Teething is likely to be the first dental issue that parents face after the birth of their child and it can be a source of great anxiety. Teeth do not really “cut” through the gum as most people think but is a natural process which occurs gradually, with few or no associated problems.
Tooth development starts in the womb. By the fourth month of pregnancy, the child’s front teeth have already started to form. The lower front central teeth are usually the first to erupt at approximately six months of age, followed by the upper front central teeth at around seven months. The first primary molars are next, making their appearance at around 12 to 16 months. This is followed by the eruption of the canines between 16 and 20 months and finally, the second molars at 20 to 30 months of age. All the primary teeth (20 in total i.e. 10 on top and 10 at the bottom) are usually present at the age of two years.
The first permanent tooth (first molars) can be expected to erupt at around six years of age and appear behind the last primary molar. The permanent teeth which are hidden below the surface of the gum move in an upward direction, the roots of the primary teeth resorb (dissolve) and they fall out. The front teeth are usually lost first at around six to eight years. By the age of twelve, most children have all their permanent teeth (except their wisdom teeth which erupt at around 18 years of age). Variations in the eruption patterns may occur and delayed eruption of up to 10 to 12 months can still be considered normal and need not be a cause for concern.
Although there is little consensus on the matter, teething is often associated with swollen, inflamed gums, irritability, sleeplessness, excessive drooling, facial rashes, increased biting, gum-rubbing, loss of appetite and sometimes a slight fever. Contrary to popular belief, there is little evidence from the literature to suggest that diarrhoea can be the result of the teething process.
Teething remains a controversial subject amongst health professionals. There is, however, evidence to show that illness is not caused by teething. If symptoms persist for more than 24 hours, other possible causes for these symptoms must be ruled out by a medical doctor.
To relieve some of the discomfort caused by teething, the child can be encouraged to bite on a cold, rubber teething ring. Rubber is easy to clean, can’t be swallowed and doesn’t injure the gums. Drinking lots of fluids should also be encouraged as children can often become dehydrated during this time.
It is advisable for parents to keep an eye on the progress of tooth eruption in their children in order to spot potential problems early. All 20 teeth should be present in the mouth by the age of three years. If there are too few or too many teeth, it could be a cause for concern and needs to be investigated further by a dentist. - Dr Nadia Mohamed, B.Ch.D, BSc Hons/ MSc Dent Sc.