Saturday, May 7, 2011


Yes, teething is fun! You can find Jett crawling around with an ice cube-filled sock in his mouth. Here is my collection of research for your enjoyment, which includes other ideas for teething relief.

When will your baby's first teeth appear?
As seen in the chart below, a typical child's first teeth begin to break through the gums at about 6 months old. Usually, the first two teeth to erupt are the two bottom central incisors (the two bottom front teeth). Next, the top four front teeth emerge. After that, other teeth slowly begin to fill in, usually in pairs -- one each side of the upper or lower jaw -- until all 20 teeth (10 in the upper jaw and 10 in the lower jaw) have come in by the time the child is 2 ½ to 3 years old. The complete set of primary teeth is in the mouth from the age of 2 ½ to 3 years of age to 6 to 7 years of age.

If you feel your child's teeth aren't appearing as soon as a typical child's, you may want to check his thyroid because, in hypothyroid children (the majority of the DS population is hypothyriod) the eruption of primary and permanent teeth is delayed and the teeth may have hypoplastic enamel -- "dental fluorosis"-- while hyperthyroid children, on the other hand, will have accelerated tooth eruption. (More information on this below.)

Reports do show that children with T21 have delayed eruption of the primary teeth (which could be from the thyroid or from poor ability to metabolize nutrients). Their teeth may also appear in an unusual order. (Mussig et al, 1990; Fisher-Brandeis, 1989). The delay in eruption may be as long as two to three years. Ondarza et al. (1997) showed that boys with T21 had significant delay in eruption of six teeth, specifically the upper right central incisor, upper right and left lateral incisors, lower right central incisor and lower right and left canines. Girls with T21 showed significant delay in eruption of 11 teeth. However, this study showed no difference in the pattern of tooth eruption. From other mom's blogs, it seems that a lot of babies with DS get their first teeth at around 12 months.

For Jett, he had an MRI at 12 months old that showed he had all of his teeth. (No, that's not why we got the MRI!) But, his first two bottom teeth didn't erupt until 12 months. At 13 months, the top front teeth came in slowly. At 14 months, ALL the teeth on the top left side of his mouth came in. At 17 months, he has 6 upper teeth, 3 front bottom teeth and one molar on each side on the bottom -- for a total of 11 teeth. At 18 months, he has an additional tooth in the front bottom and two more molars on top -- for a total of 14 teeth. He is being treated for hypothyroidism and has been since maybe 4 months old? (But I now know that he wasn't fully or properly treated for his hypothyroidism.)

Typical Teeth Eruption Timetable

Primary teeth eruption chart

The following chart shows when primary teeth (also called baby teeth or deciduous teeth) erupt and shed. It’s important to note that eruption times can vary from child to child.

Upper Primary Teeth Development Chart
Upper Teeth When tooth emerges When tooth falls out
Central incisor 8 to 12 months 6 to 7 years
Lateral incisor 9 to 13 months 7 to 8 years
Canine (cuspid) 16 to 22 months 10 to 12 years
First molar 13 to 19 months 9 to 11 years
Second molar 25 to 33 months 10 to 12 years

Lower Primary Teeth Development Chart
Lower Teeth When tooth emerges When tooth falls out
Second molar 23 to 31 months 10 to 12 years
First molar 14 to 18 months 9 to 11 years
Canine (cuspid) 17 to 23 months 9 to 12 years
Lateral incisor 10 to 16 months 7 to 8 years
Central incisor 6 to 10 months 6 to 7 years

Other primary tooth eruption facts

A general rule of thumb is that for every 6 months of life, approximately 4 teeth will erupt.
Girls generally precede boys in tooth eruption
Lower teeth usually erupt before upper teeth
Teeth in both jaws usually erupt in pairs -- one on the right and one on the left
Primary teeth are smaller in size and whiter in color than the permanent teeth that will follow
By the time a child is 2 to 3 years of age, all primary teeth should have erupted

Shortly after age 4, the jaw and facial bones of the child begin to grow, creating spaces between the primary teeth. This is a perfectly natural growth process that provides the necessary space for the larger permanent teeth to emerge. Between the ages of 6 and 12, a mixture of both primary teeth and permanent teeth reside in the mouth.

If baby teeth fall out after a couple of years, why is it important to care for them?

