The initial growth period for primary (baby) teeth begins in the second trimester of pregnancy (around 16-20 weeks).  During this time, it is especially important for expectant mothers to eat a healthy, nutritious diet, since nutrients are needed for bone and soft tissue development.

Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old.  Altogether, a set of twenty primary teeth will emerge by the age of three.

The American Academy of Pediatric Dentistry (AAPD) recommends a first “well-baby” dental visit around the age of twelve months (or six months after the first tooth emerges).  This visit acquaints the infant with the dental office, allows the pediatric dentist to monitor development, and provides a great opportunity for parents to ask questions.

Which teeth emerge first?

In general, teeth emerge in pairs, starting at the front of the infant’s mouth.  Between the ages of six and ten months, the two lower central incisors break through.  Remember that cavities may develop between two adjacent teeth, so flossing should begin at this point.

Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months.  Teething can be quite an uncomfortable process for the infant.  Clean teething rings and cold damp cloths can help ease the irritation and discomfort.

Between the ages of nine and sixteen months the upper lateral incisors emerge – one on either side of the central incisors.  Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches.  Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.”

Eight more teeth break through between the ages of thirteen and twenty three months.  On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor.  Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws.

Finally, a second set of molars emerges on each arch – usually beginning on the lower arch.  Most children have a complete set of twenty primary teeth before the age of thirty-three months.  The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.

How can I reduce the risk of early caries (cavities)?

Primary teeth preserve space for permanent teeth and guide their later alignment.  In addition, primary teeth help with speech production, prevent the tongue from posturing abnormally, and play an important role in the chewing of food.  For these reasons, it is critically important to learn how to care for the child’s emerging teeth.

Here are some helpful tips:

1. Brush twice each day – The AAPD recommends a pea-sized amount of ADA approved (non-fluoridated) toothpaste for children under two years old, and the same amount of an ADA approved (fluoridated) toothpaste for children over this age.  The toothbrush should be soft-bristled and appropriate for infants.
2. Start flossing – Flossing an infant’s teeth can be difficult but the process should begin when two adjacent teeth emerge.  The pediatric dentist will happily demonstrate good flossing techniques.
3. Provide a balanced diet – Sugars and starches feed oral bacteria, which produce harmful acids and attack tooth enamel.  Ensure that the child is eating a balanced diet and work to reduce sugary and starchy snacks.
4. Set a good example – Children who see parents brushing and flossing are often more likely to follow suit.  Explain the importance of good oral care to the child; age-appropriate books often help with this.
5. Visit the dentist – The pediatric dentist monitors oral development, provides professional cleanings, applies topical fluoride to the teeth, and coats molars with sealants.  Biannual trips to the dental office can help to prevent a wide range of painful conditions later.

If you have questions or concerns about the emergence of your child’s teeth, please contact your pediatric dentist.