Baby may be a teething pro by now, but their mouth is also about to face a challenge that’s bigger, wider, and toothier than anything they has faced before – their molars. The first set of molars, canine teeth, and second set of molars generally come in some time between a child’s first birthday, and the time that they’re 2 and a half, though just like with earlier teething, every child follows his or her own timeline.

Timing

• First molars: Between 12 and 18 months
• Canines: 16 to 23 months
• Second molars: 23 to 33 months 

Teething pain

Whether Baby has had serious teething pain in the past or a largely comfortable teething experience, there is a good chance that molars coming in will be more painful than earlier teeth, since molars are broader and more blunt. Soothing teething pain may also be more difficult since Baby has more teeth now than they did when you first started looking into teething remedies. Molars also grow in further back, so be careful of your fingers – those brand new teeth can hurt! On the other hand, Baby may be better equipped to tell you what hurts than they was when they was younger.

Sources

• “Teeth Erruption Timetable.” Cleveland Clinic. Cleveland Clinic, 1995-2015. Web.
• “Dental Development.” Canadian Dental Association. Canadian Dental Association, 2016. Web.
• “Teeth development in children.” BetterHealth. Victoria State Government, March 2014. Web.

1. Right out of the gate
   Baby’s teeth are vulnerable to plaque and cavities from the moment they start to peek their way above the gum-line, but they may not be overly into brushing if their first try comes right in the middle of their first round of teething pain. If, on the other hand, they is used to having their gums wiped with a clean cloth after eating, a toothbrush may not feel like such a big next step. Baby also wants to do what you do. If you let them see you brushing your teeth, they may want to join you.
2. Find the brush that fits just right
   Baby toothbrushes that work best for young mouths have soft bristles and small brushes, as well as big, grippable handles, for when Baby starts to reach the point where they has the ability to start brushing on their own. If Baby doesn’t react well to a brush at the very beginning, or if you’re having trouble navigating such a little mouth with a brush, a clean gauze pad wrapped over your finger with a little water and a smear of toothpaste will work for a while, too.
3. The great fluoride debate
   As of February 2015, both the American Dental Association and the American Academy of Pediatric Dentistry recommend using a rice-grain-sized smear of fluoride toothpaste with Baby as soon as their first teeth come in. This contradicts previous ADA advice to wait on fluoride until Baby’s second year, when they recommended diving right in with a pea-sized dollop (the current recommendation advises waiting on the pea-sized amount of toothpaste till Baby hits 3).
   The change, the ADA’s report explained, had to do with the rapid rise in cavities in children under 5 (the NIDCR cites tooth decay as the most common chronic childhood disease in the US). Too much exposure to fluoride still carries the risk of fluorosis, a chalky white discoloration on Baby’s teeth as they grow in. Small amounts of toothpaste, and wiping Baby’s mouth for excess toothpaste that they may not be able to spit out yet after brushing can help combat this risk.
4. Sit down and make yourself comfortable
   It may take a little while to figure out the most comfortable way to sit or stand with Baby while tooth brushing, and the most comfortable positions may change over time as Baby grows. You may be most comfortable facing Baby, or holding them on your lap with both of you facing a mirror.
5. Mountains out of molar-hills
   When Baby’s back teeth start coming in, they may not feel entirely comfortable with the toothbrush making its way into the back of their mouth. This may be because the sensation feels like a choking risk, so a slow, gradual move from front teeth back to their molars may help offset this feeling.

Teething can be an uncomfortable time for Baby, though it won’t cause them to have flu-like symptoms like some older advice would tell you. The most notable symptom of teething is sore gums, but because Baby may not be quite ready to use their words to tell you what’s wrong, you may have to rely on other symptoms to guess that it’s their gums that are bothering them. These symptoms include fussiness or crankiness, chewing on things, or an increased level of drool. Contrary to some literature, fever and diarrhea are not signs of teething.

Because teething is a natural part of Baby’s growth, it’s not technically something that needs to be treated, but it can definitely make their life a bit less comfortable. Fortunately, there are things you can do to help them out, which will make both of your lives a little easier for the next 2 and a half years or so. Teething gels, including homeopathic teething gels, which carry their own risks, are not recommended.

