Developmental milestones: teething

Teething can be a long, drawn-out process for your baby (and you). In fact, the move from that gummy grin to a mouthful of gleaming teeth can take your baby his first three years to complete.

Read on to find out when your baby will start teething, how to help your teething baby, and how to care for his new teeth.

When will my baby get his first tooth?

It can vary hugely. A few babies are born with a tooth, some start teething at three months, and others don’t sprout their first tooth until their first birthday (NHS 2019a, SAH 2019). In most babies, the first ‘white cap’ appears at around six months, usually at the front on the bottom (ADA 2016a, NHS 2019a, OHF nd).

The last baby teeth to arrive, which are the second molars right at the back of the mouth, are usually in place by 33 months (ADA 2016a). So by your baby's third birthday, he should have a full set of 20 baby teeth (ADA 2016a, nda, NHS 2019a, OHF nd).

Tooth development is hereditary, so if you or your partner got your teeth early, chances are your baby will, too (Maheswari et al 2012).

Read more about when your baby will start teething.

Will teething be painful for my baby?

The arrival of your baby’s first tooth may not be much fun for either of you.

Your baby may be in pain and drool for a month or two before his tooth appears. You could be up at night trying to console him while he waits for a tooth to break through.

To ease his pain, your baby may start biting, but not out of anger or hostility. Give him something to bite on, or rub his gums gently with a clean finger to help soothe the ache (ADA 2016b, NICE 2014).

Your baby's gums can also become inflamed when he cuts a tooth, which may make his cheek appear red and swollen (NHS 2019a).

You may worry that your baby has a fever or diarrhoea when a tooth is about to come through, but teething shouldn't cause illness (ADA 2016b, NHS 2019a, NICE 2014).

If your baby seems ill, it's more likely he's coming down with a cold, an infection or a tummy bug. Take him to your doctor if you’re concerned (NICE 2014).

For some babies, though, teething can be a fairly painless mouth makeover (NHS 2019a). One week your baby is sporting a toothless grin, and the next a jagged white edge may appear on the gum surface, without causing much upset.

Celebrate your baby's first tooth by taking lots of pictures, and note its arrival date in his baby book, if you have one.

Your baby's teeth will sprout one after another. After the arrival of the two bottom front teeth, expect the top two middle teeth, then the teeth along the sides and back (ADA 2016a, NHS 2019a).

What is the spot on my baby’s gum?

You may have noticed a small bruise or blood blister on your baby’s gum. It can be a blue or red colour. This is called a teething blister or eruption cyst and may appear before your baby’s tooth cuts through the gum (DHSV 2010).

These blisters usually go away when the tooth appears and don’t need any treatment (DHSV 2010). Don’t be tempted to try and pop the blister. Let your dentist know if your baby has a blister for a few months and no tooth comes.

How can I help my baby through teething?

You can't do anything to encourage your baby's teeth to appear, but you can comfort him if he's in pain:

• Gently rub your baby’s gums with your clean finger (ADA 2016b).
• Give your baby something cool to chew on, such as a teething ring or clean, damp face cloth that you’ve chilled in the fridge (ADA 2016b). Stay near your baby when he’s chewing anything in case of choking (NHS 2019b).
• If your baby is older than four months, you can rub infant teething gel on his gums. Ask your pharmacist for one that’s free of sugar (NHS 2019b) and salicylates (MHRA 2014, Nguyen et al 2018, Williams et al 2011). Although some parents think teething gel helps to relieve their baby’s discomfort, there isn’t much good evidence that it works (NHS 2019b, NICE 2014). Make sure you follow the dosage instructions on the tube.
• If your baby is older than six months, he may get some relief from eating cold foods, such as apple puree, cucumber sticks or yoghurt, straight from the fridge (ADA 2016b). It’s best not to give your baby teething biscuits or rusks. Nearly all brands and homemade versions contain some added or fruit-based sugar, which can damage his teeth (NHS 2019b, NICE 2014).
• If your baby is really in distress, you can give him the correct dose of infant paracetamol (if he’s older than one month) or ibuprofen (if he’s older than three months). Always follow the correct dosage instructions on the packet. Ask your doctor or pharmacist if you're unsure how much to give your baby. Never give a child under 16 years old medicine containing aspirin, as it can trigger Reyes syndrome, a rare but potentially fatal condition (NHS 2019b).
• Teething can make your baby dribble a lot. Protect his chin from soreness by smoothing some petroleum jelly on to his skin (NCT 2018) and gently patting his chin dry often (NHS 2019b).
• Avoid amber teething necklaces and jewellery. There’s no evidence that they work, and they pose a strangulation and choking hazard to your baby (ACCC 2011, ADA 2016b, Queensland Government 2017, Red Nose 2019, Soudek and McLaughlin 2018, Taillefer et al 2012, TGA 2013).
• Some parents swear by homeopathic or herbal teething gels and powders, which you can buy from your pharmacy. But there isn't any medical evidence that they work (NHS 2019b, NICE 2014). Never buy unlicensed homeopathic tablets or gels online. They could be dangerous for your baby (MHRA 2016, NHS 2019b).

