My decision to create this site was made because of the many questions I get as a dentist from parents regarding their children’s oral health. It seems that many of the “What to Expect ” books and childcare guides omit something very critical in raising and caring for children. A subject that is so simple but so easily dismissed as common knowledge or topics that your pediatrician will discuss with you. Unfortunately, most pediatricians know VERY LITTLE about the dental health of your child. So, this leaves many parents wondering if they are providing adequate dental care for their children. Too often this lack of knowledge causes irreversible damage to their kid’s teeth and a serious dent in their wallets.

I hope you find the information on this site to be a  mildly humorous, very informative, myth-busting, easy to understand guide that should help you feel confident that you are on the right track with your child’s oral health. My other hope is that this knowledge will allow you to save money when it can be saved, and to spend it when it really needs to be spent.

These questions were chosen because they are by far the most common I receive at the dental office or more often, when I am at social functions for my own kids! The answers are then provided in a way which I think just about everyone can understand. I hope after reading some of these posts, you find yourself empowered and fully informed.
I hear all of these questions far too often, which leads me to believe that there is a serious lack of knowledge on the subject. Since dental decay in children is the #1 childhood disease, it is very important that parents are well educated on the subject. I feel strongly that we can better help the future of our children if we can share the knowledge to prevent these dental problems. These problems are far too often physically, mentally and financially challenging for parents and children, both short and long term. So, my hope is that after you find something useful or helpful, you feel confident in sharing the vital information with others so that they too can avoid some of the costly or worrisome situations.
You may also have friends in your social circle with younger children who may have questions that you will now feel confident answering for them. Even though you may only have a teenager now, life can be full of many unplanned miracles-so it is always better to be prepared now! Whatever the reason, share the knowledge with your friends and family.

If your county or city provides your drinking water, you are more likely to be receiving the correct amount of fluoride. Most U.S. cities that have a municipal water supply are now mandated to monitor and adjust the amount of fluoride in the communities’ drinking water. Community water fluoridation is considered to be the single most effective public health measure to prevent tooth decay. It has been successful in the reduction of tooth decay among different populations and is the most cost-effective form of public prevention. Fluoridation is endorsed by the Centers for Disease Control and Prevention, which has listed community water fluoridation as one of 10 great public health achievements of the 20th century.

The optimal fluoride level in drinking water is 0.7 – 1.2 parts per million, an amount which has been proven beneficial in reducing tooth decay. Naturally occurring fluoride may be below or above these levels in some areas. Under the Safe Drinking Water Act, the U.S. Environmental Protection Agency requires notification by the water supplier if the fluoride level exceeds 2 parts per million. People living in areas where naturally occurring fluoride levels in drinking water exceed 2 parts per million should consider an alternative water source or home water treatments to reduce the risk of fluorosis for young children
Children drinking well water for their primary source should have their well water tested for fluoride concentration. The results should be discussed with the child’s pediatrician or dentist to determine whether or not the child should be given fluoride supplements. NEVER, I repeat, NEVER give a child any kind of fluoride supplement pill or vitamin without having your well water tested and consulting your physician/dentist. Too much fluoride is dangerous and can have devastating effects on the appearance of your child’s teeth as discussed above.

However, correct systemic fluoride amounts (taken in through drinking water) are very beneficial. Because I live in an area of suburban and rural populations, I have been exposed to patients both with and without well-water as their primary drinking water supply. The difference is astounding. In fact, it is so obvious, that an individual can usually be identified as a well-water patient just during an exam!

This is a common concern among parents and has a fairly simple response. In general, your pediatrician will recommend that you plan on discontinuing the use of a bottle by age one. There is, of course, a little flexibility with this so that the child can undergo a relatively smooth transition to the use of a sippy-cup.

Every child is different in their need for that warm bottle of instant comfort. It is indeed an amazing cure-all for infant displeasure, but like all addictions, it isn’t easy to stop. Other children will give it up easily, gladly welcoming the new benefits of becoming a toddler. Most child-rearing books, like the “What to Expect” series, will give you tips and tricks of how to wean both the bottle and the pacifier. My biggest advice would be to start sooner rather than later, especially if you have a strong-willed child.

If you are successful in weaning both the pacifier and the bottle around 12 months, then you have no concern that either one will affect the orthodontic relationship of your child’s teeth. If you go much beyond this time frame, then it is possible that you may have some future orthodontic problems. Again, there is leeway with this, and in general we say that most of the permanent effects occur if the child has not completely stopped by age four. Of course I assume that your four year old is not drinking out of a bottle anymore, so I am speaking particularly about the use of a pacifier. If your four year old is still drinking from a bottle, you are way overdue for a crisis intervention!

The other big concern to be aware of is that, the pacifier can also cause trauma to the child’s gums. This can cause painful ulcers but can also cause the gums to recede from the tooth. This can cause many problems including gum damage for the soon erupting permanent tooth, tooth decay of the baby-tooth or painful root exposure. Your child may experience mild to severe sensitivity to hot and cold foods or even just when the air from speaking passes by the area where the gums have receded. Adults experience this too, but generally it is not caused by the use of a pacifier! There are many causes for adults, but the end result is the same resulting in sensitivity, pain or possible loss of the tooth from becoming loose. So again, stop the habit early, as it will be better for everyone!