1. Gum massage
   The first weapon in your arsenal against Baby’s teething pain is pressure – gentle pressure can ease the pain of their gums, and can distract them from focusing on the pain. No special equipment needed for this one either – just your clean forefinger. Don’t be discouraged if Baby squirms or winces at the first touch – after a moment, they will probably appreciate the pressure of a gentle massage. Once Baby gets a tooth or two, this option can get a little trickier, though – those little teeth can be pretty sharp!
2. A touch of chill
   Teethers are designed to help with teething pain, and they work even better if they’ve been chilled in the refrigerator, so that the cold can act as a mild anesthetic. They also give Baby a tool for applying as much pressure to their as they wants by chewing. Teethers shouldn’t be frozen, as that level of cold can be painful on Baby’s gums, and gel or liquid-filled teethers should be checked for leaks or punctures.
3. Double duty
   Some teething babies stop eating briefly, when the teething pain is at its worst. If Baby is still exclusively bottle or breastfeeding when this comes up, there’s nothing wrong with waiting it out – they will be hungry again soon enough. Switching the style of nipple you’re using (bottle, not breast) to see if a different shape will be easier on their gums could also prove helpful. You can also try massaging their sore gums or giving them a cool teether before each feed. If Baby refuses to feed for more than 5 to 6 waking hours, or doesn’t have a wet diaper in 6 to 8 hours, contact your healthcare provider.
   If Baby has started to eat solid foods though, you’ve got a whole new world of options, as you can start by feeding them chilled mashed or pureed fruits, like applesauce, or refrigerated mashed bananas.
4. Scrub-a-dub (not just for the tub)
   A chilled, damp washcloth is a great teething toy for Baby to gnaw on – the rough texture can help keep them interested, the cool temperature can soothe their gums, and the durable fabric of the washcloth can hold up to even Baby’s most committed gnawing. Most parents dampen the washcloths with water before refrigerating, but some use expressed breast milk or formula, especially for particularly young babies who aren’t supposed to be consuming much water yet. Occasionally, parents may use chamomile tea, which is thought to have a soothing effect.
5. Rehearsal
   Baby wants something to chew on, and they needs to start getting used to the idea of brushing their teeth, now that they’ve started coming in. By giving Baby a soft-bristled, big-handled toothbrush in a fun color to chew on, you’re giving them a head start on both!
6. When all else fails
   If Baby is in a lot of pain, and nothing else is making them feel better, Baby’s pediatrician might recommend an over-the-counter painkiller, most likely acetaminophen, especially if they is 6 months old or older. During the first 6 months, Baby should probably only have over-the-counter acetaminophen if it’s recommended by a pediatrician.
7. Keep it clean
   Baby’s gums aren’t the only things that can get a little uncomfortable during teething. The increased drooling that can happen when their teeth come in can leave them feeling sticky and uncomfortable, and if left on their face too long, can lead to chapping and dry skin. Drool can travel further, too, and an extra bib even when it isn’t mealtime can help cut down on how many changes it takes to keep Baby comfortable and dry throughout teething. Keeping their face dry by wiping it periodically with a soft, damp cloth should generally keep them comfy though, and if chapping starts to creep up anyway, an occasional thin layer of mild, baby-friendly moisturizer can help as well.

In fact, Early Childhood Caries (ECC), or tooth decay, is the most common childhood disease, according to the American Academy of Pediatric Dentistry, even beating out asthma for the top spot.

What are cavities?

In order to understand cavities better, let’s first define what they are. Cavities – also known as dental caries or tooth decay – are holes in a toddler’s teeth that are caused by bacteria. Not all bacteria inside the mouth are harmful, though. Some bacteria help to keep the mouth healthy.

The bacteria that cause harm on your little one’s teeth feed on sugar. When the bacteria combine with sugar, it forms plaque. After a while, the plaque starts to eat away at the enamel on the teeth.

Take a look inside your toddler’s mouth right now. Do you see any white spots on their teeth? That’s the start of the decaying process. If not treated, the decay will continue to eat away at the tooth through the enamel (the first layer of the tooth), exposing the dentin (the second layer of the tooth). When this happens, pain and infection will occur.

The effects of cavities in baby teeth

It’s easy to wonder why cavities in baby teeth matter, when they’ll fall out with the baby teeth in just a few years, but the truth is, cavities and decay in baby teeth can have an impact that lasts much longer than the teeth they’re in.

