To better understand the relationship between teething and sleep, it’s best to break down the basics of teething. I was lucky enough to pick the brain of the talented pediatric dentist Lauren Alavanja, MS DDS to get some answers to common questions about teething & more.
When does teething begin?
On average, the first tooth erupts (emerges from the gum) around 6 months of age. However, symptoms can begin a month or so before. 6 months is an average so no need to worry if your little one does not have a tooth by that age.
Signs and Symptoms of Teething
According to medical and dental research, the only symptoms that have been associated with teething are pain, fussiness and increased drooling. Developmentally, drooling is a common practice from age 3-6 months so sometimes the symptoms overlap.
Although in her professional practice every baby reacts differently. Commonly, parents have reported runny nose, fever and diarrhea during teething.
Teething Remedies Basics 101
You see the swollen gums, you’re covered in drool and the irritability is testing your patience. Here’s what can help!
Providing something cold and safe to chew on can be very beneficial. A few teethers that can be helpful are the Sophie the Giraffe or banana toothbrush. The larger Sophie is easy to hold, can provide entertaining squeaks, but be sure to wash properly. It has a tiny hole that water can sneak in leading to mold growth. Small Sophie is perfect to clip on while going on a walk or traveling.
Using mesh or silicone teethers, you can place frozen breastmilk cubes inside them for your child to gnaw. Getting the go ahead for solids from your pediatrician, place frozen fruits or veggies into it. Silicone teethers are much easier to clean vs the mesh, but both get the job done. Check out this blog post to find a great teether.
Why check with your pediatrician before giving medications like Tylenol or Motrin? Your little one could be masking a fever related to something else so it never hurts to ask (and no Motrin before 6 months of age).
Have you ever tried a DIY teether? Simply dip one end of a washcloth in breastmilk or water, place in a plastic baggie and freeze for 15-30 minutes.
What to avoid while teething?
- Topical anesthetic teething gels
- Amber necklaces- FDA has reported injuries associated with these
- *Freezing* liquid teething toys- once the teether freezes, it can become too hard for baby’s gums and can bruise or cut their sensitive gums
When to start brushing teeth?
Start brushing as soon as the first tooth comes in or at age six months – whichever comes first. Keeping the teeth clean is important. Getting used to brushing early in life helps make the brushing routine easier throughout childhood.
Fluoride toothpaste- Yes or no?
YES. Start using a fluoride toothpaste as soon as the first tooth comes in. Use a small smear of fluoridated toothpaste. What does smear mean? The amount you use is so small that if you gathered it together it would be the size of a grain of rice – until your child is 3 years old. If your child swallows all of the toothpaste on the brush (which they probably will), it will not cause them harm.
From age 3-6 years old, use a pea-sized amount of toothpaste with fluoride. This is in accordance with practice guideline from the American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics.
Here’s a website with some great options for different types of toothbrushes.
When to start flossing teeth
Start flossing for your child as soon as the teeth are all touching. If you can still see space between the teeth all the way down to the gums, brushing is enough to keep your child’s teeth clean. The spaces between teeth usually disappear once your child’s second set of molars come in around 24 months. Keep an eye on the back of the mouth which is where they disappear first! This is when flossing is so important to prevent cavities forming between the teeth.
Tips & Tricks for brushing and flossing
Lots of options so feel free to try something new each day and figure out what works for you and your child!
- If your child is a “helper” give him or her your toothbrush to brush your teeth. While he/she is helping you brush your teeth, he/ she is often distracted enough to open and allow you to brush his/her teeth.
- You can give your child one or more toothbrushes and brush while he or she is brushing simultaneously
- Developing a routine (does this sound familiar?) that involves singing a song while you are brushing often works great. One great example is “This is the way we brush our teeth, brush our teeth, brush our teeth. This is the way we brush our teeth, all day long!” over and over until you have brushed all the surfaces of all the teeth.
- If you find your child is resistant to brushing using a manual toothbrush, try an electric toothbrush or vice versa.
- If your child is resistant to brushing, try a different flavored toothpaste. Most children under the age of 8-10 years old do not like mint. Colgate has some great fruit flavors that even picky eaters usually tolerate.
Flossing Tips
- You can use traditional string floss or floss picks – whichever you feel more comfortable using. Often for little mouths, it is easier to use floss picks than get both hands in there with traditional string floss. Just make sure you are flossing all the way between the teeth down to the gums.
- You should brush and floss your children’s teeth until you trust them to cut their own steak (usually at least until age 9-10 years old).
What age to first visit the dentist?
It is recommended that a child’s first dental visit is scheduled following the eruption of the first tooth or at the latest, by age one. This is so that you and your child can develop comfort going to dental checkups and also so that the dentist can assess the child’s development and dental health. Keeping a positive association with
If there is a dental issue, it can be addressed earlier with less drastic treatment usually.