While it’s true that primary teeth are only in the mouth a short period of time, they play a vital role in the following ways:

  • They reserve space for their permanent counterparts
  • They give the face its normal appearance
  • They aid in the development of clear speech
  • They help attain good nutrition (missing or decayed teeth make it difficult to chew causing children to reject foods)
  • They help give a healthy start to the permanent teeth (decay and infection in baby teeth can cause dark spots on the permanent teeth developing beneath it)

Permanent teeth eruption chart

The following chart shows when permanent teeth emerge.
Upper Permanent Teeth Development Chart

Upper Teeth
Central incisor
When tooth emerges
7 to 8 years
Lateral incisor 8 to 9 years
Canine (cuspid) 11 to 12 years
First premolar (first bicuspid) 10 to 11 years
Second premolar (second bicuspid) 10 to 12 years
First molar 6 to 7 years
Second molar 12 to 13 years
Third molar (wisdom teeth) 17 to 21 years

Lower Permanent Teeth Development Chart
Lower Teeth When tooth emerges
Third molar (wisdom tooth) 17 to 21 years
Second molar 11 to 13 years
First molar 6 to 7 years
Second premolar (second bicuspid) 11 to 12 years
First premolar (first bicuspid) 10 to 12 years
Canine (cuspid) 9 to 10 years
Lateral incisor 7 to 8 years
Central incisor 6 to 7 years

As seen in this chart, permanent teeth begin to come in around the age of 6.

In some children, the first permanent molars are the first to emerge; in others, the incisors are the first to emerge. By the age of 13, most of the 28 permanent teeth will be in place. One to four wisdom teeth, or third molars, emerge between the ages of 17 and 21, bringing the total number of permanent teeth up to 32.

Here is a chart that shows the typical progression of teeth:

Here's a teething chart so you can chart when those precious teeth come in:

How To Support Healthy Teeth & Eruption

I had been giving Jett cod liver oil all along, but it wasn't until later that realized that I should be using the fermented cod liver oil with butter oil. At 11 months, I also started taking shark liver oil and extra calcium in hopes that he would get it in the breast milk. It was then that I also added bone broth to his nutrient-dense diet. These items all help with remineralization. White oak bark also helps fortify teeth and bones. I simply swab this onto his teeth before bed. Since he started teeth eruption late and has exploded in teeth since taking these supplements, I have to think there is a correlation. You may want to look into adding magnesium as well since it works synergistically with calcium.

Avoid fluoride as a supplement and in your food and drinking water. See fluoride post below.

Maintaining good oral hygiene is very important. Even if your baby has no teeth yet, you should keep his gums clean by wiping them with a clean cloth at least once daily. When his teeth erupt, you should begin brushing his teeth with non fluoridated tooth paste or something like a Nuk finger cover that acts as a soft toothbrush. Gentle tooth brushing has the added benefit of oral stimulation both tactile and sensory.

If your child has teeth that don't look quite "right" an may need to be further remineralized, avoid using tooth pastes with glycerin in it as well. Glycerin is good to help protect healthy teeth, but it adds a coating on unhealthy teeth that would prevent it from being properly remineralized. A good toothpaste, the one we use is from Heritage Essential Oils called Tooth Suds: Enhance. Yes, it's expensive, but it lasts a long time.

Top Ten Ways to Ease Teething Pain

10. Plush Chew Toys Organic toys by Under the Nile, for instance, are safe for teething. Jett chews on a soft little bunny ring.

9. Supplements for Mom If you’re nursing, try chamomile tea or Rescue Remedy yourself and beef up on Vitamin C which is supposed to help.

8. Cold Fruit or Vegetables Mesh feeders with frozen bananas (careful can be messy!), mangoes (can cause constipation), or other frozen fruit can help soothe painful gums.

An alternative to the mesh feeder (one that avoids the issue of plastic or petroleum-based synthetics altogether) is a knotted handkerchief, sock, a muslin or cheesecloth sack. Many health food stores sell reusable tea bags in undyed cotton or eco-friendly hemp that are ideal for the purpose and food safe. Be sure that the tie strings are cut shorter than 9″ as longer strings can represent a strangulation hazard for babies.

