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Pediatric Dentistry

Colored Dental Tooth Fillings

“Your child has a cavity.”

Not many parents want to hear those words, especially if their child has dental anxiety.

Last summer, I saw a three year old child who needed to have a filling on one of his upper molars.

Green Colored FillingThe only reason he sat still in the chair long enough for us to remove the decay and get a filling put in was because we told him we were going to give him a yellow colored filling.

He loved tractors, and wanted it to be yellow like his toy tractor. When he was all done, we took a picture of it and gave it to him so he could show his friends and family.

I’ve found that giving children a colored filling (along with some other things we do to make the comfortable), helps them to sit in the dental chair and get their needed dental work completed.

Find out why baby teeth need to have fillings if they just fall out.

Colored Fillings

Pink Colored FillingColored fillings are made of the same composite materials as tooth-colored fillings, they simply have more exciting coloring added to them.

At our office, we have five colors to choose from: blue, green, yellow, orange, and pink.

To the right, you can see how the pink filling looks on a tooth – it’s what most of the girls end up choosing.  That filling, as well as the green one above, was placed to fill in a cavity that formed between the teeth, which is one of the more common places you can get a cavity.

While we can do a colored filling to repair most cavities in baby teeth, nobody has had us do one on a front tooth yet!

Dental Eruption Cyst Upper Front Teeth

A little over a year ago, I wrote an article discussing eruption cysts.  Those are the bluish-purple bumps that can form on the gums right before a tooth pushes its way into the mouth.

Upon first glance, many parents are understandably concerned that their child has a serious problem in their mouth.  The photo I used in the original article isn’t very clear, and I thought it would be good to post a couple more photos that were recently shared with me.

Photos of Eruption Cysts

The photo below shows two eruption cysts over the permanent upper front teeth.  The teeth are still white, the purple color is due to bruising that has occurred between the gums and the permanent tooth.  Usually, no treatment is necessary and the teeth will come through within a couple of weeks.

Dental Eruption Cyst Upper Front Teeth

The next photo shows an eruption cyst where the upper left six-year molar is preparing to come into the mouth.  Many parents may not even notice eruption cysts when they occur this far back in the mouth.

Eruption Cyst Upper Back Molar

Fact: Since many eruption cysts occur on the back teeth and only last a few weeks, they often go undetected.  Because of this, nobody really knows how common eruption cysts really are.  Most estimates say that they occur in under 1% of all children.

To Treat or Not to Treat

Normally, eruption cysts don’t need any treatment.  The tooth will usually poke through the eruption cyst and come into the mouth on its own within a couple of weeks.  If the eruption cyst is causing lots of pain, or if it is causing concerns due to its appearance (as in the first photo), it can be cut open to expose the tooth.

You can click the following link to check out a picture of a tooth after its eruption cyst has been opened.

More Pictures of Eruption Cysts

You can find more photos of eruption cysts in this article that appeared in the Indian Journal of Dental Research.

If you have any questions or concerns on eruption cysts, feel free to leave a comment in the comments section below.  Thanks for reading!

Photos generously provided by Dr. Sarah Hill, a pediatric dentist in Oak Harbor, WA.

Double Tooth Photos

Since starting Oral Answers, many people frequently email me photos that would be useful to share with everyone here on Oral Answers to illustrate a particular dental condition.  Since many parents end up coming to Oral Answers via the page on double teeth, I thought it would be appropriate to start a collection of double tooth photos.

This double tooth photo collection will start out with the three photos below.  If your child has a double tooth (either gemination or fusion), a photo of your child would benefit other parents who come to this site searching for photos and information.

To get your photo below, simply use this contact form or simply send them to OralAnswers [at] gmail [dot] com, replacing the bracketed words with the normal email symbols.

Double Tooth Photos

This first photo is the one I featured on the original post that discusses double teeth.  It is Rachel’s son, who has gemination:

Double Tooth Gemination

The following two photos are from Tiffany.  At first glance, her son appears to have a gemination tooth on the opposite side as Rachel’s son in the photo above:

Double Tooth from Tiffany

Here’s a close-up of the tooth pictured above:

Double Tooth Tiffany

Here’s an updated photo of Tiffany’s son now that he’s two years old:

Double Tooth 2 Years Old

Submit Your Photos

I would love it if you would submit your photos of a double tooth to help parents gain a better knowledge of what double teeth can look like.  Please use this contact form or simply send them to OralAnswers [at] gmail [dot] com, replacing the bracketed words with the normal email symbols.

