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Introduction The first teeth (also known as milk teeth or deciduous teeth) have usually developed before your child is born. They normally start to break through the gum from at around six to nine months old. Usually the bottom front teeth come through first, followed by the top front teeth (central incisors) and then the top and bottom incisors either side (lateral incisors). Most children will have around eight teeth by their first birthday, although this is just an average. The first molars (back teeth) start to come through at about 12 to 14 months, followed by the canines (next to the lateral incisors) at 16-18 months and finally the second molars at 18-30 months. The full set of first teeth is usually through by the age of two and a half years. Teething can start as early a 3 months and continue to 3 years old. Rarely, your child may be born with one or two teeth or will have a tooth emerge within the first few weeks of life. This does not give cause for concern unless the teeth interfere with feeding. Symptoms The movement of new teeth in the jawbone and as they push through the gum can cause some discomfort, although this should stop as soon as the tooth appears. Some babies may have a hard time with the emergence of each tooth, whereas others sail through the experience. Symptoms of teething include: pain swollen gums red, hot cheeks excessive dribbling nappy rash changes to sleep pattern and/or appetite increased tendency to chew objects general irritability

Treatment There are several things that you can try to help relieve the discomfort of teething: Rub a small amount of infant teething gel onto the affected gum area with a clean finger and gently massage it into the gums. Some of these contain a mild local anaesthetic to dull the pain. Alternatively, use infant liquid paracetamol (e.g. Calpol). Your child may benefit from a homeopathic remedy such as chamomilla. Remedies specifically for teething are available from pharmacies, supermarkets and health food stores. A qualified homeopath can provide more individualised remedies in stronger potencies if required. A chilled teething ring may distract the child whilst helping to soothe their sore gums. Be sure to take the ring out of the freezer before it becomes rock hard to avoid bruising already sore gums. Never tie a teething ring around a babys neck. Chewing on hard biscuits, frozen bananas or chilled raw carrot can help but should be given under careful supervision (in case a large piece breaks off in the mouth). Apply a little petroleum jelly or aqueous cream around the mouth and chin to prevent soreness from excessive dribbling and wipe your babys face often with a cloth to remove the dribble and prevent rashes from developing.

Never place an aspirin against the tooth and dont rub whisky on your babys gums. If you are uncertain, always check with your dentist or health visitor. Complications If your child experiences significant delay with teething, speak to your dentist or health visitor. Prevention As soon as the first baby teeth begin to appear you should start to clean them. At first you may find it easier to use a piece of clean gauze or cloth wrapped around your forefinger. As more teeth appear you will need to use a baby toothbrush. Use a soft toothbrush designed for very young children, and a small pea-sized smear of baby toothpaste. It can be easier to clean their teeth if you cradle your babys head in your arms in front of you. Once your child reaches two you should start to use fluoride toothpaste. As the child gets older it may be difficult to use this technique but you can gradually give more responsibility for cleaning their teeth to the child. It is important to clean teeth twice a day with fluoride toothpaste. Check with your dentist or health visitor if you are unsure about how to look after your babys teeth.

If you can, avoid using a dummy and discourage thumb sucking. These can both eventually cause problems as the teeth grow and develop. This may result in treatment with a brace when the child gets older. Never dip your babys dummy or teething ring into fruit syrups, honey, fruit juices or anything containing sugars, particularly at bedtime. These can expose your babys teeth to harmful acids, which can attack the newly formed teeth and cause decay. 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). A baby is not born with a sweet tooth and will only have a taste for sugar if it is given at an early age. Encouraging your baby to drink from a cup can help prevent dental problems that can be caused by drinking from a bottle. Try to get your baby to drink from a special cup by the time they are six months old, or when they are able to sit up and hold things on their own. Take your dentists advice on when first to take your baby to the dentist. You could take your baby to your own routine check up. The babys own check-ups can start any time from about six months. Cautions You know your child best. If you think your child is teething but seems obviously unwell, always seek professional advice. Teething is sometimes attributed as the cause of symptoms that may indicate illness, such as fever, diarrhoea or vomiting. See your GP or call NHS Direct on 0845 4647 for advice if your child has these symptoms during an episode of teething.

© Queen's Printer and Controller of HMSO, 2005

Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.



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