By Dr. Catherine Gant

First teeth erupt at about six to eight months. Usually the central mandibular incisors appear first (the teeth in the middle of the lower gum).

A graphic showing the usual ages at which teeth appear can be found at this American paediatric site.

The first teeth are called the milk teeth or deciduous teeth and the second teeth are called the permanent teeth.

Teething may produce a small amount of local discomfort, dribbling, red cheeks and slightly looser stools, but it does not cause fever, diarrhoea, vomiting or rashes. If your baby becomes unwell then do not blame the teething but seek medical advice if necessary.

The teething baby may have small lumps on his gums and even a tiny spot of blood, this should not affect feeding. Some mothers give their babies something to chew on, make sure that it’s too big to swallow or choke on. Babies don’t usually need pain-killers and should not be given anything containing aspirin (salicylic acid).

Delayed teething can be caused by a number of things, it may run in the family or be associated with endocrine disorders e.g. hypothyroidism or genetic disorders.

Discoloured teeth can be caused by trauma, excess fluoride, illness and some drugs e.g. tetracycline.

EMERGENCY TIP

If your child knocks a whole tooth out (including the root) rinse it in cow's milk and try to push it back into the hole in the gum. Do not soak it in tap water as this kills the ligament. A tooth can re-attach if re-implanted within two hours, so get to a dentist or casualty department as quickly as possible. Be very careful that the tooth is not inhaled during the journey if it is back in the gum, drive carefully, secure the child well and hold the tooth in place with a cloth. If you cannot re-implant it yourself transport it in milk or in the child’s mouth between the inside of the cheek and the teeth. Obviously this is not worth worrying about if the tooth is a milk tooth.

FLUORIDATION

A huge debate rages at present about the merits of putting fluoride in the water - possible health risks and fluoridosis (mottled teeth) versus decreased dental decay. If you use a toothpaste containing fluoride, encourage your child not to swallow it and only use a pea-sized amount on the toothbrush; this has been proven to decrease tooth decay.

The British Dental Association Fact Files describe how to use fluoride toothpaste in children and discusses its safety (see the subsections, 'More about dental care for children' and 'BDA advice'). Information on fluoridation of the water supply can be found at the British Dental Association Fluoride fact page (search for fluoridation to see a full government report on the pros and cons of fluoridation). There is also information at the British Fluoridation Society website. Facts on tooth care and decay prevention can be found at MedicineNet.com - Health Facts - Cavities in Kids - The Truth.

A map of UK fluoride levels provided by the Department for Environment, Food and Rural Affairs is available – showing fluoride levels by region - and information on how local authorities add fluoride can be seen at UK Drinking Water Inspectorate Information.

Anti-fluoridation pages are all over the net. Read Guide to reading web pages on fluoride (you will need to register and go to Volume 189, Issue 10 in the British Dental Journal archive) before reading Fluoride warnings and Fluoride Action Network Homepage: An Updated Source of Fluoridation News, Reports, Facts, and History.