Begin oral care early! Before teeth appear, clean baby's gums daily with a clean wash cloth. This helps develop a good mouth cleaning routine and gives the baby the feeling of a fresh, clean mouth. Cleaning the gums can help to reduce teething discomfort.

Breast-feeding helps develop the muscles and bones of baby's face. The muscles of the face and the shape of the jaws play an important role in the position of the primary (baby) teeth. This in turn will affect the positioning of the permanent teeth.

A child's first tooth will come in, (erupt) at about six to ten months. Most babies will have 12 teeth by 18 months. All 20 baby teeth should be present by 3 years of age. The baby molars are not usually lost until 10-12 years. The following chart shows the approximate age that each tooth comes in and falls out.

The lower front teeth are usually the first to come in. If your baby's gums look irritated, red and puffy, and if you can feel or even see the tip of a tooth coming through, then your baby is teething.

Teething may cause some discomfort making the baby irritable, fussy and not wanting to eat. Biting or chewing on a clean teething ring or a cold wet wash cloth can make baby feel better and help the teeth come through the gums. There is some evidence that cleaning the gums can reduce teething pain.

Fever, nausea, congestion and diarrhea are not normal for a teething baby. If your baby has any of these symptoms, call your doctor or public health office.

Teething cookies or biscuits are NOT a good choice because they can stick to baby's teeth and cause tooth decay.

Teething gels or ointments are NOT recommended because they may numb baby's throat and cause choking.

Drooling is normal for babies, because they do not have the muscle control to keep saliva (spit) in their mouth. Keep the baby's mouth clean and their face dry.

Early childhood tooth decay affects the teeth of babies and young children.

Your baby's teeth can begin to decay from the first day they come in. When a baby uses a bottle for long periods, especially during rest or sleep times, cavities can develop.

Early childhood tooth decay most often starts behind the top front teeth, which makes it hard to see. It then spreads to the front of the teeth and may appear as a chalky white line around the neck of the tooth. Decay can then spread to all the other teeth.

Fruit juice, sweetened tea, pop, breast milk, cow's milk and formula ALL contain sugars that can cause tooth decay. Water is a good choice at bed and nap times and between regular feeding times.

At birth, babies do not have the bacteria that cause tooth decay. These bacteria are passed from parents to babies through kissing and sharing utensils, like spoons. The more bacteria the parents have in their mouths, the more bacteria that will be passed onto the babies. This can increase the risk of early childhood tooth decay. Therefore, if the parent's mouth is clean and free of disease, both the parent and the baby will benefit.

Remember:

• Clean your baby's gums and teeth daily.
• If baby goes to bed with a bottle, fill it with water, not milk or juice.
• Avoid using the bottle or breast as a pacifier (soother). This causes milk to dribble slowly into the baby's mouth over a long time, causing repeated acid attacks to the teeth.
• While feeding, never prop the baby bottle or leave the baby alone. This may cause choking.
• Encourage the baby to use a cup for drinks when old enough, usually after 6 months of age.
• Keep your own mouth clean and healthy to prevent the spread of decay causing bacteria.

People enjoy the feeling of a fresh clean mouth after flossing and brushing. Imagine how a baby would feel not having his mouth cleaned for a couple of months. It is important to start a regular routine of mouth care even before the first tooth appears. Your baby will feel so much better if you clean the mouth by wiping the baby's gum and cheeks with a soft, moist, clean cloth.

As soon as the first tooth appears, the parent can begin using a small, soft-bristled toothbrush. Parents must continue to clean their child's teeth daily.

Breastfeeding is the best way to feed your baby. It promotes the development of the baby's muscles around the mouth. If bottle-feeding, the bottle nipple should be soft enough to flatten out against the roof of the baby's mouth. A hard, poorly shaped nipple can cause the baby's jaw to develop an abnormal shape leading to dental and speech problems in later years. The hole in the bottle nipple should not be enlarged, as this can cause the baby to swallow improperly and cause future speech problems.

Check with your lactation consultant, public health nurse, nutritionist or doctor if you have questions.

Sucking is a normal, natural habit for infants. A pacifier (soother) can satisfy this need and help to comfort or relax a baby. It is better for a baby to suck on a pacifier than on a finger, toy or blanket.

Breastfed infants should not use a pacifier until breastfeeding is established - usually 6 weeks. The sucking action used for the breast and the pacifier is different. Some infants have trouble switching between the breast and pacifier.

Remember:

• A pacifier should never be coated with sugar, honey or any sweet substance because this can cause the baby's teeth to decay. Honey may contain spores that can cause food poisoning in infants under one year of age.
• A pacifier should be soft enough to flatten out against the roof of the mouth.
• Buy a pacifier that is one piece, not one that is made of several parts.
• Never tie a string to the pacifier as it may strangle the baby.
• Check the pacifier often to make sure it is in good condition. Tears cracks or other signs of wear may make it unsafe for your baby to use.

Talk with a health professional if you have questions about phasing out the use of a pacifier.