What to expect and how to care for your baby's new teeth.

Parents think of teething as the few days of swelling, discomfort, and irritability before a baby's tooth erupts, but tooth development actually begins before birth. Primary or "baby" teeth from below the gum line around the sixth week of pregnancy, and they're covered by hard enamel during the third to the fourth month. Permanent or "adult" teeth also begin developing at this time. During pregnancy, you can get your child's teeth off to a healthy start by following your doctor's advice and eating a well-balanced diet, including calcium-rich foods such as yogurt and dark leafy greens. And once your baby sprouts these little teeth, you'll need to take good care of them. Here are some frequently asked questions about baby teeth.

When can I expect my child's first tooth to come in?
Teething can begin as early as 4 months of age, but most babies don't get their first tooth until 6 months. Teeth usually come in pairs. The bottom front two teeth typically show up first, followed by the top ones (both sets are called central incisors). Then the side front teeth (lateral incisors) fill in, followed by the molars and then the canines, which are the pointy teeth next to the front teeth. The back molars erupt last. Your baby should have a full set of primary teeth by age 3; permanent teeth won't begin to replace them until the child is 4 to 6 years old.

My baby was born with a tooth. Does it need to be pulled out?
It's rare, but some children already have a tooth when they're born, usually a bottom front tooth. It may be a real baby tooth or an extra tooth in the set that has grown over the baby tooth and permanent tooth underneath it. This extra tooth will fall out when the baby tooth erupts. But sometimes these teeth -- real or extra -- need to be removed, to avoid the risk of choking if they're loose, for example, so a tooth doesn't get in the way of breastfeeding.

My child is 8 months old and still doesn't have his first tooth. Is something wrong?
Don't worry. The first tooth can come in anytime between 4 and 12 months. If a tooth hasn't come in by 1 year, there's probably still no reason to worry if your child is growing fine otherwise -- he may just be a late bloomer. In rare instances, lack of teeth is a sign of metabolic disorder, but if that were the case, a child would have other growth problems as well.

My 4-month-old is drooling and chewing on his hand. Does this mean he's teething?
It's possible, but drooling and chewing aren't always signs of teething. Your baby is on the young side for teething, and at 4 months, it's natural for a baby to put objects into his mouth to explore them. Also at this age he's beginning to produce more saliva than he can swallow, which causes drooling. But if you notice that your child is also cranky and fussy, and he tends to chew or gnaw on the breast or bottle more than suck, that sounds like teething. Besides increased drooling, chewing, and crankiness, another common teething symptom is loss of appetite. Gum swelling and the resulting sensitivity to hot and cold foods will make eating uncomfortable for your baby, and can also interfere with sleeping.

In addition, when teeth are coming through, the gums will look swollen and bumpy, and they may be lighter or darker in color. Sometimes a bluish-red blister (called a hematoma) appears on the gum line where the tooth is coming in, and it may bleed a little when the tooth breaks the surface. Call your doctor if the blister lasts for more than a week without the tooth poking through.

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