If you have any questions or comments, feel free to leave a comment in the comments section below.  Thanks for reading!

Teething Baby Pictures
©Sokolova Maryna/

One of the most frequently read articles on Oral Answers over the past year is an article that I wrote back in January called What A Baby’s Gums Look Like While Teething.

Teething BabyThat article only showed pictures of the two lower teeth coming in.  I figured that it would also be helpful to show what the upper two teeth look like while coming in.

Also, since all babies are different, I figured it might be helpful to see pictures of a different teething baby.

Melissa, an avid photographer, did an excellent job of documenting her son’s teething experience.

Her son Logan is now four years old and has all of his baby teeth.  Melissa generously allowed me to use her photos in this article to show what his teeth looked like as they came through his gums and how he made it through the teething stage.

How A Baby’s Teeth Look As They Cut Through The Gums

Here’s a picture of Logan’s two upper front teeth as they came poking through the gums:Teething Teeth Poking Through Gums

Here’s a slightly different angle of the same picture:

Teething: Teeth Cutting Through Gums

Here’s a photo of Logan 8 days after the two above pictures were taken:

Teething Teeth Through Gums

Melissa says that Logan’s teething lasted about one week per set of teeth that came in (teeth usually come into the mouth in pairs.)

How to Help Your Baby Survive Teething

There are many things that you can do to help your baby survive the teething process — I don’t mean survive literally, as modern science has shown that babies don’t die from teething!

Melissa states the following about how she helped Logan make it through his difficult teething experience:

“Since he did have one set come in right after another, it was hard to tell when he wasn’t teething minus the spike of a fever right before his teeth would come in. We constantly kept a bib on him to help soak up the drool. He had eczema and the drool made it worse, so I used a clear diaper rash ointment down his chin, neck and chest to protect that area and treat and prevent the rash from getting worse. Logan liked small, plastic, water filled teething rings that you put in the refrigerator. He also liked cold, wet wash cloths to chew on. Apples helped for some of his teeth, but he didn’t like them every time. We tried Orajel, but he didn’t really like it that much. It did seem to help when he would let us get it in there.

Hyland's Teething TabletsMostly, he liked chewing on our fingers. It could hurt us, but at a certain point you will do anything to give your little one some relief. Baby Tylenol for the fevers and night time pain helped once in a while, but if you have a baby who is constantly teething, like Logan, you can’t exactly keep them hopped up on Tylenol. Hyland’s has a teething pill that is natural that really helped Logan and I highly recommend. I also nursed Logan until he was 12 months old, and I think that helped. He never bit me, but it seemed to sooth him somehow.”

Here’s a link to the Hyland’s Teething Tablets that Melissa mentioned.  They seem to have pretty good reviews on Amazon – I wish I’d known about them with our first child!

Here’s a few photos that show Logan easing his teething pain with plastic teething rings, a toy he ripped off his bouncer, and an apple:

Teething Habits

Just as a comparison, here’s two photos that show Logan teething as a baby, then again as a toddler.  It seems like he didn’t mind it as much once he got a little big older.

Teething as a Baby and Toddler

You and Your Baby Will Make It Through Teething

I remember when our oldest son was teething for the first time, my wife and I had no idea what to do.  He was extremely irritable.  At the time, I was going to school full time and my wife was working full time.  We were both exhausted and I vividly remember one night we were both up with our son and my wife ran out to go get some Orajel (which we’ve since learned more about).

Those days are far behind us and we now have a couple of kids with full sets of teeth.  In retrospect, teething was just one small part of their infancy.  Although it was uncomfortable for them at the time, it really is just a distant memory now.

Near the end of her email to me, Melissa said:

“Time has a way of making you forget some of the little parts of their childhood.

Teething will be over before you know it, and you and your baby will both make it through just fine!

If you have any questions, comments, or concerns about teething, feel free to leave a comment below.  Thanks for reading!

Baby Teething Symptoms

In a paper presented over 100 years ago (1896) at a meeting of the American medical Association, Dr. S.W. Foster said the following about teething:

“The [teething] child becomes wakeful, restless, and fretful, refuses nourishment; the alimentary canal becomes more active, diarrhea follows, and if relief is not given, relaxation of the vital forces follows, and we have nausea, vomiting, confulsions, paralysis, and not infrequently, death.” (Source)

Fortunately, modern medicine has come a long way since the late 1800’s and we now know a lot more about teething.

Want to know what symptoms teething does cause?  Learn about ten real teething symptoms.

