By Robin Stevenson
From the print edition, Summer 2011
Virginia Lethangue’s daughter Addison is nine months old and has started the long, sometimes hard, road to getting her teeth. The drooling, irritability, change in sleep patterns and ear pulling are clues that something is brewing under her gums, believes Lethangue. “I think my husband and I have bought every product under the sun to help her along,” says the Peterborough, Ont., mom. “I think the hardest part of her teething for me is feeling so helpless.”
So how can you ease your child through this milestone stage? We asked Dr. Sarah Hulland, a pediatric dentist in Calgary, and Dr. Irwin Fried, the director of McGill University’s Division of Paediatric Dentistry, for their advice.
When Does Teething Start?
Most babies will start getting their primary teeth—typically the two bottom front teeth, called the central incisors—around five or six months of age. However, it can happen as early as four months or as late as 12 months. Though uncommon, some babies will be born with teeth or have a tooth erupt within the first month of life. “Depending on the scenario, the teeth may need to be extracted or monitored,” says Dr. Hulland. Have a late teether? Don’t worry, but consult a dentist if there are still none by 14 months.
Signs of Teething
Beyond an increase in drool and your baby placing his fingers and hands in his mouth constantly, parents will often see the gum pads widening out in the area of an erupting tooth. Parents may see a dimple over the edge of the tooth a day or two prior to its emergence. Many babies will find relief from any discomfort by biting on something cool. A cold, wet washcloth; an approved teething ring placed in the freezer ’til cooled, not frozen, which can bruise the gums; or a half-frozen bagel (if she is already eating solids) are good options, suggests Dr. Fried.
Is It Okay to Give Pain Relievers?
Over-the-counter remedies intended to provide temporary relief of symptoms can be useful, says Dr. Fried, but he cautions parents to mind the dosage (even for homeopathic brands). “Some contain benzocaine, a topical anesthetic, that numbs the area. But too much benzocaine can be dangerous. It is important to follow the directions very carefully.” In April, Health Canada issued a reminder of the health risks associated with benzocaine related to a rare condition called methemoglobinemia. The condition causes greatly reduced levels of oxygen to flow through the bloodstream which can cause pale- or blue-coloured lips and skin, shortness of breath, nausea and confusion. In rare cases it can be fatal. For the times when a child is very irritable or has a fever, parents can administer ibuprofen or acetaminophen—but never Aspirin—in the recommended dosages. Dr. Hulland advises reserving their use for feeding times or to assist in bedtime settling. “Remember that the best treatment is tender loving care,” says Dr. Fried.
Does Teething Cause a Fever?
“There is evidence that infants may increase their temperature by less than a degree Celsius when teething, but if there is a larger spike, it usually indicates something else, such as an ear infection, and should be assessed by the family doctor,” says Dr. Hulland. And despite the claims of parents everywhere, there is limited evidence to link teething with diaper rash or diarrhea, she says.
Take Good Care
Even before teething starts, Dr. Hulland recommends that parents wipe their baby’s gum pads after each feeding to remove milk protein residue. Once the teeth emerge, use a finger brush or an infant toothbrush with a small smear of toothpaste. (Ask your dentist if your child needs one with fluoride.) If you see white or brown spots on your child’s teeth, consult a dentist.
When to See the Dentist
Your child’s first dental appointment is recommended within six months of the first tooth erupting or by one year of age. Expect the dentist to examine your baby and to discuss oral hygiene, nutrition, growth and development. “Early evaluation often identifies small issues that are easy to manage versus waiting until there are many large problems,” says Dr. Hulland.