What is teething?

Structure and Functions

A child’s teeth begin to develop about the second month of pregnancy. The first tooth does not usually appear above the gum line, however, until the sixth or seventh month after birth. The tooth is pushed upward through the gum by growth at the base of the tooth. At the same time, the root sheath grows downward toward the jaw. Studies indicate that dental development does not seem to be affected by nutrition, illness, or climate. In addition, there seems to be little difference between girls and boys in their dental development.

Dental development follows a typical pattern. The teeth generally emerge in pairs. Usually, the lower central incisors are the first teeth to erupt, between five and seven months after birth, followed by the upper central incisors at six to eight months. The upper lateral incisors make their appearances between nine and eleven months, followed by the lower lateral incisors at ten to twelve months. The first molars, two upper and two lower, usually emerge between twelve and sixteen months. The cuspids follow next, at about sixteen to twenty months. The final deciduous teeth to emerge are the second molars, at twenty to thirty months. Most children will have twenty teeth, ten on the top and ten on the bottom, by their third birthday. By the time that they are six, most children begin to lose their primary teeth as the permanent teeth emerge.

While this is the typical pattern, there is much individual variation in both the time frame and the order of tooth eruption. Some children do not get the first tooth until their first birthday. On the other hand, children are sometimes born with teeth or have their first teeth erupt in the first month after birth. Those teeth present at birth are called "natal teeth," and those that emerge soon after birth are called "neonatal." Natal and neonatal teeth have been associated with other oral abnormalities, including cleft palate and cleft lip, although many children with these teeth have no abnormalities. Natal and neonatal teeth can present problems for babies, who may cut their tongues on the teeth, and for nursing mothers, who may experience lacerated nipples.

Although not permanent, a child’s primary teeth are important. The primary teeth are necessary for the child to chew solid food. In addition, they are important as space holders and guides for the permanent teeth.

Disorders and Diseases

Some children have a more difficult time teething than do others. Common symptoms of teething in an infant include wakefulness, excessive drooling, fussiness, refusal to nurse, and chewing on fingers or hard objects. An infant’s gums may also be swollen and tender. These symptoms have also been observed in animals as their teeth erupt.

Some debate exists over other commonly held beliefs concerning symptoms associated with teething. Historically, fever, diarrhea, and ear pulling have been attributed to teething; however, there is no scientific evidence to suggest that teething causes any of these symptoms. In a 1992 article, “Teething,” in the Journal of Pediatric Health Care, Patricia T. Castiglia suggests that parents often attribute behaviors such as wakefulness to teething because it alleviates parental worry. She further argues that wakefulness at six to nine months is caused by separation anxiety, not teething.

Those researchers who have attempted to associate teething with disease have found it difficult to do so. The teething period is also the period when babies are no longer fully protected by the mother’s antibodies but have not yet built up antibodies of their own, thus rendering them susceptible to disease. Consequently, while diseases may coincide with the teething period, it is difficult to associate teething with disease. The risk of infection during the teething period can be reduced by regularly cleaning the objects with which the child comes in contact.

Nevertheless, most pediatricians agree that babies experience some discomfort from teething. Many believe that allowing the child to chew on a cold rubber teething ring or damp washcloth will relieve the pain. While some experts suggest offering frozen teething rings and/or frozen bagels or bread, others argue that neither should be given. They contend that the frozen teething ring can damage the baby’s gums, while bits of the frozen bagel can break off, potentially choking the baby. Likewise, there is little agreement about whether acetaminophen or teething gels should be used.

Most experts discourage using breast-feeding, a bottle, or a sweetened pacifier to help a teething baby fall asleep. The milk or sugar pools around the new teeth, potentially causing decay. Indeed, many pediatricians suggest that a baby’s gums and new teeth should be wiped with a clean, damp gauze pad several times a day to remove traces of milk or juice from the mouth. Nonfluoridated toothpastes can be used to brush an infant's or toddler's emerging teeth; fluoridated toothpastes may be used once the child can spit on his or her own.

Perspective and Prospects

Teething has been a concern for doctors and parents for many years. Theorists as early as Hippocrates attributed fever, convulsions, and diarrhea to teething. During the eighteenth and nineteenth centuries, many writers considered teething to be the leading cause of death among infants.

During the last quarter of the twentieth century, however, the use of teething as a diagnosis for diarrhea, fever, and other childhood illnesses diminished among pediatricians, although studies indicated that some pediatricians continued to connect teething with diarrhea.

Bibliography

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