Teething

A baby's first tooth is an exciting milestone for his or her parents, but a potentially painful right of passage for the little teether. The symptoms and severity of pain associated with teething can vary as greatly as the age at which it occurs. Some babies become very fussy and irritable while others have no problems at all; you may not even know your baby has cut a tooth until she flashes you a toothy grin.

Babies usually begin teething between five and seven months of age, but don't be alarmed if your baby's gums are still toothless at her first birthday, or she is cutting one as young as three months old - all of the above are perfectly normal. Natal teeth, or teeth present at birth, are found in about one out of two thousand newborn infants. These are often extra teeth and the doctor may recommend removing them to prevent nursing problems and self-injury, but this should be confirmed with x-rays before they are removed. In general, most babies have all 20 of their primary (first) teeth by three years old, and will begin replacing them with permanent teeth around 4 to 6 years of age.

Teeth tend to sprout in a predictable pattern: first the two bottom front, followed by the top two front, and finally the teeth along the sides and back (incisors and molars). In general, lower teeth come in before the upper, and girls' teeth usually erupt earlier than those of boys. Tooth development is hereditary, so if you or your partner got your teeth early, chances are your child will, too.

Excessive drooling is a one of the most common signs that a baby has entered the teething stage, and this extra saliva can cause the skin around the mouth to become dry and chapped and even break out in a rash. Other symptoms of teething include:

• Chewing and biting - Your baby may chew and bite down on anything she can get her mouth around. The counter pressure from biting on something helps relieve the pressure from the erupting tooth. Unfortunately, your baby may mistake your nipple for a teething ring during feedings. Try not to overreact if this happens - calmly but firmly tell your baby no, remove your nipple from her mouth, and wait a few minutes before trying to nurse again. When you take the source of food away, your baby will quickly learn not to bite the nipple that feeds her.

• Cheek rubbing and ear pulling - Pain in the gums may extend to the ears and cheeks, especially when the back molars begin coming in, so you may see your baby rubbing her cheeks or pulling at her ears. However, if your baby is showing other signs of an ear infection, call your pediatrician.

• Night waking - Your baby may be more restless and wake more often during the night when she is in pain.

• Hematoma - This is a bluish red blister that may appear on the gum line and may bleed a little when the tooth emerges. If the blister lasts for more than a week without the tooth poking through, call your pediatrician.

• Mild fever and diarrhea - These symptoms are under some debate among pediatricians, scientists, and parents. Many believe that fever and diarrhea are not associated with teething and instead are symptoms of a virus that occurs simultaneously. However, many parents and experts disagree and believe that the diarrhea is caused by the excess saliva produced during teething. If your baby presents either symptom, play it safe and notify your pediatrician.

To help comfort your teething baby, try rubbing her gums with your clean index finger (if she will let you), or give her a chilled teething ring. Don't give your child ice cubes to suck on; they are a choking hazard; instead, freeze or refrigerate a wet washcloth and let her chew on that. If she is eating solid food, try feeding her cool, mushy food such as applesauce or a cold, ripe banana. Infant Tylenol (acetaminophen) and oral teething gels can also help ease teething discomfort. As always, be sure to check with your pediatrician before giving your baby any medication.

You should begin brushing your baby's teeth with a baby toothbrush as soon as there is something big enough to brush. Doctors recommend brushing with water only until your baby is at least 2 years old and understands that she must spit out the toothpaste and not swallow it. According to the American Association of Pediatric Dentistry, in order to prevent dental problems your child should see a pediatric dentist when the first tooth appears, or no later than his/her first birthday.