• The cavities on baby teeth can affect the permanent teeth if left untreated.
• Baby teeth guide the permanent teeth. If they fall out before adult teeth are ready to grow in, there is a good chance that the permanent ones will be crooked.
• Baby teeth play an important part in helping toddlers learn to speak properly.
• Cavities are painful.
• If cavities are not prevented or immediately suppressed, the necessary dental care will be more expensive.
• Good dental habits built early on carry over to dental habits children have later in life.

Preventing cavities

• Brush your child’s teeth regularly. The National Institute of Dental and Craniofacial Research recommends brushing the teeth twice per day.
• Do not let your child fall asleep with a bottle. The sugars in the liquid, if it’s milk or juice, can pool around the teeth and lead to enamel erosion, which is a step towards cavities. For tots already in the habit of falling asleep with a bottle, weaning away from the habit can involve offering bottles of watered-down liquid and, eventually, water.
• Give your child fluoridated water – the fluoride level should be at least 0.6ppm. Fluoride helps to strengthen enamel and protect the teeth. You can also get fluoride from solid food such as grapes, chicken, and asparagus.
• Keep an eye on what your toddler eats. Sugary foods like ice cream, candies, and chocolates can definitely spur the process of tooth decay on.
• Since baby teeth are more prone to cavities than permanent teeth, it is important to bring your little one to the dentist regularly for proper care and management starting at the age of one.

Dental care is a hygiene habit that will be an important part of Baby’s routine for the rest of their life, and now is a great time to get started.

Sources

• “Early Childhood Caries.” mychildrensteeth. American Academy of Pediatric Dentistry. Retrieved August 16 2017. http://www.mychildrensteeth.org/assets/2/7/ECCstats.pdf.
• “The Tooth Decay Process: How To Reverse It and Avoid a Cavity.” National Institute of Dental and Craniofacial Health. National Institutes of Health, May 2013. Retrieved August 16 2017. https://www.nidcr.nih.gov/OralHealth/OralHealthInformation/ChildrensOralHealth/ToothDecayProcess.htm.
• “The True Story of Why You Get Cavities, According to a Billion Microbes.” UIC Dentistry. UI Health, March 29 2017. Retrieved August 16 2017. https://dentistry.uic.edu/patients/cavity-prevention-bacteria. 

According to the American Dental Association, one in four children will have a cavity before starting kindergarten. With such a high rate of tooth decay in young children, it’s critical to begin and stick with a good tooth brushing routine at this stage.

For a child under the age of three, it’s recommended to use fluoridated toothpaste, applying an amount about the size of a grain of rice to the brush. If Baby has teeth that touch, now is a good time to begin flossing as well.

It may be tempting to skip tooth brushing if it also means skipping the complaining and crying, but early tooth decay can lead to problems with adult teeth, too. Instead, getting Baby used to (and maybe even able to enjoy) brushing will help them out in the long run.

• Sing a song: Seek out a song about brushing teeth, or even make up a silly jingle of your own, and let Baby get used to the idea that brushing lasts for the length of the tune. This adds an expected element to the routine, and also assures them that when the song ends, so does the brushing.
• Ensure comfort: Having someone prod around your mouth with a toothbrush isn’t the most fun activity; just think of how much most adults dread going to the dentist. To help Baby feel a little better about it, be sure you have a cozy spot for tooth brushing, and that they is at a comfortable angle while you’re doing the job. It’s also helpful to make sure they has a toddler-sized brush with soft bristles – if they’s been using the same brush for a while, it may be time for an upgrade, before it gets too scratchy on their gums.
• Make the most of your time: As you’re building up to a good routine, be sure you’re using the time they is willing to stay still for effectively. Gently glide the toothbrush in a circular motion throughout their mouth, making sure you’re cleaning all teeth, as well as their gums.
• Brush together: At this age, Baby still needs you to brush their teeth for them, and will for years to come. Still, once you’ve finished up, there’s no harm in letting them take over. Brush your teeth after, and let them “finish” brushing while you clean your own teeth, which will help them practice and feel more independent.
• Make a chart: Children this age love rewards for a job well done, so setting up a tooth brushing chart may be helpful for encouraging good brushing habits. Put a chart on the bathroom wall, and let Baby add a sticker each time they cooperates for brushing time. The idea of getting a prize may just be their ticket to the no-cavity club.