Large refrigerated or frozen pieces of carrot, celery, or beet stalks (can be messy) cut too large to place entirely in the mouth work great. Jett liked to chew on beet stalks or celery stalks which has anesthesia like qualities.

Once your baby has broken teeth both at the top and bottom, however, use caution giving him food unsupervised. According to Wikipedia:

Infants chew on objects to aid in the teething process. This can be dangerous if your baby is allowed to chew on objects which are small enough to be swallowed or which could break while being chewed and cause choking.

7. Wooden Teething Toys and Rings Wooden teething toys are a generations-old solution to teething pain. You can find natural wood teethers from Camden Rose, Haba, Selecta , and organic toys by Keptin Jr.

A wooden cooking spoon works great too. Nearly every kitchen has them, and they’re food safe! Keep an eye out for wooden spoons, measuring cups, and measuring spoons while garage sale shopping, too. They’re all inexpensive favorites.

6. Single Dose Chamomilla Homeopathic Remedy Chamomilla is a single dose homeopathic remedy. Simply crush the very small tablet with a spoon, add a bit of water, and give to you child. I just stick it in the bottom of a baby sock, put an ice cube on top, tie a knot in the sock and give it to Jett to chew on.

5. Oils for Painful Gums I put Lavendar oil on Jett's baby brother's gums and the bottems of his feet. I put melaleuca oil on his gums.

Clove oil is a favorite too that I haven't tried.

You can make your own clove oil home remedy. Cynthia Mosher from the Mothering forums explained:

Clove oil is a possibility too and it works very well but you must be very careful with it as it can cause blistering of the gum if used in excess. It should be diluted in a carrier oil - 1 drop of clove oil in 1-2 tablespoons of almond oil or another edible oil - and gently massaged into the gum.

Castor oil was mentioned as an anti-inflammatory and a good carrier oil for home remedies. Use caution when using clove oil and clove-based treatments like Gumomile since it is quite strong.

Always test on yourself first and remember that you’re treating a baby who may not be as sensitive to pain as most babies. If it seems strong to you, it will be very strong for your little one.

4. Amber Teething Necklaces
Amber teething necklaces are a beautiful way to comfort your teething baby. I haven't tried this, but moms swear by it. There's a mom w/a child with DS who makes them on Etsy. Her store is called Small Lucky Package.

3. Ice Cube and Slushy Remedies
You can chose either plain water, breast milk, or diluted chamomile tea, frozen in cubes and dropped in a knotted baby sock, handkerchief, washcloth, cheesecloth or a feeder. For younger children, you can crush the ice cubes first. As mentioned above, re-usable tea bags in undyed cotton or eco-friendly hemp are also an option. As you experiment, try wetting the cloth, or wetting just the center, before you set the ice cube inside.

You can also give:

Ice cubes prepared as a slushy.
Ice cubes scraped with a spoon and fed to baby.
Favorite drink frozen in a popsicle mold.

Once your baby is comfortable with solids, another idea is actually placing cubed baby food in the feeder or cloth, if you prepare your food with the ice cube method.

2. Cold, Frozen Washcloths
The most frugal of possibilities is the simple washcloth teething remedy. Simply wet, wring out, and place in the freezer. Experiment with duration to see how cold your baby likes it. Similar to the ice cube remedy, above, you can also dip the washcloth in chamomile tea before freezing.

Try out different degrees of coldness for your baby. If she doesn’t seem to enjoy the sensation, you can also try a damp or dry washcloth with knots tied in it; some babies enjoy the hardness of the knots. Finally, experiment with different textures and thicknesses.

1. Hyland’s Teething Gel/Tablets or Boiron Camilia Both the Hyland’s and the Boiron brands are multi-dose homeopathic remedies. The concept here is that though not all babies have the same symptoms, most babies will respond to one of the ingredients included in the multi-dose treatments. You could achieve the same effect by testing various single-dose remedies on your child until you find the one that works best. No baby needs all of the ingredients at once; they’re just included for convenience to cover the most likely candidates for a large number of babies’ symptoms.

Bear in mind that Boiron Camilia is a liquid and a vegan solution, but Hylands is not, due to its inclusion of lactose in the tablet formulation. Also, be aware that parabens are listed among the ingredients of the Hyland’s teething gel, but not the teething tabs. Parabens have been potentially linked (although inconclusively) to cancer, so if you’re the cautious type you might prefer the Hyland’s tablets.

