I know you remember the scene where Shrek is explaining to Donkey that ogres are more than the frightening fairy tale lore they are known for. “They have layers. Onions have layers” explains Shrek huffily. Donkey thinks for a minute and replies, “Not everybody likes onions. CAKE! Cake’s got layers. Everybody likes cake.” Teeth, like cake, have layers.
The white outer layer is called enamel. Enamel is the second hardest compound in the
world, preceded only by one of my other favorite things, diamonds! Enamel protects the inner tooth layers from
extreme temperature changes and normal wear and tear from chewing food. Enamel is densely mineralized and is
constantly responding to changes in its environment.
The middle layer is called dentin. It is less mineralized than enamel and has a yellow
hue. Dentin is amazing because it can
sense if a cavity is forming, and it will lay down more dentin to wall off the
cavity and protect the nerve and blood supply inside the tooth.
The innermost layer is called the dental pulp which contains the nerve and blood supply to the tooth. This is why a tooth can feel cold, heat, and pain. If a cavity comes close to or reaches the pulp, it can allow a pathway for bacteria to proliferate and cause an infection.
Each layer has its unique purpose. It is amazing how a tooth can fight a cavity without a single action from us. Whether it be a cake, an ogre, or a tooth, I am a fan of layers, and you should be too. Now, please pass the cake!
To sedate or not to sedate, that is the question. Dental sedation has been brought to light by the media in the past few years and the light has not been very complementary. Sedation is when medications are administered to create a relaxed or peaceful state. It is a spectrum, and depending on the patient’s needs, the provider will decide what level of sedation is necessary to accomplish the desired goal.
Dental sedation can be used for adults, but I will be focusing on sedation for children since that is my area of expertise. When I was in residency, in our first sedation class my professor said, “Children are not little adults! Do not sedate them like they are an adult.” At the time, I did not know what he meant. When working with adults, there is more standardization as far as prescribing medications. With a child, typically, prescribing should be based off his weight and not his age or maximum dosage. Young children do not have mature respiratory systems, do not have a large oxygen reserve, and can become overly sedated quickly.
There are hundreds of medications that can be used to sedate children and as some would say, “many ways to skin a cat.” I will not discuss specific medications, but each provider has their “go to” medications that they use depending on the situation and the desired goal. When the term “conscious sedation” is used, I am referring to minimal sedation. My goal for a child is that he be awake but relaxed for the procedure. The child should be able to follow my instructions and have all his normal reflexes intact.
Conscious sedation is safe when practicing within the
guidelines set forth by the American Academy of Pediatric Dentistry. This is not to say that there should not be some
level of healthy fear anytime medications are introduced. As I stated before, sedation is a spectrum
and a child can easily slip further down the sedation spectrum than may be
intended. Whenever a child is sedated,
it is important to keep in mind where the child is on the spectrum, and as a provider,
“Am I comfortable with how this child is responding?” If not, what is the causing the problem and
how do I fix it quickly.
When I was in dental school, I had several patients that were terrified of the dentist. Many of these patients had a bad experience as a child and have carried these fears into adulthood. Sedation was not a common practice even twenty years ago. At that time, it was not uncommon to use restraints or behavioral techniques that are not as acceptable at this day in time. Children are impressionable creatures and do remember bad experiences that may affect them for the rest of their life. This is one of the reasons why I decided to go into pediatric dentistry. If I can give a child a good dental experience, then that child will carry this mindset to adulthood and is more likely to seek dental care on a routine basis instead of waiting for an emergency to arise.
I am not going to lie, sedation appointments are not my favorite, but if it will give a child a good experience, I will do it. During residency, I completed over double the amount of sedation cases required and feel comfortable with the medications I prescribe. I maintain my Pediatric Advanced Life Support certificate. All my staff is certified in Basic Life Support. I complete an inventory of our crash cart monthly to make sure I have everything I need on the off chance I run into a situation where I may need to rescue a child. We have staff meetings weekly where we discuss various office emergencies, and how we will handle them. I hope to always maintain a healthy fear that I may need to use my advanced training. Sedating a child is never something to be taken lightly, but it can be a useful tool in creating an enjoyable dental experience for some children.
Infant tongue tie is something that has come to light in the past few years as more and more of us mommies are breastfeeding our babies. I have been getting questions at an increasing rate on this topic. Does my baby have tongue tie? Is it a problem? Do I need to do something about it?