Baby may not love tooth brushing, but they doesn’t have to dread it, either. If they has a specific objection to tooth brushing, try and see if there’s anything you can do to.

Source

• “ADA Uses Fluoride Toothpaste to Fight High Cavity Rate in Children.” American Dental Association. American Dental Association, February 10 2014. Retrieved 14 September 2017. http://www.ada.org/en/press-room/news-releases/2014-archive/february/ada-uses-fluoride-toothpaste.
• “Frequently Asked Questions.” American Academy of Pediatric Dentistry. American Academy of Pediatric Dentistry. Retrieved 14 September 2017. http://www.aapd.org/resources/frequently_asked_questions/. 

Flossing can bring a whole new battle to the teeth-cleaning routine, but it’s an important step to introduce at this time to keep your little one’s teeth as healthy as possible. Cavities are common in young children, and often form between teeth. This happens when food and bacteria get stuck there, which is why flossing, which helps to dislodge food and bacteria before they can do much damage, cuts down on the risk of cavities.

Still flossing and toddlers can feel like a tricky combination, and it can be helpful to have some specific ideas about where to get started.

• Use appropriate gear: For toddlers, using floss sticks in place of regular floss can be a less intimidating place to start. These sticks come in fun colors, and some are even flavored. The sticks are softer, too, and easier to hold, making it a more comfortable experience.
• Stick with a routine: The best time to floss is after dinner so all the food from the day can be removed. Flossing right after brushing, before bed, and being consistent about it, can help them begin to get used to flossing as an expected part of their day.
• Make it interactive: Let Baby get used to the floss by letting them hold the floss and try to floss on their own, before showing them how it’s really done. You may decide to brush and floss your own teeth next to them, then let them know they is up next. Seeing you floss, and getting used to this new object, will help keep them from getting nervous about it.
• Be mindful of the timing: Since some toddlers are still teething at this age, it’s extra important to be gentle when flossing their sensitive gums. You may decide to skip the painful areas where teeth are about to come up until teething is over.
• Keep the explanation simple: Let’s face it: someone maneuvering floss in between your teeth isn’t most people’s idea of a good time. If Baby puts up a fight, or asks why they needs to floss, explain it in a way they’ll understand – cavities are bad and can hurt, and the floss is going to fight off the yucky stuff to keep their teeth happy.

Flossing can feel like a difficult thing to add the bedtime routine, especially if Baby is already resisting when it’s time for bed, but their teeth will thank you later!

While adults understand the importance of keeping our teeth clean, brushing can be a dreaded experience for young children. Toddlers don’t understand why you’re prodding at their gums, which can frustrate them, but it’s important to establish a routine early to reduce the risk for future dental problems.

According to the American Academy of Pediatrics, tooth decay is the most common chronic children’s disease in the United States, and nearly 40% of children are affected by kindergarten. Tooth decay in baby teeth also increases the likelihood of cavities as an adult. 

Keeping the pearly whites clean and bright

• Regular routine: Incorporate brushing into your regular morning and evening routines with Baby so it doesn’t catch them by surprise. Let them wake up a bit in the morning before starting to brush, as they will be more likely to resist if they is still groggy and grumpy. Similarly, try brushing right after dinner or before their last snack of the day, so you won’t be trying to hold their mouth open while their eyes are starting to shut.
• Familiar faces: Toothbrushes and toothpaste come in many varieties, and some even have characters on the brush or bottle. While you’re shopping, let Baby point out supplies they likes, and remind them of how much fun it was to pick them out when brushing time comes around. Brushing is a lot less intimidating with Baby’s favorite color for a theme, or their favorite character along for the ride.
• Sing songs: Toddlers love music, and incorporating a song into the brushing routine can be a great way to get them to relax. Find a brushing song online, or make up one of your own. This will make brushing more fun, and it will also help Baby connect the end of the song with the end of the brushing.
• Mimic motion: Since toddlers are great imitators, now is a good time to show Baby how you brush your teeth, and then let them follow your lead. Pull a step stool alongside the sink and have them practice brushing their teeth by copying your motions. Of course, you’ll want to finish up the job to make sure their teeth get a good cleaning, but this will allow them to better understand the logistics of how brushing works.
• Pretend play: If Baby is resisting because they is afraid of brushing, it may be helpful to let them brush their favorite stuffed animal’s “teeth” first, before doing their own. This works in the same way that giving a doll a shot or a bandage to help show that going to visit the doctor isn’t so scary might. If Baby’s teddy bear can handle it, surely they can, too!
• Lead by example: Letting Baby see you brush your teeth in the morning, even just by leaving the bathroom door open when you do, or brushing your teeth with Baby can help prove to them that toothbrushing is a normal, grown-up part of day-to-day life. You probably won’t convince them to want to brush their teeth, but you can at least reassure them that they isn’t the only one who has to do it.

