When Does Teething Begin?
Teething in babies generally begins between 6 and 12 months of age. In most babies, the first teeth to appear are the lower front incisors, followed by the upper front incisors. However, this sequence can vary from baby to baby, and this is entirely normal. Some babies cut their first tooth at 4 months, while others may not show their first tooth until 13-14 months.
The general order of teething is as follows: First, the lower and upper front incisors (6-12 months), then the lateral incisors (9-16 months), first molars (13-19 months), canines (16-23 months), and finally the second molars (23-33 months). By approximately age 3, all 20 primary teeth are expected to be complete.
Every baby develops at a different pace, and individual variations in teething timing are quite common. Genetic factors from the family, nutritional status, and general health can affect teething timing. If your baby is 12 months old and has not yet cut a tooth, there is no need to worry; however, if no teeth have emerged by 18 months, it is recommended to consult your pediatric dentist.
What Are the Symptoms of Teething?
Teething symptoms in babies usually begin a few days before the tooth emerges. One of the most common symptoms is excessive drooling. Your baby produces much more saliva than usual, which can cause redness in the chin and neck area. Additionally, noticeable swelling and redness of the gums is observed. You may feel a hard bump when gently touching with your finger.
Fussiness and crying are among the most commonly encountered symptoms of the teething period. The baby may be more irritable than usual, sleep patterns may be disrupted, and they may wake frequently at night. They tend to bite and chew on whatever they can get their hands on; this is a natural instinct to relieve the pressure on the gums. Loss of appetite is also common because sucking and chewing movements can cause discomfort in the gums.
The topic of mild fever is controversial. Research suggests that teething may cause a slight temperature increase below 38°C; however, fever above 38°C should not be attributed to teething. Symptoms such as high fever, diarrhea, vomiting, or rash should not be associated with teething and a pediatrician should always be consulted. These symptoms may be indicative of another infection.
Methods to Relieve Teething Pain
One of the safest methods to relieve your baby's teething pain is chilled teething rings. Silicone or rubber teething rings cooled in the refrigerator (not the freezer) reduce swelling and pain in the gums. You can give your baby a clean, wet, and chilled piece of cloth to chew on. Additionally, gently massaging the gums with your clean finger relieves pressure and soothes your baby.
Cold foods can also be helpful. For babies who have started solid foods, chilled fruit puree, yogurt, or cold carrot sticks (keeping choking risk in mind) can be soothing. However, very hard or frozen foods should be avoided as they can damage the gums.
There are also methods that should definitely be avoided. Amber teething necklaces have no scientific evidence and pose choking and swallowing risks. Gels and creams containing benzocaine should not be used in babies under 2 years of age as they can cause serious side effects. Old methods such as rubbing alcohol on the gums are extremely dangerous. If the pain is very severe, age-appropriate doses of acetaminophen or ibuprofen can be used with your pediatrician's recommendation.
Caring for the First Teeth
Oral care should actually begin before the teeth emerge. After breastfeeding, gently wipe your baby's gums with a wet and clean muslin cloth or gauze pad. This habit both ensures oral hygiene and prepares the baby for tooth brushing in the future. When the first tooth emerges, start using a finger toothbrush or a small baby toothbrush with soft bristles.
Regarding fluoride use, current guidelines state that a rice grain-sized amount of fluoride toothpaste can be used from the first tooth onward. Fluoride strengthens tooth enamel and provides protection against cavities. However, pay attention to using a very small amount; since your baby cannot yet spit, they will swallow the toothpaste. Establishing a habit of brushing twice a day, morning and before bed, is ideal.
When choosing the first toothbrush, small-headed brushes with soft bristles should be preferred. The brush head should be small enough to easily fit into the baby's mouth. Non-slip models with easy-to-grip handles make it easier for parents to use. Remember to replace the toothbrush every 3 months or when the bristles become splayed.
When Should the First Dentist Visit Be?
International pediatric dentistry associations recommend that the baby's first dental visit should be after the first tooth erupts or by age 1 at the latest. The purpose of this early visit is not treatment but introduction and preventive assessment. The pediatric dentist checks your baby's oral development, performs a cavity risk assessment, and provides guidance to parents on nutrition and oral care.
At the first visit, the baby's mouth is usually evaluated with a brief examination. The number of teeth, eruption pattern, gum health, and oral structure are examined. Information is provided on topics such as bottle or pacifier habits, dietary patterns, and fluoride needs. This visit also helps the baby become familiar with the clinical environment and form a positive first impression with the dentist.
Children who meet the dentist early are much less likely to experience dental fear in later years. Through regular check-ups, potential problems are detected early and can be resolved with simple interventions. This protects both the child and the family from more comprehensive and stressful treatments in the future.
Commonly Encountered Problems
Natal teeth are teeth that are present at birth or appear shortly after birth. They occur in approximately 1 in every 2,000-3,000 births. These teeth are usually located in the lower front area and their root development may not be complete. If they cause injury to the baby's tongue or are very loose, they may need to be extracted due to the risk of aspiration. However, stable natal teeth are generally left in place and monitored.
Delayed teething should be evaluated if no teeth have emerged after 18 months. This condition is usually a familial trait and does not require concern. However, in some rare cases, it may be associated with vitamin D deficiency, hypothyroidism, or genetic syndromes. The pediatric dentist can check the presence and position of tooth buds with a panoramic X-ray if deemed necessary.
Ectopic eruptions, meaning teeth emerging in a different location than expected, are also a condition that may be encountered. For example, a tooth emerging at an unusual angle or in a different area may be due to space shortage or the position of neighboring teeth. These situations usually do not require intervention during the primary dentition period; however, with regular follow-up, necessary guidance can be provided in a timely manner during the permanent tooth eruption process.
Written by
Dt. Gaye Üstüner
Pediatric Dentistry Specialist · PhD Researcher at Yeditepe University