10 Symptoms that Teething Doesn’t Cause

False Teething Symptoms1 – Congestion

2 – Diarrhea

3 – Rashes that aren’t on the face

4 – A high fever (teething can cause a minor fever)

5 – Nausea

6 – Convulsions

7 – Paralysis

8 – Vomiting

9 – Sicknesses such as croup and primary herpetic gingivostomatitis

10 – Death

Although it can be argued that death isn’t a “symptom”, but I thought I would add it to the list since many years ago it was a very common belief that teething caused death because so many deaths occurred around the teething ages.  These deaths were likely caused by sicknesses.

Find Out the Real Cause of the Symptom

A study that examined 125 children’s teething symptoms concluded the following:

“We discovered no evidence that teething was associated with any severe, health-threatening conditions. Thus, before attributing any signs or symptoms of a potentially serious illness to teething, physicians and parents must rule out other possible causes. Additional prospective studies may help determine whether occasionally individuals experience signs and symptoms in association with tooth eruption not described in our article.”

If it appears that teething is making your baby sick then you should try to figure out the real cause of the problem.

Do you have a question, comment, or story to share about teething symptoms in your baby?  Go ahead and leave a comment in the comments section below.  Thanks for reading!

Pregnant Women and Fluoride Supplements

Fifty years ago you could have walked into a pharmacy and seen fluoride drops that were specifically targeted toward pregnant women. The packages claimed that fluoride drops, when taken during pregnancy would help keep their children cavity-free.

That all changed on October 20, 1966 when the FDA cracked down on the fluoride supplement makers.  They banned them from making claims that fluoride would benefit unborn babies’ teeth due to a lack of clinical evidence to substantiate that claim.

Source: Food and Drug Administration: Statements of general policy or interpretation, oral prenatal drugs containing fluorides for human use. Fed Regist Oct. 20, 1966

You may be wondering what we’ve figured out in the past 50 years about taking fluoride supplements during pregnancy.

Should Women Take Fluoride Supplements During Pregnancy?

Pregnant Women and Fluoride SupplementsThe answer is no — there is no evidence that taking fluoride supplements during pregnancy helps improve the baby’s chances of having healthier teeth.

Since fluoride supplements taken by the mother can cross the placenta, there is a chance that the well-meaning mother-to-be could actually cause their baby to get dental fluorosis.

The Evidence Against Taking Fluoride Supplements During Pregnancy

Here’s three different credible sources that all agree that there is no benefit derived from taking fluoride supplements during pregnancy.

A Clinical Trial

This clinical trial took 1400 pregnant women and divided them into two groups.  One group received 1 mg of fluoride per day during the last six months of their pregnancy while the other group received a placebo.  The kids were followed until age 5.  No noticeable difference in the amount of cavities was noted between the two groups.

A Scholarly Article

This scholarly article from the journal Pediatric Dentistry states, “Although fluoride crosses the placenta, prescribing fluoride supplements to pregnant women is not recommended because there is little evidence that fluoride provided to the mother during pregnancy reduces caries prevalence in their offspring.

A Statement from the American Academy of Pediatric Dentistry

This guideline from the American Academy of Pediatric Dentistry states, “The AAPD does not support the use of prenatal fluoride supplements to benefit the fetus.”


Although 50 years ago many people thought that taking fluoride supplements during pregnancy was good for their baby’s teeth, it turns out that modern science has debunked that myth.

There is no reason to take fluoride supplements during pregnancy.  And there’s actually a good reason not to: dental fluorosis.

Do you have any questions or thoughts regarding fluoride supplements and pregnancy?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Names for Baby Teeth

Dentists often use many different words that all refer to the same thing.  Dentists say calculus when they mean tartar and radiographs when they really mean to say x-rays.  One interesting group of synonyms like this are used to describe a child’s first set of teeth.  Here are six different names that are all used to describe our first set of teeth.

Six Names for Baby Teeth and Their Meanings

Baby Teeth1. Baby Teeth

The first set of teeth are most often known as baby teeth.  This is because they start to come in around the age of six months, when you’re a baby.

2. Primary Teeth

Primary means first.  Baby teeth are often called primary teeth since they are the first set of teeth that come into the mouth.

3. Milk Teeth

Long ago, people thought that babies’ teeth grew in as a result of the mother’s milk washing over the baby’s gums.  This is how the first set of teeth became known as milk teeth.  Because this was so widely believed, many babies would be put to death if they were born with teeth, a condition known as natal teeth.

To learn more, read When Your Baby is Born with Teeth: Natal Teeth.