What is tongue tie? Tongue tie is when the tip of the tongue is attached to the floor of the mouth. There are varying degrees of tongue tie from minimal attachment to the full length of the tongue being attached to the floor of the mouth.
What problems can it cause? In infants, it can cause difficulty feeding/latching and for momma, it can cause nipple pain upon feeding.
Do I need to do something about my infant’s tongue tie? This is the process I use to decide if my patients are candidates for the surgical procedure to relieve the tongue: I ask parents if it is causing a problem?” If the parents say no, it is usually something they have noticed visually and not noticed problems. These children are not a candidate. If the parents say “yes,” then I ask what problems they are experiencing. If the parents say the child has colic or gastric reflux and is fussy, they are not typically a candidate. These issues are best brought up to the child’s pediatrician and once GI issues have been ruled out, they may be a candidate. If the parents say the child is having difficulty eating, is in a low weight class, or the mom is having pain on feeding, then the surgery may be helpful. Notice, I said MAY be helpful. This is the controversial part! Scientific research has found a correlation between the surgical removal of the attachment and better feeding/less nipple pain. Is it a relatively harmless procedure? Yes. Is the recovery difficult? Not typically. Is it helpful in some cases? Yes. Is it 100% effective? No. Am I going to recommend it to all of my patients with tongue tie? No. A serious discussion needs to occur between the provider and the parents where the pros and cons of the procedure are weighed to determine if it is the right course of action. A good clinical evaluation is important. Sometimes the tongue is not the main source of the problem. Occasionally, the top lip can be attached firmly and is not allowing the baby to latch effectively.
Who performs this type of procedure? Due to its controversial nature, only a select few doctors perform it. The best place to start in most cases is a lactation specialist. Although they do not perform the procedure, usually they know who in your area does. Among the list may be Ear, Nose and Throat physicians, Neonatologists, Periodontists (dentists who specialize in gums), Pedodontists (children’s dentist), and Oral Surgeons.
What does the surgery entail? There is a section of gum tissue under the tongue that attaches to the floor of the mouth. This tissue is called a “frenum” or “frenulum.” The frenum is cut with either scissors, a scalpel, or a soft tissue laser to allow the tongue to move freely. Sometimes it is necessary to place stitches to allow the tissue to heal, but it is not always required.
Will my baby have to be put to sleep? This depends on the surgeon you are using. Typically these babies are less than 6 months of age and general anesthesia is not required. Some ENT physicians may combine this procedure in with another surgery, for example, if your child also needs ear tubes. Most of the time, these procedures can be completed with your baby awake.
Will my child feel pain? Babies are like adults. They do feel pain just like anyone else. But, there are risks to giving infants numbing medication because they are so small, and it is easy to give them too much. Some practitioners are of the school of thought that the child will not remember the procedure, so they do not give the baby numbing medicine. This is a topic to discuss with your surgeon and decide how you would like to proceed.
What is the recovery like? Typically, following the procedure, the provider will give the baby to the mom to begin breastfeeding and help soothe the child. Yes, unless your child was put to sleep, your baby will scream throughout the procedure. This is normal and is not necessarily indicative of pain. Most babies do not like to have their mouth messed with, and their only known way of responding is to cry. Before you leave with your baby, you may be given instructions to do tongue and lip exercises at home. Typically the surgeon will schedule a follow up exam a week to a month following the surgery. This will allow them to monitor the healing and make sure the procedure was successful. In the meantime, Tylenol/Motrin can be used for any post-operative pain unless the pediatrician recommends otherwise.
I hope this is helpful and not overwhelming. I am attaching links to this post with more information on the topic.
“You’ve got what?!?
Dental fluorosis? That sounds
serious. I hope it’s not catching.”
Fluorosis is a dental
condition that occurs during the years that a tooth is developing. Excess fluoride is absorbed through the
gut and can be stored in bones and teeth.
It is noted clinically as white striations but can appear brown that may
be attributed to dietary staining of the effected enamel. Severe fluorosis can present as pitted
enamel. Microscopically, the enamel
layer is more porous and thus, weaker in nature.
The age that fluorosis occurs is during the time the
permanent teeth are forming, but it is not seen clinically until the teeth
erupt into the mouth. The top front four
teeth are where fluorosis is the most commonly visible. These teeth are affectionately called the
central and lateral incisors. The
incisors begin forming early in a child’s first year of life and the visible
portion of the tooth (crown) completes forming when the child is 4-5 years
old. Teeth begin forming at the bottom edge
and form upwards until the root has been completed. As you can see in the picture above, the
staining occurs in lines. The fluorosis
is seen in the tooth layer that was forming at the time the child received
For example, in the picture above, the central incisors have
a brown line near the top third of the tooth.
