8+ Tips for managing teething troubles

Few children escape teething without some discomfort. Rosy flushed cheeks, a runny nose, irritable behavior, disturbed sleep and bowel function are all hallmarks of tooth eruption.

As these symptoms are also associated with some childhood illnesses it is wise to consult your doctor if you are concerned.

Whilst some babies are born with teeth most appear during the period 6 months – 2 years. During this time their jaw is developing and it is important to provide them with things to chew on.

This need not be an excuse to introduce solid foods early (before 4-6 months) nor become an avenue for overfeeding or continuous grazing, as this may diminish appetite for regular meals and contribute to obesity.

1. Try to use non-nutritive teething aides in preference to foods. Most kitchen drawers will provide a variety of teething aides: plastic scrapers and garlic crushes, wooden spoons and teething rings all come in handy.
2. Watch sharp edges and pointed objects; knobs which might fall off and get stuck in your baby’s throat.
3. Never leave your baby alone with a hard or small object which they could choke on or poke in their eyes.
4. When solid foods are introduced don’t be afraid to include some soft lumpy foods.
5. Stewed apple is an excellent food which can be taken from the puree stage to the translucent stage relatively quickly and given in small soft pieces with some of the fruit juice (i.e the unsweetened water the fruit has been cooked in).
6. This consistency helps your baby to change the position of their tongue utilizing the roof of their mouth for breaking down food. It also encourages chewing.
7. Mashed vegetables and mince are far more interesting than puree, and by 9 months most infants will  be eating foods of this consistency.
8. If an infant is particularly feverish then encourage fluids (particularly water) and avoid sudden changes of temperature in foods. Ice cold drinks may help an adult to cool down but a baby may be less impressed.

Tooth care

Dental caries can quickly develop in susceptible teeth when the bacteria in the mouth utilize the sugars in foods and beverages to produce acids which demineralize teeth, breaking down tooth enamel. Over a relatively short space of time the damage can occur. Here are some quick tips to help prevent dental caries:

• Avoid putting a baby to bed with a bottle as the sugar in milk and fruit juice can be very corrosive if it is allowed to pool around a baby’s teeth.  Demand breast-feeding during the night may in some situations, also lead to dental caries. If your baby likes to be comforted by sucking a bottle, one filled with water maybe a better alternative.
• Toddlers waking in the night should be given water rather than milk, juice or food.
• Fruit juice may claim to have no added sugar but in fact it is full of fruit sugars and acids which are very harmful to teeth. If using them dilute all juices and fruit drink powders at least 5 parts water: 1 part juice.  Milk and water are cheaper and healthier alternative to juice or cordial.
• Any drink containing sugar (e.g. fruit juice) should never be fed via a bottle as it is harder for the infant to pace their own intake. Feeding from a cup is preferable as it enables the infant to control the flow rate as well as their breathing and swallowing rate.
• Be aware that medicines are often based on sugar syrups so give before teeth are cleaned. Alternatively ask your pharmacist if the prescribed medicine comes in a sugar-free form.
• Avoid foods which stick to the teeth e.g. potato chips, toffee or caramel. These retentive foods are more likely to cause cavities than food such as a raw vegetable which stimulate saliva flow reducing  the harmful effects of acids on tooth surfaces.
• Dental studies suggest the ideal snack should be high protein, low-fat foods, which contain minimal fermentable sugars, have a high mineral content and are minimally retentive e.g. egg, cheese, whole wheat breads and raw vegetables.
• If sweet foods are consumed then try to limit them to meal times when salivary flow is high.

Fluoride – The MOH recommendations

While some fluoride will certainly help your baby’s teeth to strengthen too much may lead to mottling of tooth enamel. The amount of fluoride that a child needs is determined by their level of risk. The NZ Ministry of Health recommend the following:

Dental caries risk factors

Socioeconomic deprivation, fluoride exposure, ethnicity, poor oral hygiene, prolonged bottle feeding, poor family dental health, enamel defects, eating disorders,irregular dental care, high sugar diet, high carbohydrate diet(in people with complex medical conditions), active orthodontic treatment, low salivary flow.

Children at low risk of dental caries

•  No evidence of active caries in the past 3 years and no other significant risk factors listed above.
• Fluoride mouthwashes, vanishes, gels, foams or tablets are not recommended  for this low risk group of people.

Children at high risk of dental caries

• There is evidence of caries (including pre-cavitated regions) in the past 3 years and health professional assessment of the individual and/or family are a high risk of developing cavities as outlined above.
• 0-5 years Use a smear of toothpaste with a fluoride content of at least 1000 ppm. (Only use less than 1000 ppm if you are living in a fluoridated area).
• 6 years and over use a pea sized amount of toothpaste.
• Supervise children when they are using toothpaste, encouraging them to spit out as they brush as toothpaste should not be eaten.
• Fluoride varnishes  can be professionally applied to all erupted teeth for people of high risk after months of age. These varnishes need to be applied every 6 months as part of a preventive oral health plan
• Fluoride mouthrinses should not be used by people under 6 years or those at low risk of dental caries. Those people 6 years and over who choose to use mouthrinses should spit these out after use as  they should not be swallowed.
• Topical fluoride gels and foams can be professionally applied to those at risk over 6 years and should be applied at 3-6 monthly intervals. Neutral gels are preferable to acidulated gels in people with porcelain and composite restorations.
• Fluoride tables are not recommended for general use in New Zealand however these may be recommended for people aged 3 years and over at high risk of dental caries. If taken these tablets should be chewed or sucked, or dissolved in drinking liquid.

If you have concerns about your children teeth at any stage of their development talk to your GP or dentist. If dental treatments (such as oral surgery or braces) are interfering with normal eating then contact us for practical feeding ideas.