Sources

• “How to Prevent Tooth Decay in Your Baby.” Healthy Children. American Academy of Pediatrics, May 15 2015. Web.

Once the toddler molars have battled their way through, gone are the days of teethers, (tooth-related) crankiness, swollen gums, mild fever, sleepless nights, and constant drooling. So much drooling.

After the marathon that started with the eruption of that first tooth at around 6 months old, it’s easy to start to wonder, “What comes next?”

By the time Baby was two years old, they probably had about eight of deciduous teeth, commonly called baby teeth, or temporary teeth. By the time they turns 3, they will probably have the full set of 20 deciduous teeth.

And then, just when they has gotten used to having them, they’ll start to fall out one by one.

Not-so-easy come, easy go

The school-age years (starting around 6 or 7 years old) are the time when Baby will start losing their baby teeth. Luckily, unlike the eruption of their first tooth, the falling out phase won’t be painful – most of the time, the entire experience is practically painless.

The first tooth that will fall out is usually the first one that erupted – generally either one of the middle bottom teeth or one of the central incisors. A tooth starts to get ready to come out by getting wiggly – this means that the new tooth is coming up and pushing out the old one.

There’s no reason to pull out a loose tooth before it’s ready – waiting for it to come out on its own generally hurts less, and sets the new tooth up to grow into gums that aren’t already sore. On the other hand, there’s also no reason to stop your little one from wiggling it until it falls out – which is good because trying can easily turn into a losing battle. Once the tooth is completely detached from the socket, ask Baby to rinse his or her mouth with water, especially if there’s bleeding. You can also have them bite down on a piece of clean cotton ball to create pressure to stop the bleeding.

Tooth care present and future

Preparing Baby for the second phase of their tooth development by helping them form good dental hygiene habits now will help you both out in the future.

• You can help make brushing fun for a reluctant tooth-cleaner by getting them a toothbrush with a character they likes, letting them pick out the toothbrush or toothpaste, and just generally making the act of brushing itself into a bonding experience! Brush together regularly. Show Baby how to properly brush their teeth, and then encourage them to do it on their own.
• Say no to juice, and yes to fluoridated water! According to the American Dental Association, not only will fluoridated water prevent cavities from forming, but it is also inexpensive and calorie-free! In most areas in the United States, and in many other countries, local tap water is already fluoridated. In areas where the general water supply is not fortified with fluoride, interested families can drink bottled, fluoridated water.
• Try to avoid or limit giving your child foods that are high in sugar, like sugary cereals, cakes, or cookies. Protein-rich foods like cheese, chicken, and nuts make great, high-energy substitute snacks. Fruits are also great snacks that are less likely to contribute to dental caries than sugary processed foods.
• You can help to put your little one’s mind at ease before their fears about dentist visits even have time to form, just by getting started with regular dental visits when they is young. The American Academy of Pediatric Dentistry recommends that the first visit should be at the age of one, and should continue about once every six months from then on. You can prepare Baby for the visit by showing them photos of dentists or by playing dentist at home. 

Baby’s baby teeth may not be around too much longer, but the dental habits they develops now can last a lifetime.

Sources

• Brittany Seymour. “Is Fluoride Safe for Children?” Mouth Healthy. American Dental Association. Retrieved July 5 2017. http://www.mouthhealthy.org/en/babies-and-kids/moms-guide-to-fluoride.
• “Fast Facts.” American Academy of Pediatric Dentistry. American Academy of Pediatric Dentistry, 2014. Retrieved July 5 2017. http://www.aapd.org/assets/1/7/fastfacts.pdf. 