The lateral incisors have brown staining in the bottom third of the
tooth. It is likely that the fluorosis
occurred at the same time, but the centrals and the laterals were at different
stages of crown development.
Fluorosis is more common in the southwestern United States
due to its higher naturally occurring fluoride levels. Typically, fluorosis occurs from a long-term
ingestion of excess fluoride and is not noticeable if a child has an acute
fluoride toxicity event from eating a tube of toothpaste. One instance that can cause fluorosis is
using fluoridated water to mix infant formula.
Since this is the basis of the infant’s diet, especially early on,
fluorosis can occur if fluoridated water is used on a regular basis.
How do we treat a tooth with dental fluorosis? Back in the day, the only treatment
options were to use a high-speed handpiece to remove the stained tooth
structure and place a filling or a crown.
I’ve said it before and I’ll say it again, I love the day and age we
live in because we have more conservative options at our disposal. I will list the options from most
conservative to most aggressive:
Tooth whitening – no tooth structure will be
removed, but the discolored tooth may blend with whitening treatments. Follow up treatment is usually required.
Resin infiltration: a treatment option where the
enamel is opened with an acid to release staining, apply a bleaching agent to
the tooth, and apply a sealant to protect the tooth and prevent future
Microabrasion: the top layer of the enamel is
removed with an abrasive to reveal a more esthetic layer of the tooth (not
always an option for fluorosis, due to it affecting the entire depth of enamel)
Remove the stained portion with a dental handpiece
and apply a filling
Remove tooth structure to allow for an esthetic
crown to be placed
To summarize, causes of fluorosis can be atributed to
long-term fluoride ingestion such as, drinking fluoridated water at levels
higher than recommended by the CDC or using fluoridated water to mix infant
formula. Fluoride varnish is the most
commonly placed dental fluoride at cleaning appointments. Research studies do not support a correlation
between increased dental fluorosis and fluoride varnish application.
You mean you’ve never heard of silver diamine fluoride? It is hot, hot, HOT, right now! I’m surprised it is not trending on Twitter. Silver Diamine Fluoride, known among dentists
as SDF, is a liquid with a high concentration of fluoride that is applied to a
cavity to prevent it from getting larger.
You may ask, why would one apply this to a tooth instead of
just getting a filling? A filling or crown
would be a more permanent fix, but what if the child is two years old and is
unable to behave for a filling? What if
the child has special needs that make it dangerous to sedate or have the
fillings done under general anesthesia? What
if the child is eight years old and will lose the tooth in a year or two and
the parents insurance benefits have been maxed out for the year? These are all reasons to consider SDF in a dental
As costs increase and dental insurance benefits stay the
same, it is becoming more and more of a struggle for parents to pay for their
children’s dental needs. SDF may not be
long term treatment, but if there is a need to defer treatment, it can be
applied to the teeth to prevent the cavity from becoming larger. Typically, SDF needs to be applied every six
months until the final treatment can be completed, or the tooth falls out. Some
practitioners will place it once and follow up a week later to add another
coat. Some practitioners will place the
SDF and add some type of temporary restoration to further protect the tooth
It sounds too good to be true, right? There is always a catch, isn’t there? The downside to SDF is, it turns the cavity
black. When I say black, I mean
black! It not only turns cavities black,
it turns anything it touches black, as well.
If it were to touch a child’s cheek, the soft tissue would be black for
a week. For some children, if they cannot follow
instructions and will be fighting the treatment, they are not candidates for
SDF. For some parents, the esthetics
would eliminate SDF as a treatment option completely. Attempts have been made to make SDF more esthetically
pleasing, but at this time, they do not look as natural as a traditional filling.
If SDF is placed and a white filling is indicated later, the
dark staining can be removed with a dental handpiece, but it is not always completely
successful. This is one reason why SDF
is not commonly used on adult teeth. It is
great for baby teeth, because they fall out in a few years and you get a “do
over.” In the past when treatment needed
to be delayed, the cavity sat exposed for six months or a year until treatment
could be completed and what originally needed a filling now needs a crown or
extraction. SDF prevents cavities from
getting larger, so in theory, a cavity that requires a filling should still
require a filling in six months following SDF application. SDF is not recommended on teeth that have
been deemed non-restorable and need to be removed to prevent the risk of
What are the advantages of SDF?