This is a very common question, particularly with first-time parents.  One thing you must understand is that children are highly variable in their personalities, growth and especially their teeth.  There is no hard and fast rule as to when your child will get their first tooth, but rather general guidelines to refer to.  These relative times of tooth eruption can vary by many months, so when I say it is a general guideline I truly mean it.  Generally speaking, the first tooth will appear between 6 and 9 months of age.  My youngest son did not get his first tooth until he was 11 months old!  So don’t worry too much if your child is not following the guidelines exactly.

There are also extremes on the other end of the spectrum.  There are some infants that are actually born with a tooth or two.  These are called “natal teeth” and are a lot of fun for breastfeeding moms! It is usually only a concern  if they interfere with breastfeeding or if the teeth are loose and feared to be a choking hazard..  This is a situation that your pediatrician will discuss with you.

Here is a quick reference guide to follow and refers only to baby teeth:

6-8 months old

The first tooth usually appears and is almost always a lower front tooth (called lower central incisors)

8-12 months old

The top front teeth appear (called upper central incisors)

9-13 months old

Upper lateral incisors appear; these are the teeth immediately next to the already existing top teeth (lateral simply means “to the side of”)

10-16 months old

The lower lateral incisors appear; these are the teeth next to the now existing lower front teeth

13-19 months old

The first primary/baby molars appear on the top and bottom; They may appear simultaneously or at various times; There will be a large space between these molars and the other existing baby teeth.

16-22 months old

The canine teeth appear (also called cuspids or “fangs”) on the top and bottom and may appear simultaneously or separately.

As both a dentist and a mommy, I get many questions about teething both at the office and in my own circle of friends. As a first time parent, many areas of parenting and childcare seem like such a mystery. We struggle our best by trial and error and constantly wonder if the question or problem really requires us to take a trip to the pediatrician. Do we want to shell out a co-pay or “wait it out” and see if the problem resolves on its own?

Well, my hope is that I can provide you with a little relief in this area child-rearing. Babies go through so many changes so quick, baby teething can bring about difficulties that feel like an eternity! Just when your bundle is finally sleeping through the night and you are settling in to the groove of being a new parent, the process throws you a new curve ball. Around 6-7 months, you may find your baby acquires some peculiar behavior and not all of it is enjoyable!

In general, the process of baby teeth begins at 3-4 months old, despite the fact that a tooth may not appear for several months after this. The baby teeth start their ascent into the mouth during this time and parents may notice some of the following behaviors in their infant: Excessive drooling, crankiness, biting and sticking objects in their mouths, coughing or colds, cheek or ear-pulling and unfortunately, night waking! While all of these can be signs baby teething, they can also be signs of other problems, so when in doubt, don’t be afraid to call your pediatrician-that’s what they are there for!

As these new baby teeth make their way in, they typically cause a lot of pressure and discomfort inside the gums. This process can cause crankiness and irritability and even cause baby to wake up at night in a crabby mood. It isn’t abnormal to have baby wake up crying or whimpering at night, only to attempt a bottle with no success. Sometimes they may even take the bottle only to fall right asleep without drinking much.

Babies often try to relieve this pressure during the day by chewing on any object they can fit in their mouth, including their hands. In addition, this grand appearance of teeth very much stimulates saliva flow, causing baby to drool excessively. All of these habits can cause other issues and strange behavior for baby. Excessive drooling during baby teething can cause a rash on the chin as well as stimulate the coughing and gagging reflex. They may also experience discomfort that is referred to the ears or cheeks.

The rashes are not usually a problem unless you find the rash to be causing pain, has open sores or bleeding. If this occurs, see your pediatrician for medicated creams to help heal the area and make baby comfortable again.

While ear and cheek pulling can be a sign of baby teething, it can also be a sign of an ear infection. My kids have had their fair share of ear infections and they can be such a frustrating experience. I have noticed ear and cheek pulling from baby teething to be pretty infrequent but not impossible. So, my suggestion would be that if you see this behavior, especially if accompanied with a fever, have your child evaluated by the pediatrician. Ear infections can be a very painful experience with possible complications and should not be “waited out.”

The drooling may also cause loose or runny bowel movements, but generally not diarrhea. If your baby has diarrhea lasting more than a day, call your pediatrician. While baby is trying to relieve pressure by putting object and fingers into their mouth, they unfortunately can be introducing unwanted germs into their bodies. So, you may notice and increase in colds or illnesses which may cause mild fevers or diarrhea. Fevers are not believed to be from teething directly, but are thought to be from the “bugs” that babies expose themselves to while going through the baby teething process.

So, how can you help your precious baby through this tough time which can last for months? Baby teething rings and toys or cold foods are a good start. Be sure that they are foods your baby is normally able to eat without choking! You can also gently massage the gums with your own fingers but please be sure to wash your hands first! Baby Orajel can be used, however, as a dentist I can tell you that unless you dry the area of gums completely before applying, it really will not work-you’ll only be providing bad taste and a numb tongue! So, if you can dry the area well, and your pediatrician has given you the recommendation to use it, then see if it works for your baby. Infant Tylenol or acetaminophen is another great option when baby is having a really difficult time during baby teething. However, before giving your baby any kind of medicine, always consult your pediatrician and be sure that you give the proper dosage for your child.