Teething babies, get more sleep now!

Teething babies, get more sleep now!


One day, my usually happy son changed.  He became more aggressive, biting everything in sight and crying throughout the night.  I thought to myself, this is it, my baby is teething, now what?  How can I help?



How do you know if your baby is teething?


  • A more irritable baby
  • Changes in usual sleep pattern
  • Increased crying
  • Increase fussiness
  • Biting fingers and objects
  • Increased drooling
  • Swelling/bleeding of the gums
  • Finger sucking
  • Gnawing
  • Loss of appetite


When do babies usually start teething?


  • Usually between 3 months to 1 yr old


What tooth comes first in a baby?


  • Usually the 2 bottom teeth- the central incisors


How long do symptoms of teething last?


  • About 8 days
  • First 4 days before the teeth erupt, the day that teeth erupts, and then about 3 days after


How to soothe a teething baby’s sore gum/ help a teething baby sleep?


  • Teething Rings- solid plastic teething rings, not liquid filled
  • Cuddle Therapy
  • Rubbing the gums


What is Cuddle Therapy for teething?


  • Giving a baby extra attention and hugging them when they seem more distressed from teething.
  • Cuddle therapy can also include reading, singing, or playing


How do you rub a baby’s gums to help with sore gums?


  • Using clean fingertips or soft toothbrush, massage the baby’s gums for 1-2 minutes


Are teething necklaces and amber teething necklaces safe for babies?


  • No it is not safe.
  • Multiple studies have shown that infants wearing teething necklaces is a “quack” or fake remedy, and actually contributes to strangulation or choking of infants on the beads.
  • In a study by Machet et al (2016), ALL the infant’s teething necklaces were colonized by bacteria, mostly coagulase-negative staphylococci
  • A recent study by Soudek and McLaughlin (2018) revealed that most infant necklaces did not meet the American Society for Testing and Materials (ASTM) Standard Specification for Consumer Product Safety for Mechanical Requirements of Children's Jewelry- almost half failed to open with 15 pounds of force



Why does teething hurt more at night?


  • Teething hurts day and night but babies are more distracted by activities during the day


Why do babies get fevers when teething?


  • Studies have shown was no association between teething and symptoms such as fever or diarrhea.


Early signs of tooth decay in toddlers?


  • Maxillary incisors (front teeth) start to have dull white or brown spots along the gingival margin (area between tooth and gums)
  • Decay can advance to a complete destruction of the crown, leading to root stumps


What are causes of early childhood caries?


  • Bottle feeding and sleeping with a bottle
  • Increased consumption of Non-milk extrinsic sugars (NMES) like juices- limit intake to less than/equal 10% of the total calories daily and no more than 4 times a day
  • Increased saliva sharing activities- caregiver’s sharing utensils, food, and drinks
  • Letting baby breastfeed as much as they want after first primary tooth erupts
  • Allowing infant to bottle feed past 14 months of age
  • Repeatedly drinking any liquid like soft drinks or juices from a bottle/ training cup
  • Snacks rich in “fermentable carbohydrates” such as bread, crackers, bananas, and most breakfast cereals


What are the stages of early childhood caries stages?


  1. Classification based on severity and cause


  • Type I- Mild to moderate
    • “isolated carious lesion” involving incisors and/or molars
    • Cause: combination of Semisolid or solid food and poor oral hygiene
  • Type II- Moderate to severe
    • “Labiolingual lesions” of maxillary incisors (top front teeth) with or without molar caries
    • Cause: Inappropriate use of feeding bottle or at will breast feeding or a combination of both, with or without poor oral hygiene
  • Type III- Severe
    • Carious lesions affecting almost all teeth including front teeth
    • Cause: Combination of foods that cause tooth decay and poor oral hygiene


  1. Classification based on pattern of ECC presentation


  • Type 1- lesions associated with developmental defects
    • Pit and fissure defects
    • Incomplete development of teeth (hypoplasia)
  • Type 2- Smooth surface lesions
    • Labial-lingual lesions / rough chalky areas on tooth
  • Type 3- Rampant Caries
    • Caries in 14 of 20 primary teeth, with 1 mandibular incisor (bottom front tooth)


What is the best early childhood caries treatment?


  • Use of fluorides
    • Fluoride toothpaste
    • Water fluoridation- in tap water
    • Fluoride mouth rinse- supervised
    • Topical fluoride application


When should you start cleaning baby’s teeth?


  • After the first eruption of teeth, you can use a soft toothbrush to wipe your baby’s tooth at least twice daily


When should you start brushing your baby’s gums?


  • When your baby is eating some solid food, it is a good practice to wipe their gums at least daily or after meals, with a clean gauze dipped in distilled water


How do you brush a baby’s teeth?


  • Brushing “gums”
    • Wash your hands with soap and water
    • Prepare a woven gauze – do not cut to avoid loose fibers
    • Prepare Distilled water
    • Moisten the gauze in the distilled water
    • Wrap the moist gauze
  • Manually brush
    • Wash your hands
    • Place appropriate amount of toothpaste for age
    • Place your toothbrush at a 45-degree angle to the gums. 
    • Move the brush in back and forth strokes along each tooth
    • Brush all surfaces of each tooth- inner, outer, and chewing
    • ALTERNATIVE- use a circular rolling stroke along each tooth
    • Total time should be about 2 minutes, twice a day
  • Replace the brush as soon as the bristles are worn
  • Chewable brush
    • Wash your hands
    • Place appropriate amount of toothpaste for age
    • Have child chew on toothbrush
    • Total time should be about 2 minutes, twice a day


Do babies need to brush teeth?


  • Yes, at least daily when starting on solid food


When should toddlers start brushing teeth?


  • As soon as teeth appear, toddlers should brush their teeth twice a day


How to brush baby’s teeth when they refuse?


  • Distraction to make brushing fun
    • Sing songs about brushing
    • Make up rhymes while brushing
    • Read books about brushing to make them excited to brush
    • Watch a favorite cartoon brush their teeth
    • Give them a their own brush to follow the motions of brushing then finish brushing properly


Recommended amount of baby toothpaste


  • Buy toothpaste with fluoride only if teeth have erupted, it only has a topical effect
  • Infants greater than 6 months to 3 years old should have a “rice-sized” amount of toothpaste; recommended 0.25mg/day if fluoride concentration less than 0.3ppm (parts per million)
  • Children from 3-6 years old should use only a ‘pea-sized’ amount of toothpaste- a ‘pea-sized’ portion weighs approximately 0.75 g and contains about 0.4 mg of fluoride
  • Children greater than 6 years old can use a “full cover” of toothpaste on the brush and should receive about 1mg/day if fluoride concentration is 0.3ppm (parts per million)
  • Remember to have children spit out toothpaste but not to rinse with water “spit don’t rinse”- this has been shown to wash away the protective fluoride


Can babies use fluoride toothpaste?


  • Use toothpaste with low dose of fluoride (less than 0.05% or 500ppm/parts per million)
  • Use toothpaste with over 0.1% or 1000 ppm (parts per million) fluoride after permanent teeth- usually 6 years old


What is the best type of baby toothbrush?


  • Various toothbrush types are on the market from finger to chewable toothbrushes but a recent study by Govindaraju and Garunathan (2017) revealed “a marked reduction in  mutanslevels and a significant difference in the pH were noticed after using chewable brush”
  • A chewable toothbrush is effective in babies, young children, handicapped individuals and even elderly adults due to decreased dexterity






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