THE BLOG
10/13/2015 01:59 pm ET Updated Dec 06, 2017

Everything You Need to Know About Baby Teeth

Some of the most common questions I get as a dentist have to do with deciduous teeth: When do they come in? When should parents brush them? What about flossing?

I thought it might be helpful if I answered some of these questions. So here you go: everything you need to know about baby teeth.

When do baby teeth start to come in?

Baby teeth can start coming in as early as five months. By one year, a child typically has six baby teeth: usually the top four front teeth, and the bottom two front teeth. By three years old, children should have all 20 of their baby teeth.

Some children are actually born with teeth. We call them natal teeth, or milking teeth. In fact, in my residency I was called to the hospital to evaluate a 12-hour old child with multiple teeth. Because there was a risk of aspiration, we had to pull them. I really hope the Tooth Fairy made an early stop to that baby!

When should I take my baby to the dentist for the first time?

Both the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentists (AAPD) recommend that children establish a dental home by the time they are 12 months old. This first appointment is usually focused on educating the parents on how to take care of their young children's teeth. If the young patient is cooperative, the dentist or hygienist may even try to do a cleaning. And of course, patients -- even the tiny ones -- usually get a prize for being good!

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(Alex Motrenko/flickr)

My baby just started teething. PLEASE SEND HELP!

There's a simple fix here: give the kid some whiskey!

Just kidding. There are a few things you can do to help your teething baby. (Save the whiskey for yourself!) Dr. Ed Moody, President of the AAPD, suggests gently rubbing the baby's gums with a fresh, cool, wet washcloth. Teething rings can also help soothe your baby's gums. Just make sure they aren't filled with liquid in case they burst in the baby's mouth. And be sure to avoid over the counter topical anesthetics with benzocaine, since serious reactions have been noted in a small number of children.

When should I start brushing my child's teeth?

As soon as teeth come in, they are ready to be brushed. You should use a smear of toothpaste, and brush with a soft, child-size toothbrush. Both the AAPD and AAP recommend you use fluoridated toothpaste.

Do I floss my baby's teeth?

I love when patients ask me this one! It's never too early to start good oral hygiene habits!

If baby teeth touch each other, they should be flossed. If, however, there's a big enough space in between the teeth for bristles to fit into, brushing is fine.

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(makelessnoise/flickr)

When should my child start brushing his own teeth?

A child should be able to brush their own teeth when they are 6-8 years old. While it's great to encourage independence in kids, they're often not coordinated enough to thoroughly brush by themselves before this age. What I usually suggest is to have the child start the process, and then let mom or dad finish up. And even when they are old enough, it is still a good idea to supervise.

Is it bad for my child's teeth if he sucks his thumb or a pacifier?

Either of those activities can cause changes to the position of the front teeth and shape of the roof of the mouth. In addition to cosmetic issues, this could lead to bite problems and maybe even speech issues. Luckily, these habits really do not have a major effect until the permanent teeth come in. Children tend to stop these habits on their own by age two. If they have not stopped by four years old, talk to your dentist or pediatrician about how you can encourage your child to break the habit.

If your child is using a pacifier, there are a couple of things to remember. Please don't ever dip the pacifier in sugar, honey, or anything sweet to help soothe the child! That's a surefire way to cause cavities early on. Also -- and I see a lot of people do this -- if the pacifier falls on the ground, DO NOT clean it with your own mouth. You may have gotten a few specs of dirt off of it, but now the pacifier is riddled with your own bacteria. Trust me: that dirt isn't really going to hurt your kids. How do you think they develop an immune system, anyway? You don't lick your child's fingers before she put them in their mouth, so don't. lick. the pacifier.

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(clappstar/flickr)

What's the point of baby teeth anyway?

Many people see baby teeth as just practice teeth for children. If one of these teeth get a cavity -- who cares? Just let the dentist pull it since it's going to fall out anyway.

You should know, however, that baby teeth serve many important functions for children, beyond their obvious use for chewing food. If a child loses a baby tooth too early, then some other tooth already in her mouth might shift into its place. If that happens, it will prevent the adult tooth from coming in correctly.

Baby teeth also play a role in speech development, which is partly informed by the way our tongue and lips interact with our teeth. Say the word "teeth" out loud. Go ahead -- I'll wait for you. Did you feel what was happening inside your mouth? Your tongue slapped against your top front teeth to make the "th" sound. Now say a word with an "f" or "s" sound -- you get the point. When children are first learning to speak, it's important that they are able to pronounce words clearly and correctly. Without the proper teeth present, it certainly becomes difficult to say, "Sister Suzy sitting on a thistle".

When should baby teeth naturally fall out?

Pending any traumatic accidents, baby teeth start falling out around age six. By the child's ninth birthday, she should have about 12 permanent teeth. The Tooth Fairy's last visit is usually around age 12.

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(Philippe Put/flickr)

Since you brought it up, what kind of money does the Tooth Fairy pay these days?

The Tooth Fairy left a whopping $255 million underneath kids' pillows in 2014, according to The Original Tooth Fairy Poll. The survey, sponsored by Delta Dental, found that the 2014 going rate per tooth was $4.36, up from $3.50 in 2013. (Some have suggested that Tooth Fairy polls aren't reliable -- but they might be over-thinking this.)

Remember, the Tooth Fairy can be creative with her gifts -- she's magic after all! Stuffed animals and books are great for kids to find underneath their pillows. The Tooth Fairy might also think about leaving coins from different countries, or a U.S. silver dollar. My preferred Tooth Fairy currency has always been the $2 bill!

My child hasn't lost all her baby teeth -- and she's in high school!

That's OK. Not all of us will lose every baby tooth. Sometimes, we don't grow a replacement adult tooth, which means the baby tooth has to stick around. (FYI: The most common baby teeth to stay are the upper laterals and lower second premolars.) A panoramic x-ray will show whether or not your child is going to be missing any adult teeth.