If your baby has a temperature, or if he’s inconsolable, see your doctor (ADA 2016b). Your baby may have an ear infection or other illness (NICE 2014).

Get more tips on easing your teething baby's distress.

How should I care for my baby's teeth?

Once your baby's teeth arrive, it's up to you to keep them clean. Even before his first tooth appears, try to gently wipe his gums with a clean, damp gauze or soft cloth twice a day (ADA 2019, nda, RCN 2018). This will help him get used to the idea of having his teeth cleaned (ADA nda, RCN 2018).

Once your baby has teeth, try not to put him to bed with a bottle. Formula milk can pool in your baby's mouth at night and lead to tooth decay.

Some research suggests that babies who’ve started eating solid foods may also get tooth decay from breastfeeding continuously and frequently at night once their teeth start coming through (AAPD 2018). You can avoid this by detaching your baby from your nipple when the feed is finished, or gently wiping or brushing his teeth and gums when he's finished feeding.

Try to make brushing your baby's teeth a fun part of his bedtime routine. Once his teeth start appearing, use a soft baby toothbrush twice a day (ADA 2019, nda).

As your baby grows, show him how to move the brush around on his teeth. You could also let him have a go at brushing your teeth, if it’s not too uncomfortable.

Start flossing your baby’s teeth as soon as he has two teeth that touch (ADA ndb). Your dentist can show you how to do this.

Find out more about how to care for your little one's new teeth.

What’s the best toothpaste to choose for my baby?

At first, you don’t need toothpaste for your baby’s teeth (ADA nda).

When he’s 18 months old, use a small smear of low-fluoride (500ppm), sugar-free children’s toothpaste (ADA 2019, nda). Fluoride helps prevent tooth decay (OHF nd). When he’s older and able to spit out toothpaste, you can start using a small pea-sized amount of toothpaste on his brush (ADA ndb, RCN 2018).

Keep using low-fluoride toothpaste until he’s six years old, unless your water isn’t fluoridated (ADA 2019, NSWH 2014).

In most areas of Australia fluoride is added to drinking water, but in some areas it isn't, or you may use tank water. Your local water supplier should be able to tell you how much fluoride is in your drinking water.

Fluoride supplements aren’t recommended any more (NSWH 2014). If your water doesn’t have fluoride added, your child should use a small amount of full-fluoride toothpaste (1,000ppm) from 12 months old (NSWH 2014).

Find out more about caring for your baby’s teeth.

My baby hasn't got a tooth yet. Should I be worried?

Some babies don't sprout their first tooth until they’re a year old or even later, so try not to worry if your baby is still giving you gummy smiles.

If you still don't see any sign of a tooth appearing by the time your baby is 12 months, mention it at his next check-up.

If your baby was born early (before 37 weeks of pregnancy), he may start teething a little later.

How long will my baby have his first teeth for?

Years! Your baby's milk teeth won't fall out until his permanent teeth are ready to come through. This will happen when he's about six or seven years old (ADA 2016a, NICE 2014, OHF nd).

More on teething and dental care

• Check out our slideshow of signs of teething.
• Read more about how to ease your baby’s distress while he’s teething.
• Find out how to care for your baby’s teeth.