medical mondays: teething

I think it's nice, when possible, to time some of these Medical Mondays topics with what we are experiencing here at home. Teething is right up our alley...

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In the textbook

I'm starting with the background stuff today.

This handy diagram is from the American Dental Association (ADA). I'll write out the gist of this in some sentences in case your brain turns off when you see lines of numbers.

Almost all babies are born with their 20 primary teeth already formed and waiting to appear. Teething usually starts around 6 months, and by age 3, all 20 of the primary teeth have erupted. Often, the two lower "central incisors" are first to make an appearance, followed by the two upper "central incisors." Usually teething happens fairly symmetrically, with both the right and left side of a particular tooth emerging at the same time. Also, a lot of babies start getting their first molars before their canines have cut through. I don't know why.

Let me be frank and tell you that I am just now learning the names of these teeth.

At the office

So now that you know the basics about what is supposed to happen, let me be clear: it never happens this way. I tell parents all the time that, when it comes to the timing of teething, I can almost more reliably count on babies not following the norm.

One thing that I do see consistently is that every parent thinks their baby is teething at 3 or 4 months. While, maybe, those teeth below the gumline are starting to move around, I have never seen an actual tooth erupt before 5 months. I've heard about it, but never seen it. It is true, though, that drooling peaks around 4 months for a variety of reasons: salivary glands are in high gear, babies are putting everything in their mouths making salivary glands even more active, and they don't quite get the swallowing-without-sucking thing, so most of that saliva comes right out the front.

On the flip side of thinking teething is beginning really early, I see lots of kiddos who don't pop a tooth at all until late in their first year, or even after their first birthday. No big deal. I wouldn't make a fuss about it unless the kid is around 15-18 months and hasn't gotten a tooth yet, in which case, I might refer them to a dentist just to get things checked out.

Speaking of the dentist, I just read that the ADA recommends the first dental visit as soon as the first tooth erupts. Um. I don't know if I could ever convince a parent to bring their 6-month-old to the dentist to get two teeth checked out. I haven't tried, though. Most Pediatric dentists I know want to see a kid sometime between 18 and 24 months. I think that's a little more likely. The ADA also recommends cleaning those teeth as soon as they appear with a soft brush and some water. I do tell parents to do this. At least daily, the teeth should be wiped clean, and preferably after any feeding. The ADA also says no fluoride in the toothpaste until after age 2, but I know there are some kid's toothpastes out there that have a small amount of fluoride that I think is ok as soon as the kid learns how to spit it out. I will check into that.

cute

So, I talk about teething pretty often at work, and usually the conversation centers around two things: is my kid teething, and what can we do for the pain.

Let's talk about signs of teething first. If you read any study about teething, it will emphatically tell you that the process of teething causes nothing other than tooth eruption. But every mom (and I think every Pediatrician) knows that teething can come along with lots of other symptoms. Lots of kids have a little runny nose, and lots are more drooly than normal (hm. spellcheck is not trying to correct drooly--weird). Because of all this increased spit and snot, sometimes some looser stools are a result. And let's not forget, teething HURTS. Because of this pain, babies might have their hands in their mouths more, or they may play with their ears because of "referred" teething pain (referred pain is pain that happens somewhere other than its source). Babies are for sure more fussy, sometimes want to eat less, and can develop a low grade fever (I say nothing higher than 100.5 can be attributed to teething alone).

You are probably well versed in the possible remedies for teething pain. But let's just review them for fun. Pain reliever/fever reducer is ok to use. Anecdotaly (and maybe scientifically), ibuprofen helps a bit more for teething pain than does acetaminophen. You can buy things to rub on their gums, but I warn parents not to use any numbing stuff if baby is about to eat or sleep--they can swallow it and then have trouble managing saliva or food. The trend now is moving away from recommending benzocaine-containing numbing products at all, due to other potential side effects. We also don't recommend teething tablets because some contain alcohol or an ingredient called bella donna, which is an herb that has dangerous side effects. The old stand-bys for teething relief seem to work the best: cold teething rings, or a cold washcloth, or rubbing the gums with your finger.

also cute

A quick story: One time I was in the emergency room late at night because a family member was in a car accident. The nurse found out I was a Pediatric PA, and she asked me what to do "about molars." Apparently her two-year-old was cutting some back teeth and was having some trouble. Well, I thought she said "moles." It was very late at night. I looked at her, confused, and replied something like "Uh. I don't know. Uh. The dermatologist could take them off or something." Brilliant. It wasn't until later that I realized what she actually said. I don't think the dermatologist would be very happy if I referred a patient to them who was having teething pain.

At the Buck house

When Jonathan's first two teeth started to appear, I cried. I was totally caught off guard and totally sentimental about it. He got his first teeth at 5.5 months--WAY earlier than I expected given my knowledge about teething and the fact that his parents were late teethers. It was only after I could actually see those little teeth popping through that I realized he had been having all the signs of them for weeks. Way to be observant, mama.

This was Jonathan's first response when I said "Show me your teeth."
Thanks for cooperating, son. 

Since those first two, I feel like we have been constantly teething for the past 3 months. He is working on his EIGHTH tooth. Yep, my little guy is an early bloomer. Not many 9-month-olds I see have that many. Remember I told you teething never happens by the book?

OK that's more like it.

He has been such a trooper. The first two came with a couple of sleepless nights, and this one that he's working on now makes him fussy during the day. But I would say some of them came through without him (or us) even noticing. Tylenol has been helping him with the pain, and just in the past few nights we have tried some Motrin before bed and that has worked well, too. Cold teething rings help when he's in the mood for them. He did not know what to do with a cold wet washcloth the other day. And we tried this "homeopathic" teething gel but it did nothing and it tasted gross. Probably his favorite thing is gnawing on a plastic baby spoon, which is cheap and has no side effects!

Oh how I love that toothy grin!

Nursing has been interesting these past few months as he figures out what these extra things in his mouth are. When it was just the first two, it wasn't too bad because his tongue covered them while he nursed. Once he had some on the top AND bottom, though--watch out. So how do I get him to stop biting if he does? I have no idea. I've tried pushing his face into my boobs so he can't breathe and will let go. Sometimes I just say a stern "no." I don't know. Most of the time, I just flap my hands around, try not to move my boob, and get him to unlatch. With every new tooth, we have a day or two of biting--maybe by accident, maybe to ease his teething pain, maybe on purpose. But then he seems to get used to the new things in his mouth and the biting subsides. I am getting good at telling when he is going to bite, so I can usually stop it before he gets going.

And one final note: we do clean Jonathan's teeth just about every night. We should probably do it more often, but I feel it's a success when I just remember at bedtime. We use some Orajel-brand teeth cleaner. It has a little blue brush that you put on your finger and then rub the teeth with some gel stuff. I don't even know what's in the gel. I don't even know if it does anything. It's probably a total marketing scheme--water probably works just fine. But isn't that the story of mommying--50% actually doing the right thing, and 50% thinking you are doing the right thing. Actually, there's probably a large percentage in there of having no idea what to do, but those are thoughts for another time...

And, if you haven't already, check out the disclaimer.

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That's all I got!