Primary Tooth Eruption: A Timeline and What to Expect

The arrival of a baby’s first teeth, known as primary or milk teeth, is a notable developmental milestone. These teeth are instrumental in a child’s ability to chew food, speak clearly, and maintain spacing in the jaw for future permanent teeth. While babies are born with a full set of teeth hidden within their jawbones, the process of these teeth breaking through the gums, called teething, can be a source of concern for parents. Understanding the general timeline and what to expect can provide reassurance during this phase.

Your Baby’s Teething Timeline: What to Expect

The eruption of primary teeth begins between 6 and 12 months of age, though this timing can vary considerably. Some infants may see their first tooth as early as three months, while for others it may be closer to their first birthday. These variations are common and not a reason for alarm.

There is a predictable sequence to tooth eruption. The first to appear are the two bottom front teeth, the lower central incisors, which emerge between 6 to 10 months. These are followed by the four upper front teeth, the central and lateral incisors, between 8 and 12 months. Subsequently, the lower lateral incisors, first molars, canines, and finally the second molars fill in the gaps.

This process continues over a couple of years. By the time a child is 2.5 to 3 years old, they will have their complete set of 20 primary teeth. Significant deviations from this timeline, such as no teeth appearing by 18 months, may warrant a discussion with a pediatrician or pediatric dentist.

Identifying the Signs of Teething

As teeth push through the gum line, babies exhibit a range of symptoms. Increased drooling is a common sign, which can lead to a mild rash on the chin and face if the skin is not kept dry. The gums where a tooth is erupting may also appear swollen, red, and tender.

This discomfort can lead to changes in behavior, such as becoming more irritable, fussy, or prone to crying. A strong urge to chew on objects is another sign, as counterpressure on the gums provides relief. These symptoms may also disrupt sleep or cause a temporary refusal of food due to sore gums.

It is important to distinguish teething symptoms from other health issues. While a baby might have a slightly elevated temperature, a high fever is not a direct symptom of teething. Diarrhea or widespread body rashes are not caused by emerging teeth and may indicate an unrelated illness that requires evaluation by a healthcare provider.

Comforting Your Teething Baby

Providing relief for a teething baby often involves at-home strategies. Gently massaging your baby’s gums with a clean finger can offer direct comfort. Offering safe objects for chewing is also effective; a solid rubber teething toy chilled in the refrigerator can soothe sore gums. A cool, wet washcloth can serve a similar purpose, but items should not be frozen solid, as extreme cold can be harmful.

For more significant discomfort, over-the-counter pain relievers may be an option. Infant-specific formulations of acetaminophen or ibuprofen can be used for babies over three months old, but it is important to consult a pediatrician for proper dosage information. These medications should be used as directed.

Certain remedies should be avoided due to safety concerns. The U.S. Food and Drug Administration (FDA) has issued warnings against using over-the-counter teething products containing benzocaine for children under two, due to the risk of methemoglobinemia. The FDA also advises against homeopathic teething tablets, which are unregulated and may contain harmful ingredients. Amber teething necklaces are not recommended, as they present choking and strangulation hazards.

Caring for Newly Erupted Teeth

Oral hygiene should begin as soon as the first tooth emerges. Parents can clean the new tooth and gums by gently wiping them with a clean, damp washcloth or a piece of gauze after feedings and before bedtime. This establishes a routine for future dental care.

Once teeth appear, it is time to introduce a soft-bristled infant toothbrush. For children under age three, use a tiny smear of fluoride toothpaste, about the size of a grain of rice. After age three, this can be increased to a pea-sized amount. Parents should perform the brushing until a child develops the coordination to do it effectively, usually around age seven or eight.

Preventing early childhood tooth decay is important. Avoid putting a baby to bed with a bottle containing anything other than water, as milk, formula, and juice contain sugars that can cause cavities. The American Academy of Pediatric Dentistry recommends scheduling a child’s first dental visit by their first birthday, or within six months of the first tooth erupting, to establish a “dental home” and receive guidance.