Teething and Oral Care
for Infants and Toddlers

Because teething generally occurs off and on until a child is well into toddlerhood, knowing how to help a teething baby or toddler is an important element of caregiving. When can you expect that teething will begin? Between the ages of 6-12 months, the primary teeth begin to appear. By the time a child is three-years-old, he or she should have a full set of 20 teeth, 10 in the lower and 10 in the upper jaw.

Teething Symptoms

Teething can be a stressful and uncomfortable experience for babies--and for their caregivers! Teethers may drool, chew on their fingers or toys, or have trouble sleeping or eating because of the discomfort. You may find that teething children are irritable and may have swollen and red gums. Another sign that a child is about to sprout another tooth is a small red or white spot on the gums.

Although teething causes discomfort and irritability, it does not cause high fever, vomiting, diarrhea, ear infections, or coughing. If a baby in your care seems sick or has these symptoms while teething, handle the situation the same as you would for a non teething child who is ill by calling the child's doctor or parent.

Soothing a Teether

What can you do to soothe a teething baby? Extra attention, playtime, music, or special toys may distract the baby from the discomfort. It is important to note that the excessive drooling that often accompanies teething can lead to skin rashes or irritation, so wipe the child's face and chin often to remove drool.

If medication is required, follow your program's policies, which should include written permission and instructions from the child's doctor. Help parents promote their child's health by informing them of the following:

• Teething gels are not recommended; too much gel can numb the mouth and cause difficulty swallowing or breathing. Also, the medication is absorbed into the body.
• Do not use paregoric, alcoholic beverages, or other medications for teething pain.
• Do not place aspirin or other pain relievers on the gums.
• Avoid Zwieback or other teething crackers which may present a choking hazard. These food substances will stay in the child's mouth and can promote cavities.
• Parents may check with their child's doctor about giving acetaminophen or ibuprofen for teething pain; be sure to give the proper dosage, and remember to get instructions in writing.

Avoid filled teething rings because they can break and the children may ingest the fillings. Instead, freeze a wet washcloth or use chilled rubber teething rings. Do not place rings in the freezer because frozen rings can damage a baby's teeth. Be sure to launder washcloths and teething rings after each use. The American Academy of Pediatric Dentistry indicates that rubbing a baby's gums with your clean finger can be effective for relieving pain. You also can chill a coated baby spoon in the refrigerator and run it along a child's gums for relief.

Never tie a teething ring or other object around a child's neck because it could pose a strangulation hazard.

Oral Care

Infants and toddlers can have dental problems, so good oral care should start early--before that first tooth ever appears.

Sleeping with a nighttime or naptime bottle containing juice or other sweetened liquid, or prolonged use of a bottle or tippy cup during the day, puts a child at risk for tooth decay in early childhood. Infant tooth decay, often called "baby bottle tooth decay," occurs most frequently in the upper front teeth. Bacteria in the mouth produce acids that attack the teeth. Each time the child drinks these liquids, acids attack for 20 minutes or longer. After many attacks, the teeth can decay. Try these tips to avoid tooth decay in infants and toddlers:

• Avoid giving the child a bottle of sweetened liquid several times a day or allowing a child to carry a bottle or cup to drink at will; the American Academy of Pediatrics recommends that toddlers consume no more than six ounces of juice per day.
• Avoid giving a pacifier sweetened with honey, corn syrup, or other sweet liquid. Note: Honey should never be given to an infant because it may contain harmful botulism bacteria that can form toxins in the infant's digestive system.
• Never allow the child to fall asleep with a bottle containing milk, formula, fruit juice, or sweetened liquids; not only can this lead to tooth decay, but the fluid (even water) can increase the chances of the child choking or having ear infections. If the child needs a comforter between regular feedings, give the child a clean pacifier.

Teeth Cleaning Tips

Gum and teeth cleaning are important first steps in preventing tooth decay and oral health problems. To clean an infant's gums:

• Wash your hands thoroughly; gloves also are recommended for child caregivers.
• Use your finger to gently wipe a soft damp washcloth or gauze over the baby's gums after feeding to prevent a build-up of damaging bacteria; gently massage the gums. A 2 x 2 inch gauze square works well and is disposable.
• Once the child has teeth showing, brush them with a very soft, tiny infant's toothbrush and plain water; do not use toothpaste. Clean and massage gums in areas that remain toothless.

Try these tips for helping babies and toddlers clean their teeth:

• Most babies are anxious to do things on their own, so once a child is able to get control of hands and fingers (usually after 10 months to a year), you can give him a tiny toothbrush and allow him to "brush" his teeth himself. This promotes good hygiene habits in the child. However, you should continue to follow up the "brushing" by cleaning the teeth and gums. You need two toothbrushes since the infant will probably "gum" and bite one and you need a good infant brush to effectively clean teeth and gums.
• Always supervise the child! Do not allow a child to walk or crawl with a toothbrush in his or her mouth; if the child falls, the toothbrush could easily be forced down the throat or through the roof of the mouth.

The American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend that infants have a dental exam by the age of one year or as the first teeth emerge. However, a complete dental exam may not be feasible since infants do not have many teeth. Therefore, many dental health professionals recommend an oral exam to check the infant's teeth. This may be performed by a dental assistant, hygienist, or the child's pediatrician as well as a dentist.

Amy Sutton
Former Senior Editor, Alfred I. duPont Hospital for Children, Wilmington, DE

American Academy of Pediatric Dentistry, 211 E. Chicago Ave.#700, Chicago, IL 60611-2663; 312-337-2169; www.aapd.org

American Dental Association, 211 E. Chicago Ave., Chicago, IL 60611; 312-440-2500; www.ada.org

INTERNET RESOURCES

American Academy of Pediatrics: A Guide to Children's Dental Health www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZJPK5BDDC&sub_cat=11

Centers for Disease Control and Prevention: Children's Oral Health, www.cdc.gov/nccdphp/oh/sgr2000-fs3.htm

U.S. Surgeon General, www.nidr.nih.gov/sgr/children/children.htm

Watch Your Mouth, www.kidsoralhealth.org

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