It’s recommended that children have a dentist’s appointment before their first birthday, so it’s possible that you’ve already introduced Baby to the dentist. If it didn’t go perfectly, don’t worry. Although it is Baby‘s first encounter, it won’t be a lasting memory. It’s not going to scar them for life or make them love or hate the dentist forever; it’s more of a building block for immediate future visits.

Is my child going to hate the dentist?

Get ready for what might be the most annoying answer to any parenting question: it depends! Some children love going to the dentist. They think the toys that are usually in the waiting area are really cool, they like the paper bibs they get, and they consider the toothbrush and tiny toothpaste they get at the end to be really cool little treasures. It’s also easier to love the dentist when you don’t have to undergo any harsh scraping or lectures about flossing, so children who enjoy going to the dentist are often the children with the best dental care habits. (Having a parent with a dentist-positive attitude doesn’t hurt either.)

When children don’t like the dentist, it can be for a number of reasons. Medical-looking things might freak them out, which is a valid reaction. The instruments dentists use to clean teeth can look scary, and being in an unfamiliar setting with bright lights and masks can be overwhelming. A child might also dislike the feeling of someone poking around in their mouth or using a weird flavor of toothpaste. At the end of the day, it’s unlikely that Baby would have an unreasonable dislike of the dentist, but there are things you can do to make their experience the best it can be.

How do I make the dentist more fun?

The first trick is that Baby‘s first several visits probably won’t be the dentist’s visits that you’re used to having. Instead, they’ll be set up to help your little one to get acquainted with the dentist, experience being in the office, and learn that they probably getsts a cool gift from a prize box at the end of a visit. It’s also helpful for the dentist because they get to have your child on file in case of a dental emergency, and gives them the background if your family has a history of dental issues like weak enamel. You will also benefit from these visits – the dentist can help walk you through the best strategies for brushing teeth and keeping Baby‘s dental hygiene in tip-top shape.

What you can do is help create positive energy in your home surrounding the dentist and dental appointments. Express some excitement when you go to the dentist for your appointments, and make sure Baby knows that you brush your teeth just like they does! Make sure that Baby‘s teeth are brushed at least once a day (nighttime is best if you’re picking one time of day) to help prevent cavities, and therefore help prevent unpleasant dental procedures. Let Baby know that you’re so proud that they is a big kid old enough to go to the dentist.

You can also try to create some exciting post-dentist activity that Baby knows they can look forward to after every appointment. Maybe you play a special song on the way home, take a trip to the park, or eat a special (non-sugary, you just went to the dentist!) snack. The dentist is just one stop in a special bonding session with you and Baby!

And again, if the first (or first several) appointments don’t go well, try not to force it. Your dentist or pediatrician should be able to do a general check of Baby‘s teeth without being too invasive, and you can try to come back for an appointment another time if Baby is too freaked out. The most important thing is that you’re easing Baby into the world of dentist appointments and that you’re up to date on their oral health. And, of course, that you’re stocking up on cool prizes from the prize box.

Sources

• “Frequently Asked Questions.” America’s Pediatric Dentists. American Academy of Pediatric Dentistry. Accessed June 2, 2017. http://www.aapd.org/resources/frequently_asked_questions/

• Gap teeth: Baby teeth with gaps between them may worry some parents, but they can actually be a good sign! Gaps between teeth create fewer cavity concerns because saliva has a greater chance to clean between teeth. Baby teeth with gaps are also a good sign that there will be enough room in Baby’s mouth for all of their adult teeth.
• Crookedness: Crooked baby teeth aren’t related to whether or not adult teeth will be crooked, and often resolve themselves on their own.
• Overcrowding: Overcrowded baby teeth can actually be a sign that Baby’s adult teeth might be overcrowded as well. Overcrowding is often genetic, and is a good reason to be extra careful in brushing, because tightly packed teeth are at a higher risk for cavities.

To give Baby the best shot at straight teeth as they grows, you may want to make sure thumb-sucking or pacifier use ends before their adult teeth start coming in. It’s also a good idea to help protect their baby teeth, so that they don’t come out before their mouth is ready.