No injection is required
Sedation can be prevented or delayed as
the child matures
Lower cost than a filling
Promotes a positive dental attitude for
I hope you found this post informative. I love working in this time period because we
are blessed to have so many treatment options at our disposal, and we can
customize it to the needs of the individual.
I am happy to have this option in my wheelhouse, but I very much hope it
does not put me out of business!
A common reason for parents to call Poison Control is
because their child ate an unknown amount of toothpaste containing
fluoride. And who can blame them? Toothpaste, with its sweet flavors, is quite
tempting to some kids.
We have discussed in previous blog posts that fluoride is an
ion that wants to bind to another ion.
When it is used correctly, it binds to the enamel ions to make
fluoroapatite which makes enamel less likely to get cavities. When it is swallowed, the fluoride binds to
hydrogen in the stomach creating hydrofluoric acid. The acid is corrosive and can cause an irritation
to the stomach lining, presenting as nausea, vomiting, and diarrhea. Typically, this is the extent of the
episode. But what if we could have the
fluoride bind to something besides stomach acid? The treatment of choice when your child has
eaten a small to moderate amount of fluoridated toothpaste is to give your
child a milk-based snack, i.e. a glass of milk or bowl of yogurt. The calcium in the milk binds the fluoride to
make an inert salt (CaF2) that is excreted from the body.
I have attached a chart that Georgia’s Poison Control uses to determine if a child needs a trip to the emergency room:
In rare cases, a child can ingest a larger amount of
fluoride than is safe to treat with milk or yogurt. Usually, when this occurs, a young child is
involved. It does not take much toothpaste
to cause a problem in a very small child.
For this reason, it is extremely important to keep toothpaste out of
reach of small children and behind childproofed drawers or cabinets. The symptoms that follow are nausea and vomiting
that progresses to seizures and muscle spasms.
It can potentially lead to death if left untreated. Poison Control will let you know if inducing
vomiting is recommended. Once the child
is admitted to the emergency room, activated charcoal may be given to help bind
the fluoride and the child will be treated by physicians who will be monitoring
the child’s vital signs until they have recovered.
When dealing with children, emergencies can happen in a
heartbeat, and if you find yourself in this situation, I hope you find these
In my last post, What Is Fluoride, I discussed what fluoride is and how it affects our enamel. It aids in remineralizing enamel and prevents the demineralization of enamel. It can also prevent bacteria from producing cavity enhancing acid.
Community water fluoridation began in the 40s because
studies showed that residents with higher naturally fluoridated water had fewer
dental cavities. To this day, it is
touted as the most equitable and cost-effective method of delivering fluoride
to all members of most communities. Over
the years, a significant decrease in dental cavities has been seen. In the United States, the amount of fluoride
in the water is from a range of 0.7-1.2 mg fluoride ion/L part per million
There are several classes of people that I run into:
Those that believe fluoride works and is
Those that think fluoride is toxic and harmful
And people who do not care either way
I get asked on a regular basis if I actually believe in
fluoride. It’s almost the same as if someone
asked me if I believed apples came from apple trees. Through my four years of college, I learned
about the how fluoride effects our teeth at an atomic level. During my four years of dental school, I read
countless articles that have undergone meta-analysis and systematic reviews
(highest level of validated research).
And during my two years of pediatric dental residency, I have seen how
fluoride has been beneficial to one of the poorest and most underprivileged
communities in the nation. I believe in
fluoride because I have seen its benefits first-hand. But I do understand that not everyone has had
the same experiences I have had so it is normal to be skeptical. Is it possible that I live in the Truman Show
and everything I have learned is a big hoax?
I sure hope not!
To the people who believe that fluoride is toxic and
harmful, all I can say is, “You are absolutely right.” Just about anything in excess is not good for
you. Even drinking too much bottled
water when drunk too fast at a large amount can cause your sodium levels in
your blood to drop and be fatal. It is
well known that when a small child ingests too much fluoride (typically by
eating toothpaste from a full tube), the side effects can affect their gastrointestinal
system by causing nausea, vomiting, diarrhea, and abdominal pain. If a very large amount is ingested, it can
affect the central nervous system and symptoms of convulsions, numbness, and
possible cardiovascular collapse. So,
yes, I would say it is toxic and can be harmful when used outside of its
A few years back, a study came out of Harvard University called
Developmental Fluoride Neurotoxicity: A Systematic Review and
Meta-Analysis. I have provided the
link below for your reading pleasure.
