Dra. Cléo Salustiano In this article
SummaryWhen do baby teeth come in, and in what order?How to ease discomfort and care for the first teethFAQRead nextBaby Teething: When Baby Teeth Come In and How to Soothe
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Baby teeth usually start coming in around 6 months, most often with the lower front teeth, and all 20 are in by about age 3, with normal variation between babies. Drooling, wanting to bite, swollen gums and fussiness are common; high fever, persistent diarrhea or a listless baby call for the pediatrician. Clean teething rings and gum massage help, while amber necklaces, gels without guidance and home remedies should be avoided. Brushing with a tiny amount of fluoride toothpaste starts with the first tooth, and the first dental visit is recommended by the first birthday. In Mooca, Dr. Cléo Salustiano (CRO-SP 170844) sees patients every day, from 8 a.m. to 10 p.m.
The first baby teeth usually come in around 6 months of age, most often the two lower front teeth, but there is a lot of variation: some babies get their first tooth at 4 months, others only after their first birthday, and both can be normal. By about age 3, a child has all 20 baby teeth. While teeth are coming in, babies often drool more, want to bite everything and get fussier, and this discomfort can be eased with simple, safe measures.
In clinical practice, many parents' questions come down to two things: "is this because of the tooth?" and "when should I take my baby to the dentist?". The first needs care, because high fever, persistent diarrhea or a very listless baby should not be blamed on teething without the pediatrician's assessment. The second is simpler: the first dental visit is recommended when the first tooth appears or by the first birthday.
Dr. Cléo Salustiano (CRO-SP 170844), a dentist in Mooca, explains the order in which baby teeth usually appear, the most common signs, what helps and what to avoid, how to clean from the first tooth and what happens at the first visit.
This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the general dentistry page to learn how the treatment is done here and book your assessment.
When do baby teeth come in, and in what order?
The most common order is: lower central incisors, around 6 to 10 months; upper central incisors, between 8 and 12 months; lateral incisors, around the first birthday; first molars, between 1 and 1.5 years; canines, between 1.5 and 2 years; and second molars, between 2 and 3 years. These are approximate ranges. Small differences in order or timing are common and usually do not indicate a problem.
Signs that often come with a new tooth include more saliva, putting hands and objects in the mouth, swollen or reddish gums at the spot, fussiness and changes in sleep and appetite for a few days. Sometimes a small bluish bubble appears over the tooth that is about to come in, called an eruption cyst, which usually resolves when the tooth breaks through, but it is worth showing to the dentist.
What should not be blamed on teething without an assessment: high fever, persistent diarrhea, vomiting, refusing all fluids, inconsolable crying, rashes or a very listless baby. These signs may have other causes and call for the pediatrician. If the baby has trouble breathing, becomes very drowsy or shows signs of dehydration, go to the emergency room.
Baby teeth matter even though they are temporary: they help with chewing and speech development and hold space for the permanent teeth, which start coming in around age 6. Losing a baby tooth too early, due to decay or a fall, can affect the position of the permanent teeth. That is why caring for them from the start makes a difference.
| Teeth | Approximate age | Note |
|---|---|---|
| Lower central incisors | 6 to 10 months | Usually the first |
| Upper central incisors | 8 to 12 months | A few months' variation is common |
| Lateral incisors | 9 to 16 months | Upper and lower |
| First molars | 13 to 19 months | May cause more discomfort |
| Canines | 16 to 23 months | Come in between incisors and molars |
| Second molars | 23 to 33 months | Complete the 20 baby teeth |
How to ease discomfort and care for the first teeth
To ease discomfort, these usually help: clean teething rings made for babies, which can be chilled in the fridge (never frozen solid, as they become too hard); massaging the gums with a clean finger or damp gauze; and keeping the chin dry to avoid drool rash. Cuddles, routine and patience also go a long way during this phase.
What to avoid: amber or other teething necklaces, because of the risk of choking and strangulation; gels, ointments or numbing products on the gums without guidance from the pediatrician or dentist; home remedies such as alcohol, honey or sugar on the gums; and hard foods that could break off in the mouth. Pain relievers should only be used as directed by the pediatrician and the package leaflet, never on your own.
Cleaning from the first tooth: use a soft children's toothbrush and fluoride toothpaste in a tiny amount, the size of a grain of rice until about age 3 and a pea-sized amount after that, always with an adult brushing. Avoid letting the baby fall asleep with a bottle of milk, juice or other sugary drinks, and delay sugar as long as possible. The article tooth decay in baby teeth explains how it starts.
This content is for information only and does not replace an exam. Consult a dentist when the first tooth appears or by the first birthday, and also if there are no teeth by about 18 months, if white or dark spots appear, or after a knock to the mouth. In Mooca, Dr. Cléo Salustiano sees patients every day, from 8 a.m. to 10 p.m., including Sundays and holidays, and sees children for simple cases, such as guidance for parents, prevention, cleanings, fluoride and simple cavities, in general dentistry. When a case needs special care, the dentist assesses and, when needed, refers the child to a pediatric dentist.
At what age do baby teeth come in?
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The first tooth usually appears around 6 months, but variation is normal: some babies get their first tooth at 4 months and others only after 1 year. All 20 baby teeth are usually in by about age 3. If there are no teeth by about 18 months, an assessment is worthwhile.
What are the signs of teething?
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The most common are more drooling, wanting to bite things, swollen or reddish gums, fussiness and changes in sleep and appetite for a few days. High fever, persistent diarrhea, vomiting or a listless baby should not be blamed on teething without the pediatrician's assessment.
Does teething cause fever?
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Some babies may have a slight rise in temperature, but a high fever is not an expected sign of teething. In that case, the baby needs to be seen by the pediatrician, as the cause may be something else. If there is difficulty breathing, excessive drowsiness or signs of dehydration, go to the emergency room.
How can I soothe teething pain?
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Clean teething rings chilled in the fridge and gum massage with a clean finger or damp gauze usually help. Avoid amber necklaces, gels and ointments without guidance, and home remedies. Pain relievers should only be used as directed by the pediatrician and the package leaflet.
When should I start brushing my baby's teeth?
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As soon as the first tooth appears. Use a soft children's toothbrush and fluoride toothpaste in a rice-grain amount until about age 3, with an adult doing the brushing. Before teeth come in, the gums can be wiped with clean gauze or a cloth dampened with filtered water.
When should my baby first see a dentist?
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The recommendation is when the first tooth appears or by the first birthday. At this visit, the dentist examines the mouth, gives guidance on hygiene, diet, pacifiers and bottles, and assesses the risk of decay. When a case needs special care, the dentist refers to a pediatric dentist.
Does the Mooca office see babies and children?
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Yes, for simple cases such as guidance for parents, prevention, cleanings, fluoride and simple cavities. Cases that need special care are referred to a pediatric dentist. Dr. Cléo Salustiano (CRO-SP 170844) sees patients at Rua Hipódromo, 1141, Mooca, every day from 8 a.m. to 10 p.m. Book via WhatsApp (11) 97409-7834, in Portuguese, English or Spanish.