Thyroid Controls Tooth Eruption

In 1911 it was first proposed that hormonal factors were involved in the regulation of tooth eruption (Keith, 1911). A few years later Erdheim (1914) reported on dental effects of thyroidectomy in rats, and Biedl (1914) did the same from a study in dogs. Hoskins (1928) and Karnofsky (1939) reported that hyperthyroidism produced accelerated tooth eruption and the rate of incisor tooth eruption was markedly accelerated by the injection of thyroxine, while Ziskin et al. (1940) revealed retardation in eruption time, as well as dentin and root development, in the opposite state - hypothyroidism.
Detailed investigations by Baume, Becks & Evans (1954) confirmed that thyroid hormones controlled tooth eruption.
It is now well established that in hypothyroid children the eruption of primary and permanent teeth is delayed, and the teeth may have hypoplastic enamel - "dental fluorosis", while hyperthyroid children, on the other hand, will have accelerated tooth eruption.

Dental Concerns with Children with T21

DS can cause other dental concerns. Often, these children have smaller upper jaws. The tongue, which may appear to be larger than average, may protrude if the children are forced to mouth-breathe. (See post below to prevent this.) These conditions may lead to problems with the way upper and lower teeth fit together. The teeth are generally smaller and may have more irregularities than the general population. Peretz et al. (1998) studied permanent molars from children with and without DS. The children with DS had molars that were significantly smaller and altered in shape when compared to the other children. It appears the change in size occurs early in tooth development while the change in shape happens at a later stage.

The eruption of teeth in persons with DS is usually delayed and may occur in an unusual order. (Mussig et al, 1990; Fisher-Brandeis, 1989). The delay in eruption may be as long as two to three years. Although independence in feeding and the introduction of food is encouraged in the toddler with DS, the diet may need to be altered because there are not enough teeth to chew some foods. There is an extremely high rate of missing teeth in both the primary and permanent dentitions. Other irregularities such as microdontia and malformed teeth may be seen. However, in an oral cavity with undersized bone structure, microdontia and missing teeth may be more of a blessing than a problem. Severe crowding can occur in persons with DS who have developed all of their permanent dentition (Ondarza et al, 1995). In these cases, selective extractions under the supervision of an orthodontist may be of benefit.

The incidence of tooth decay appears to be less frequent, but severe periodontal disease can occur in children with DS. The roots of the teeth in patients with Down syndrome tend to be small and conical. This is an important factor when considering orthodontic tooth movement and also contributes to early tooth loss in periodontal disease. Or this may be due to abnormalities in the immune response to the bacteria in the oral cavity. A substance present in many tissues called prostaglandin E-2 (PGE-2) plays a role in inflammation and pain. The level of PGE-2 detected in gum tissue may be increased in children with DS. Specific bacteria may also be implicated.


Peretz et al., "Modified cuspal relationships of mandibular molar teeth in children with Down's syndrome" Journal of Anatomy (1998) 193(4):529-533.

Ondarza et al., "Sequence of eruption of deciduous dentition in a Chilean sample with Down's syndrome" Archives of Oral Biology (1997) 42(5):p401-406.

Morinushi et al., "The relationship between gingivitis and the serum antibodies to the microbiota associated with periodontal disease in children with Down's syndrome" Journal of Periodontology (1997) 68(7):626-631.



Annie said...

WOW, you have done your homework, girl. Great job. Thank you for all the information, it was just what I was looking for.

Unknown said...

My problem is my 8 month old having teething pain. He has one tooth coming in on top, which can be easily seen and felt but has not broken thru the gums. He is as yet unable to hold a toy, teether, or sock. I cannot hold it for him constantly, and I am becoming very frustrated with his obvious pain and discomfort. I can find no advice anywhere on how to deal with this. Everything says he shouldn't be getting teeth at all yet, let alone on top. I'm not stupid. It's a tooth... But still here I am about to lose it with no help from any source. He can't hold things yet, so unless I hold it he has no relief.

Andi Durkin said...

I would give the homeopathic remedy that I listed above. You don't have to hold anything that way.

Unknown said...

Amber bead necklaces