This paper collected studies from around the world that compared
children’s water fluoridation levels and their IQ. “The results supported the possibility of an
adverse effect of high fluoride exposure on children’s neurodevelopment. Future research should include detailed
individual-level information on prenatal exposure, neurobehavioral performance,
and covariates for adjustment” (Choi 2012).
I reviewed the studies that were listed and the fluoride levels that are
present in many of the studies are 3-4 times higher than the amount used in the
United States water fluoridation. It is
very interesting that these studies are evaluating a long-term effect of
fluoride on children’s brains. This
research paper was well conducted by a highly prestigious university and is
something to be cognizant of.
With all of this said, it does not make a difference to me
if someone “believes in fluoride.” I do
find it important that my patients are well informed so they can decide what is
right for their family. Fluoride is not
essential to having healthy teeth, but it is a tool that can be helpful if
there is an imbalance in the oral cavity where cavities are forming. If you feel fluoride could be helpful for
your child, drinking fluoridated water and brushing your child’s teeth with
fluoridated toothpaste is a good place to start. If you do not wish to have your child exposed
to fluoride, drinking bottled or distilled water is always an option. Newer refrigerators have reverse osmosis
filtration systems which utilizes tap water but removes fluoride, as well as,
other things like lead and chlorine.
I hope this post was helpful in deciding what is right for
your family. And for those people who do
not care one way or another if their water is fluoridated, keep doing what you
are doing and thanks for reading!
The short answer to this question is fluoride is an ion that bonds to enamel and hardens its chemical structure. If you are curious about the chemistry behind it, keep reading. If you are fine with the previous answer, there is no need to suffer through this one!
Let’s take a journey back to middle school. Reach into the depths of your brain to find the periodic table. The periodic table is a chart of elements. Elements are building blocks for everything: trees, rocks, gases, skin, and food. Everything is made up of elements.
Fluorine is an element and fluoride is the ionic (active) form
of fluorine. Most ions do not like
floating around by themselves. They bind
with other ions to create molecules which are more stable. For example, oxygen is not often found by
itself. It binds to another oxygen
element to form an oxygen molecule. Fluorine is a very special element. It has the highest electronegativity of any
of the ions, forming strong ionic bonds.
Are you bored yet?
Let me get to the point. Why is
fluoride important in the dental field? To
answer this, I must explain what enamel is.
Enamel is the hardest substance in our bodies and is the white covering
of our teeth. Enamel, like anything
else, is made up of elements, such as calcium, phosphorus, and hydrogen. When our mouth becomes acidic after eating or
drinking, the enamel releases hydroxide into the mouth to help bind the acidic
ions and bring the mouth back to a neutral environment. When this happens, the enamel has two courses
of action: it can continue to breakdown further (demineralization) and result in
a cavity, or ions/compounds can bind to damaged enamel to restore the structure
When teeth are formed, the enamel is made up of interlocking
molecules called hydroxyapatite. The
fluoride can replace hydroxide in the molecule to create a stronger substance
called fluorapatite. Fluoride changes
the structure of the tooth at a chemical level to make it stronger. Fluorapatite is stronger than hydroxyapatite
and is less likely to breakdown.
I hope this post did not stress you out, because it sure stressed me out! I am sorry it was dry and heavy in the sciences. I am, ultimately, a scientist and am tasked with the burden of learning the “why” behind everything I do. I am going to continue down the fluoride rabbit hole, but I think this is enough information for one blog post. Soon I will address the sources of fluoride and its beneficial and harmful effects. As always, I love your feedback and any additional questions you may have on this topic.
Orajel is a topical numbing agent that’s uses range from
relieving pain from canker sores, tooth and gum pain, as well as for cold
sores. The active ingredient in Orajel
is 20% Benzocaine which is a topical local anesthetic (pain reliever). Some formulations also contain Menthol which
is obtained from mint oils. Menthol
increases blood flow to the area and provides at cooling sensation.
Benzocaine has been used for decades to relieve oral pain
temporarily. Dentists most commonly use
it to place on their patient’s oral tissue prior to an injection of numbing
medicine. How does it work? Pain is caused by stimulation of specific
types of nerve endings. Benzocaine stops
the nerve from being stimulated temporarily by blocking the uptake of the
molecule that stimulates the nerve.
Like any drug, we must be aware of its potential side
effects, especially when we are talking about young children. It is generally safe and non-toxic when
applied topically. So, what’s the
Benzocaine has been associated with an uncommon, but serious condition called Methemoglobinemia (pronounced Met–hemo– globe-in-emia). I found out it was one of my husband’s pet peeves when it is called METH-hemoglobinemia. To avoid a lengthy and yawn-inducing discussion over its chemical formula, and why it is called METhemoglobinemia, I am stressing its pronunciation. Please! Not again!
