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Teeth and teething.

The child drools and chews starting at 2 months but this is not a sign of teething. We have seen them born with teeth already out and the latest I've seen them erupt was 18 months old with no teeth yet. Usually it is 6 to 12 months old. The later they erupt the stronger they are and less cavities. Teething does not cause fever or wake them up at night crying for a long time. Call the office for an appointment if that occurs. If they are fussy with teeth, then give Acetaminophen or Ibuprofen.  http://www.rogerknapp.com/medical/dosage.htm for dosage.  If you use numbing gels, use it only sparingly once or twice a day.  They generally are not recommended below 2 yr old.  Do not use teething tablets.  See article below.  You need to start cleaning them when they come out. Use a baby tooth brush or a washcloth on your finger to clean them. They sell a rubber thing to fit over your finger for cleaning the teeth.   Tooth paste... see article below.    Do not put them in bed with a bottle of milk or juice or it will rot out their teeth quickly. Just do not start that bad habit and you won't have to break them of it. They do not have to see the dentist till 2-3 years old.  If you see any blemishes in the teeth, then make an appointment with the dentist.

Here are the usual published ages of teething:



Average Eruption
Age of Baby
Teeth (+/- 6 mo.)

Average Eruption
Age of Permanent
Teeth (+/- 1 yr)

Central Incisors Front Teeth 6 months 6-8 yrs
Lateral Incisors Beside Front ones 8 months 7-8 yrs
Canines Eye Teeth 18 months 9-12 yrs
Premolars Behind eye teeth --- 10-12 yrs
First Molars First year molars 12 months 6 yrs
Second Molars Second year ones 24 months 12 yrs
Third Molars Wisdom teeth --- 17-25 yrs

They always cut the bottom two incisors first so just feel the bottom ridge of gums with your finger and you will feel the sharp teeth.  The swellings come and go and does not indicate the teeth are coming in.  The next teeth are usually the top center two incisors but 5% of the time they cut the outside two incisors and looks like fangs.  Those are not the canine eye teeth. 

No not lay them in bed with a bottle or sippy cup of milk or juice or this will happen.  It can occur also with frequent breast feeding in the night.


 Medications can cause methemaglobinemia. Methemaglobinemia is a change in the hemoglobin molecule of the red blood cell causing it to not deliver oxygen to the body.    Signs and symptoms of methemoglobinemia (methemoglobin >1%) include shortness of breath, cyanosis, mental status changes (~50%), headache, fatigue, exercise intolerance, dizziness and loss of consciousness.  Severe methemoglobinemia >50% patients have irregular heartbeats, seizures, coma and death (>70%).   Medications that can cause this are: antibiotics (trimethoprim, sulfonamides and dapsone), local anesthetics (especially articaine and prilocaine), and others such as aniline dyes, metoclopramide, chlorates and bromates. Ingestion of compounds containing nitrates such as bismuth nitrate can also cause methemoglobinemia.  Benzocaine applied to the gums or throat (as commonly used in baby teething gels).


 So use teething gels sparingly and infrequently like once or twice a day.   I do not recommend teething tablets.  Just use Tylenol and if in a lot of pain, it may not be the teeth causing all the crying.   See: Warnings from FDA on Teething Tablets.


"Our research has shown that permanent damage to the tooth enamel will occur within the first 30 seconds of high acidity coming into contact with the teeth. This is an important finding and it suggests that such drinks high acidity levels in soft drinks, fruit juice and sports beverages pose a threat to youngsters' teeth are best avoided," study corresponding author Dr. Sarbin Ranjitkar, of the Craniofacial Biology Research Group at the University of Adelaide in Australia, said in a university news release.  "If high acidity drinks are consumed, it is not simply a matter of having a child clean their teeth an hour or 30 minutes later and hoping they'll be OK -- the damage is already done," he added.  The findings were recently published in the Journal of Dentistry.

 Triclosan was in the news recently with concerns about it affecting the endocrine system of our body. The research is borderline and controversial with some suggesting it does and some suggesting it does not.  I am not convinced either way but using toothpaste without it will not greatly change the effectiveness of the toothpaste.  It was mostly the Colgate brands that contained it.

 The pH and source and availability of nutrients are the critical factors in the development of dental caries. Bacteria digest carbohydrates and produce acid that causes demineralization of the tooth enamel.  The demineralization phases are followed by periods of alkalinization, which help restore the integrity of the enamel. Dental caries occurs when the acidification phases outweigh alkalization phases.  The more frequent sugar and even food is put into the mouth, the more likely cavities occur.  We do not recommend parents put the infant to bed with bottles, sippy cups or breasts with the milk pooling around their mouth.  Frequent juice or food in the older children during the day will cause cavities… it is the frequency all day long.

 Some research is looking into finding bacteria that produce more alkaline substances rather than acidic ones thereby decreasing dental caries.

 So brush teeth frequently with toothpaste approved by the American  Dental Association (“ADA approved” is on the package).  After 2 yrs. old, a toothpaste that has flouride, bacteria killing properties, and an alkaline pH is preferred.  Arm and Hammer and Aquafresh toothpaste might be a better choice but there are others.    

 Gum Crayola for kids          no fluoride     pH<5
Oragel for kids                      no fluoride     <5
Colgate for kids                    fluoride          <5
Crest for kids                         fluoride          <5
Toms for kids                         fluoride          <5
Aquafresh for kids                 fluoride          8
Arm&Hammer                        fluoride          8         

At 1-2 years old use non fluoride toothpaste since they swallow it and gives them too much fluoride.  The difference between adult and kids toothpaste is flavor and cute packaging. So 3 and older could use either one.

"What time of the day should you go to the dentist?   At tooth-hurty. Lol"

The AAP now came out and gave new recommendations for fluoride toothpaste.
In their review, the authors identified a few new recommendations regarding fluoride. They included the following:

  1.          All children should use fluoridated toothpaste after tooth eruption, which is when teeth first become visible in the mouth.

  2.          Children younger than 6 should not use fluoride rinses because they could swallow them and ingest too much fluoride.

  3.          Parents should help their kids with getting the right amount of toothpaste — a dot the size of a grain of rice before age 3 and a pea-sized dot after that.

Years ago the “authorities” recommended fluoride supplement in infants below one year who where strictly breast fed but that stained their teeth.  So they changed their mind and said no fluoride supplement until one year old.  In most formula fed babies the mom’s prepared the formula with fluoride containing tap water.  (Yes I strongly recommend fluoride in tap water…. It definitely decreases cavities.  Why people are starting to take it out of tap water…. it is like not vaccinating your children.  If you don’t want to give your child fluoride, use bottle water.  If you still prefer bottle water but want your child to have fluoride, then ask your pediatrician for fluoride containing chewable vitamins.)  Now they are suggesting fluoride containing toothpaste when the first tooth erupts… usually 6-9 months. If it was my child, I would start fluoride toothpaste at 1-2 years old and only enough to wet the bristles or your finger tooth scrubber.


 Roger Knapp MD