Family Health: Ask Dr. Rubin

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The Tooth Fairy

Get ready to make your first call to the “tooth fairy.” Dental development is a long process beginning as early as the second trimester (fourteen weeks, with so-called “mineralization”), and continues for over two decades, with eruption of the third molars.

Baby’s twenty primary (“baby”) teeth begin to appear between six-to-twelve months (parents may notice excessive salivation and slight irritability), and continues through three years of age. At six-to-seven years of age, permanent teeth begin to emerge (meaning teeth fall out beforehand). 

Before placing a shiny gift under you child’s pillow, let’s take this opportunity to highlight a few issues surrounding dental care…

Q: When should I start cleaning my baby’s teeth?

A: Protecting your child’s smile begins when teeth first appear. Use a cotton swab or a soft infant toothbrush and water every day to gently wipe the teeth and remove plaque. Initially, toothpaste is unnecessary; in time, use only a tiny amount for flavor. Make tooth brushing fun, showing enthusiasm and acting as a role model for this important lifelong activity.   

Q: When should my child first see a dentist?

A: Your child should visit a pediatric dentist when the first tooth comes in. Such “preventive medicine” will better allow your child to chew food easily, speak clearly, and smile with confidence. The establishment of good dental hygiene may later prevent a host of medical conditions—including cardiovascular illness.

Q: How can I prevent tooth decay?

A: After the first baby teeth begin to erupt, drinking juice from a bottle, at-will night-time breast-feeding, and falling asleep with a bottle should be avoided. “Encourage” your child to switch from the bottle to a cup as they approach their first birthday. This may be easier said than done. I relented and told my child (with a straight face) that I lost her bottle.

Q: Should I worry about thumb and finger sucking?

A: Although perfectly normal for infants, most stop by age two, and should be discouraged after age four, since it can create crowded teeth and bite problems.

Q: What’s the scoop on teething?

A: Some babies may have sore gums when teeth erupt, and they may find relief from a cold teething ring or wet washcloth (a frosty bagel or base of a carrot also do the trick!).  Although teething is the first of the “blame it on” triad of… “teething,” terrible two’s,” and “terrible teens,” don’t blame everything on this! For example, if your baby develops a significant fever, seek your pediatrician’s advice.

Read the May Ask Dr. Rubin column

Read the March Ask Dr. Rubin column

Family Health: Ask Dr. Rubin is published monthly. Each column features real questions from readers, and we invite other readers to respond with their thoughts and insights by posting comments. If you have a question for Dr. Mitchell Rubin, please send it to him in care of the editor at Your question will be kept in the strictest of confidence.

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