I will try to keep my “sciency stuff” to a minimum. Bear with me. Let me start with explaining what hemoglobin is. Hemoglobin is the oxygen carrying molecule in red blood cells. It delivers oxygen to the tissues in the body. The oxygen bond with hemoglobin is not strong. Some may say, it’s down-right weak! It sounds terrible, but it is actually a great thing. The weak bond of hemoglobin is what allows oxygen to be released to the oxygen-depleted tissues. Methemoglobin is a different chemical formula of a hemoglobin molecule that binds strongly to oxygen, thus not allowing for its release to the body. When this occurs, the body is unable to function well due to the decreased oxygen availability.
What is methemoglobinemia? When benzocaine is applied to the tissue and
is absorbed into the blood stream, it can convert normal hemoglobin to methemoglobin
and cause an oxygen depletion. It has
been found to be severe, especially in children ages 2 and younger. Unfortunately, this age group most often
suffers from teething discomfort.
What are the symptoms
of methemoglobinemia? Pale, gray, or
blue skin color, shortness of breath, fatigue, headache or lightheadedness, and
rapid heart rate. These symptoms can
occur in minutes to hours after Benzocaine’s application.
What is the treatment
to reverse methemoglobinemia? The child would be placed on oxygen and given
a substance called methylene blue through an IV. The improvement is typically rapid.
Methemoglobinemia is well known by the Orajel company, so
they have come out with a children’s version without Benzocaine. In fact, they have two kinds: daytime and
nighttime teething gel. It is called
Orajel Non-medicated Cooling gels for Teething.
The active ingredient in the daytime gel is Simethicone. It is commonly used to relieve colic in
babies. Simethicone drops allows for
smaller gas bubbles to come together in the stomach and become one big bubble
to aid in the baby burping. I have been
unable to find how it aids in relieving teething pain. The nighttime active ingredient is chamomile
in addition to the simethicone.
I love a good cup of tea and chamomile is one of my favorites, but I also have the unfortunate quality of being a skeptic when it comes to homeopathic remedies. Some research out of the University of Michigan supports the use of crushed chamomile tablets mixed with water and given in a dropper to your child can relieve diarrhea associated with teething. Many herbalists suggest that chamomile has anti-inflammatory and calming properties to alleviate teething pain, but currently there is not enough research I have found to prove or disprove this theory. The bottom line is, chamomile has not been found to be harmful for children. One way that it can be used is by making a cup of chamomile tea, dipping a corner of a washcloth in the tea then freezing it for your child to chew on. The rule of thumb with anything is “Everything in Moderation.”
Those sweet, gummy smiles! I, personally, cannot get enough of them, but at some point, we hope the teeth start to come in. Teeth serve many purposes: they can aid in chewing food, developing the child’s speech, give soft tissue support for an aesthetic profile, direct the permanent teeth in their eruption, and aid in the growth and development of the jaws.
On average, the first tooth comes in around 6 months of
age. Conveniently enough, this is the
time that babies begin eating solid foods.
The typical pattern is the front four teeth on top and bottom come in
first, followed by the first molar. Next
is the canines (the pointy teeth made popular by Dracula) and lastly, the
second molars in the very back. The
teeth continue to erupt until the child is 2-3 years old. There is a total of 20 primary (baby) teeth.
I have found that teeth do not always follow the textbooks. Many parents are concerned when teeth are not in by 6 months. Neither one of my babies have gotten teeth before 8 months of age. Some children get their teeth in early, but it is far more likely for teeth to erupt later. Genetics does play a role on eruption timing, so if the teeth are being slow, blame it on your spouse! Children that were born prematurely often have their teeth come in later than children that were born full-term. In many cases, the teeth will come in six months following the mother’s original due date.
Teeth can be termed “delayed” if the child is fifteen months of age and no teeth are visible. At this point, the dentist can attempt to take radiographs (x-rays) to see if teeth are present in the jaws. Blood work can also be completed by the child’s pediatrician to rule out any systemic issues. Most cases are simply delayed, and no treatment is needed to help the teeth erupt. It can be important to involve the child’s pediatrician if there is a suspected hormonal imbalance or an underlying issue affecting the child’s growth and development. But until then, enjoy those sweet, gummy smiles for as long as you can!