Teeth and teething for child
A baby’s teeth are formed in the mother’s womb so what the mother eats can affect them. Extra calcium is advisable if the mother’s diet does not include sufficient milk or dairy products. If you live in an area where the water has a low fluoride content (less than one part per million), you may be advised to take fluoride tablets. Your dentist or local municipality should be able to advise you on the fluoride content of the water in your area (the Northern Cape is a high fluoride area, for example). Do not take extra fluoride in a high fluoride area as it can stain the teeth. Certain drugs such as tetracycline can also stain the teeth so make sure your doctor knows you are pregnant if he prescribes any drugs for you.
Occasionally, babies are born with one or more teeth, or they erupt during the first month. These teeth do not usually have proper roots and if they interfere with breast feeding your doctor may remove them. However it is not always easy to tell whether they are, in fact, rudimentary teeth and the doctor will want to be fairly sure of this before he removes them, because there may not be other milk teeth under them waiting to erupt at the normal time. However, it is a rare occurrence and most babies’ first teeth appear at the expected time, around six months.
The first teeth to appear are usually the lower central incisors (sharp cutting
teeth at the front), followed by the two upper central incisors, and then on either side of these the second incisors, with the lower ones coming before the upper two. The molars (the big grinding teeth towards the back of the mouth) appear next, around the first birthday, and then the cuspids (or canine teeth which are pointed like the teeth of a dog), between 14 and 20 months.
When the child is around 18 to 30 months the second molars appear and the child has the 20 teeth that make up a full set of ‹“baby’ or ‹“milk’ teeth. These are also known as deciduous teeth because they eventually start falling out around six years of age as they are pushed up by the permanent teeth.
The order and timing in which the teeth appear do not always follow this pattern, and variations of six months and more are possible. Early or late teething is not a sign of intelligence nor has it any other significance. So, unless your child shows no sign of teething after the age of a year, do not become concerned. In this case your dentist will advise you and may take X-rays to establish if there are teeth in the gums, but this is seldom necessary.
Because teeth appear at intervals throughout the first three years, it is inevitable that their eruption will coincide with some of the ills babies experience. Although teething does produce certain symptoms, it is wrong to put every ailment down to teething and leave it untreated.
To emerge from the gum, teeth have to force their way through tissue, and as they do this the tissue is stretched and torn, causing pain and inflammation. Normally it takes only between three and 10 days before the tooth erupts. During this time you can expect your baby to become irritable, with disturbed sleep and a lot of drooling. The drooling can cause a rash and the increased activity in the area can result in an angry red patch on the baby’s face.
The increased secretions due to this activity can also make it seem as though the baby has a cold and the stools may become slightly loose. It is vitally important, however, that you do not put diarrhoea with vomiting down to ‹“only teething’ as it is an extremely dangerous condition that needs prompt treatment (117). A high temperature is also not simply due to teething. The swelling of the mucous membranes in the area as well as the increased secretions can affect the Eustachian tube leading to the ear drum, causing ear problems. Whether the problem is caused partly by teething or not, it still needs treatment.
To treat the general effects of teething you can ask your pharmacist for a teething jelly and apply it to the child’s gums. Do not buy old remedies for teething as they often contain potentially dangerous substances. If your child’s sleep is being disturbed (and this is very common especially around six months and again when the second molars appear around 20 months), you can rub the gums with teething jelly and give a dose of paracetamol or children’s aspirin to ease the pain and inflammation. It is important to be reasonably sure that the child’s wakefulness is indeed caused by teething (the gum area is normally raised and red) and not by something else. (See waking at night p. 185.) Rubbing the gums with an ice cube is also a good way of offering temporary relief. Babies who are teething like to bite on something hard – it helps get the tooth through and eases the irritation. Give your child a special teething biscuit or very hard rusk to bite on. Teething rings made from hard rubber, or the liquid-filled plastic type that can be put in the freezer to harden, are good.
The cold anaesthetises the gum and helps ease the inflammation. Rubber soap holders with suction discs are also effective teething aids but don’t let her chew on furniture or toys that may have been painted with toxic paint.
Many babies and toddlers go off their food when teething, and some reject the breast because their gums hurt when they suck. Use the teething jelly 15 minutes
before a feed, or rub her gums with an ice cube directly before a feed, and make her meals more liquid than usual. Serve yoghurt, milk jellies and puddings, ice cream, pureed milk soups, mashed banana and egg flips if she will not take her usual meals.
Parents often worry that the child who sucks her thumb or dummy will end up with buck teeth. Although this habit can encourage the teeth to protrude if carried on after the age of four or five there are other more important factors that influence the placement of teeth. Bottle feeding is one of the most important because the child uses a different action when sucking on a teat than if she were sucking on the breast. At a time when the jaw and mouth structure is at its most malleable, the constant application of pressure on the wrong areas can cause the structure of the mouth to assume a different shape. Enlarged adenoids or allergies which cause mouth breathing at night also have a bad effect on the placement of the permanent teeth. (See p. 227.)
Keeping the milk teeth until they are ready to fall out naturally is important, because early loss of teeth can cause the gum to shrink, leaving too little space for the permanent teeth which may, as a result, come out crooked. Care for your child’s teeth by avoiding sweetened drinks especially from a bottle (fruit syrups and acid fruit juices are known to decay teeth). Basically, tooth decay is a result of bacteria breaking down the starches and sugars in the diet to form an acid that is found in plaque – the colourless pulpy material that develops around teeth. This acid acts on the tooth enamel, breaking it down. Fluoride strengthens tooth enamel, making it less susceptible to the action of acid formed by bacteria.
Besides giving your child extra fluoride if you live in a low fluoride area (247) you can help reduce tooth decay by brushing the teeth with a toothpaste which contains fluoride. Avoid giving biscuits, chips and other starchy foods between meals and brush the teeth after eating. If the teeth cannot be brushed, a piece of cheese is a good way to end the meal.
Caring for the teeth. Make a practice of brushing your child’s teeth. Using a soft brush, clean from the gum towards the tooth edge. Do this on the inside of the teeth as well as the outside. The biting surfaces should be scrubbed backwards and forwards. Rinse. Children should be taught to floss their teeth so that the areas between the teeth are cleaned. Floss is a fine thread, flavoured or plain, that may be waxed for easier use, to get rid of food particles and plaque. Ask your dentist to demonstrate the right action as incorrect flossing can damage the gums. You can also ask your dentist to apply a fluoride gel to the teeth so that the surface concentration of fluoride is built up. Another means of fighting tooth decay is to have your child’s teeth sealed with a special adhesive material that is painted on. It seals the tiny crevices in the teeth so that plaque cannot get into them and cause decay.
Premature loss of a tooth. If your child loses a tooth by having it bumped out, your dentist may be able to replace it in the socket if you see him within an hour. Keep the tooth moist by placing it in salt water, taking care not to damage the delicate membrane surrounding it, until you get to the dentist. If the tooth or teeth cannot be saved he may use a space maintainer to keep the space open so that the permanent teeth do not become crowded. Teeth that are chipped should also be seen to as they can go black if the nerve dies.
Visiting the dentist. The sensible mother will never refer to doctors or dentists in a way that implies they will hurt the child, or as a punishment. Take your child to visit the dentist around the age of two-and-a-half or three, before there should be any need for fillings, so that he can check that all is well and the child can build up a friendly relationship.