool water – just make sure it is not too cold.
Comforting or playing with your baby can sometimes distract them from the pain in their gums. Your baby may be 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.
If teething is making your baby dribble more than usual, make sure you frequently wipe their chin and the rest of their face. This will help to prevent them from developing a rash. You may also find it useful for your baby to sleep on an absorbent sheet.
What to avoid
In April 2009, The Medicines and Healthcare products Regulatory Agency (MHRA) issued advice regarding the use of oral pain relief gel containing an ingredient called salicylate salts in children under 16.
The advice was introduced as the salicylate salts have been found to have the same effect on the body as aspirin. Aspirin should not be given to children under 16 because it can potentially increase their risk of developing a rare but serious condition called Reye's syndrome (which can cause serious liver and brain damage).
It is recommended that you check with your GP or pharmacist before buying a teething gel, to make sure that it is suitable for your child and does not contain salicylate salts.
Caring for your child's teeth
As soon as your baby’s teeth start to come through, you can start brushing them. Use a baby toothbrush with a tiny smear of fluoride toothpaste.
Don’t worry if you don’t manage to brush much at first. The important thing is to get your baby used to teeth-brushing as part of their daily routine. You can help by setting a good example and letting them see you brushing your own teeth.
- Use a tiny smear of toothpaste for babies and a pea-sized amount for children.
- Gradually start brushing your child’s teeth more thoroughly, covering all the surfaces of the teeth. Do it twice a day: just before bed, and at another time that fits in with your routine.
- Not all children like having their teeth brushed, so you may have to keep trying. Don't let it turn into a battle. Instead, make it into a game, or brush your own teeth at the same time and then help your child finish their own.
- The easiest way to brush a baby’s teeth is to sit them on your knee with their head resting against your chest. With an older child, stand behind them and tilt their head upwards.
- Brush the teeth in small circles covering all the surfaces and let your child spit the toothpaste out afterwards. Rinsing with water has been found to reduce the benefit of fluoride.
- You can also clean your baby’s teeth by wrapping a piece of damp gauze with a tiny amount of fluoride toothpaste on it over your finger and rubbing this over their teeth.
- Carry on helping your child brush their teeth until you’re sure that they can do it well enough themselves. This will normally be until they’re at least seven.
Taking your child to the dentist
NHS dental treatment for children is free. Take your child with you when you go for your own dental appointments, so they get used to the idea. To find a dentist you can use our services search, ask at your local clinic, contact your local primary care trust (the address and phone number will be in the phone book) or call NHS Direct on 0845 4647.
Prevent tooth decay by cutting down on sugar
Sugar causes tooth decay. Children who eat sweets every day have nearly twice as much decay as children who eat sweets less often.
This is caused not only by the amount of sugar in sweet food and drinks, but by how often the teeth are in contact with the sugar. This means sweet drinks in a bottle or feeder cup and lollipops are particularly damaging because they bathe the teeth in sugar for long periods of time. Acidic drinks such as fruit juice and squash can harm teeth, too. This is why it’s better to give them at mealtimes, not in between.
The following measures will help you reduce the amount of sugar in your child’s diet and prevent tooth decay.
- From the time your baby is weaned, encourage them to eat savoury food. Check if there's sugar in pre-prepared baby foods (including the savoury ones), rusks and baby drinks, especially fizzy drinks, squash and syrups.
- Only give sweet foods and fruit juice at mealtimes.
- Don't give biscuits or sweets as treats. Ask relatives and friends to do the same. Use items such as stickers, badges, hair slides, crayons, small books, notebooks, colouring books, soap and bubble baths. They may be more expensive than sweets but they last longer.
- If children are having sweets or chocolate, it’s less harmful for their teeth if they eat the sweets all at once and at the end of a meal rather than eating them little by little and/or between meals.
- At bedtime or during the night, give your baby milk or water rather than baby juices or sugar-sweetened drinks.
- If your child needs medicine, ask your pharmacist or GP if there’s a sugar-free option.
- Don't give drinks containing artificial sweeteners, such as saccharin or aspartame. If you do, dilute them with at least 10 parts water to one part concentrate.
- It’s OK to use bottles for expressed breast milk, infant formula or cooled boiled water. However, using them for juices or sugary drinks can increase tooth decay. It’s best to put these drinks in a cup and keep drinking times short.
- Between six months and one year, you can offer drinks in a non-valved free-flowing cup.
- Check your whole family’s sugar intake, and look for ways of cutting down.
Sucrose, glucose, dextrose, maltose, fructose and hydrolysed starch are all sugars. Invert sugar or syrup, honey, raw sugar, brown sugar, cane sugar, muscovado and concentrated fruit juices are all sugars. Maltodextrin is not a sugar, but can still cause tooth decay.