The first visit generally consists of the dentist or pediatric dentist taking a brief look in your child’s mouth and brushing the teeth with a toothbrush or gentle mechanical toothbrush. This is happening while your child sits in your lap and reclines backward onto the knees of your dentist (we call this a knee to knee exam).
Some general dentists (like your family dentist aka not a pediatric dentist) do not want to see children in their office until age three or more. If this is the case, you can always take your child to a pediatric dentist until he or she is three. At that point, you may want to stick with your pediatric dentist or you may want to bring your child to your family dentist.
When to wean from the bottle?
Following the same guidelines as pediatricians, who recommend discontinuing the bottle ideally at age 12 months – or at the latest 24 months. This promotes a healthy diet and decreases the chance of childhood obesity. It also allows for more ideal dental development and reduces the chance of dental decay.
What about thumb sucking?
- Thumb sucking is a common habit and considered normal. It is best to stop thumb sucking and any other “non-nutritive sucking habit” like pacifier use and finger sucking by age 36 months. Habits that continue past this point are associated with dental and facial growth and development issues.
- These issues include having a crossbite in the molars (where the lower teeth are closer to the cheeks than the upper teeth), a high palate (or roof of mouth), a narrow upper dental arch (this can cause the teeth to come together in a problematic way), or an anterior open bite (where the upper front teeth do not overlap the lower front teeth). Anterior open bites can be associated with speech problems and difficulty eating (it’s hard to bite into something if those front teeth don’t come together or overlap when closing the mouth!).
How to stop thumb sucking
- The method you use to stop thumb sucking depends on your child’s developmental stage, the timing of the habit, and his or her willingness to stop. It is a great idea to work with your pediatric dentist on a strategy to stop a thumb sucking habit in your child. Often the best, least invasive method to stopping thumb sucking is to verbally discourage or gently remove the child’s thumb from his or her mouth.
- If your child is mature enough to be motivated by reward systems, you can get a calendar and mark each day your child does not suck his or her thumb. After he/she gets to the goal number of days without thumb sucking (5, then 10, etc), he/she gets rewarded – with something simple like a toy from the dollar store at five days and choosing dinner/dessert at ten days.
- If your child only sucks his/her thumb at night, you can put a glove or mitten on that hand to prevent it. You can also paint something like mavala on the thumb, which makes it taste bad and this discourages sucking. Occasionally when children are older and want to but are having difficulty quitting their thumb sucking habit, a dentist will make your child an appliance (such as a tongue crib) is made to remind children not to do it.
- Again, it’s best that a pediatric or family dentist assesses your child’s habit and developmental stage to help you decide on the best strategy for your little one.
Any preferred sippy cups?
“In pediatric dentistry, we always say what is in the sippy cup is more important than the type of sippy cup you use – and I love to see water in those sippy cups! “
- According to Lauren, she recommends no juice before age 2 and from the ages of 2-6 years old only a single 4-6 ounce serving per day (but ideally no juice). This is because juice (even 100% fruit juice with no sugar added or diluted juice) has SO MUCH sugar! This is the same recommendation that pediatricians have.
- This helps support a healthy diet and reduce the chances of tooth decay. Also, if a child over the age of 2 does drink anything besides water (juice, milk, chocolate milk, soda) it should be at meal time only, not to sip on throughout the day. By following these guidelines, it reduces the amount of time the teeth are coated in sugar from the drink. Also, during mealtime, the mouth produces more saliva, and this helps wash away the sugar.
Now that we’ve finished discussing the basics of teething, let’s learn a little more about Lauren, the talented dentist I interviewed.
About Lauren
Growing up with 5 brothers without any sisters, I’ve always made it a point to find strong, uplifting and motivating women to surround myself with. I recently joined a mom group where I connected with one who is a pediatric dentist. Her name is Lauren Alavanja and she is an incredible resource! She let me ask all the teething/dentistry questions I could think of. Let’s get to know her a little better.
She first decided she wanted to become a dentist after an event encouraging young girls to be confident and pursue their dreams. Her own dentist was also there volunteering at the event. She shadowed her and fell in love with profession. Some say she inherited a “child whisperer gene” from her mom. And with that, she decided to specialize in pediatric dentistry.
She graduated from Notre Dame in 2009 with her biology degree. In 2013, she graduated from Indiana University with a doctorate of dental surgery. She then completed a residency program in pediatric dentistry in 2015 at Riley Hospital for Children serving as chief resident. Simultaneously, she finished a master of science in pediatric dentistry with a minor in psychology at Indiana University in 2015. (WOW!)
Lauren now works in private practice in South Bend, Indiana and am on medical staff at both the local hospitals as well.
She enjoys running, baking, toddler craft projects and reading – although most of her reading material consists of board books these days! Can’t we all relate?