Deciduous Teeth
Baby Teeth – Like Leaves – Eventually Fall, Leading to their name of Deciduous Teeth

4. Deciduous Teeth

Remember learning about coniferous and deciduous trees in elementary school?  Deciduous trees lose their leaves.  Baby teeth are often called deciduous teeth because they fall out, similar to how a deciduous tree’s leaves fall off.

5. Training Teeth

The first set of teeth are also called training teeth because they train the child to take care of the permanent teeth.  Although they are training teeth, sometimes it is still necessary to get dental work done on baby teeth in order to keep the permanent tooth healthy.

6. Temporary Teeth

Temporary teeth is the counterpart to permanent teeth.  Since the first set of teeth generally stay in the mouth for less than a decade, they are sometimes labeled temporary teeth due to the fact that they are eventually replaced by the permanent teeth.

Although baby teeth are “temporary” it is still important to take care of them.  Here are 5 reasons baby teeth are important.

Baby Teeth By Any Other Name Are Still Baby Teeth

Don’t let your dentist confuse you — all of these terms refer to your child’s first set of teeth!  Can you think of any other names for baby teeth?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

How Much Does the Tooth Fairy Pay Per Tooth?
©Chistyakova Julia/

Gone are the good old days of lost tooth lore when all that children wanted in exchange for their lost baby tooth was a healthy permanent tooth.

How Much Does the Tooth Fairy Pay?Nowadays, kids are demanding more and more from the tooth fairy.

Many parents want to know how much the tooth fairy pays.  Personally, I’m not sure that it’s really the business of parents to know what goes on between the tooth fairy and their children, but what do I know?

For all those curious parents out there, here’s how much the tooth fairy has paid out over the last six years.

Tooth Fairy: How Much Does She Pay Per Tooth?

How Much Does the Tooth Fairy Pay Per Tooth?

I came across a wide variety of figures while researching the amount that the tooth fairy pays.  I found this tooth fairy poll website that aims to track the current going rate for lost baby teeth as well as an article in Money Magazine from 2005.  The article pegged the value of one lost baby tooth at $1.78.

The most comprehensive tooth fairy payout statistics, however, are available from Delta Dental of Minnesota.  They seem to have a passion for finding out how much the tooth fairy pays.  They go to great lengths to figure out the national average (as well as the Minnesota average) for tooth fairy payouts.

Here’s a summary of Delta Dental of Minnesota’s annual tooth fairy reports with a graph displaying the average price that the tooth fairy has paid per tooth over the last six years:

A Graph of How Much the Tooth Fairy Has Paid

As you can see, the values are steadily rising, which is good news for the children!

On a side note, the high rate of return (around 10% since 2005) causes me to think that baby teeth might be a good investment, especially when you take into account the fact that the U.S. credit rating was recently downgraded.

Should Children Be Able to Bank Their Teeth?

While researching for this article, I came across an interesting option the tooth fairy apparently offers. Some parents supposedly encourage their children to save up multiple lost teeth and then the child can cash them all in at once.  By saving the teeth and then putting them all under their pillow at once, the tooth fairy gives them more for the teeth collectively than the good fairy would have given for each individual tooth.

Perhaps this helps children learn to save, or perhaps the tooth fairy is slowing down with old age and appreciates saving a trip.  Either way, I’d never thought about doing this with my own kids.  I’m still undecided, but I think I prefer the original system.  After all, having to save up teeth might kill some of the excitement by not allowing each child to get their 20 tooth fairy visits.

How Much Does The Tooth Fairy Pay Per Tooth At Your House?

How much does the tooth fairy pay when she visits your children?  Do  your kids save up their teeth to get a larger payout from the tooth fairy?  Does the tooth fairy pay more for teeth that have never had cavities? Do you have a child with a double tooth, an extra tooth, or congenitally missing teeth?  If so, how does the tooth fairy account for those anomalies?

I’d love to hear what the tooth fairy does at your house. Thanks for reading!

Natal Teeth: Teeth in Newborns
Natal Teeth: Teeth in Newborns | ©Langstrup/

Many hundreds of years ago, babies that were born with teeth would be tragically put to death because they were thought to be demons.

Fortunately, that doesn’t occur today.  In fact, parents may be happy to find that their child is born with some teeth because it means that their baby has to experience teething for two less teeth.  Although the mother may not be too happy to have to breastfeed a baby that already hast teeth!

Natal Teeth: Newborns with Teeth

Teeth that are present in a newborn’s mouth are called natal teeth.  Neonatal teeth, on the other hand, are teeth that come into your baby’s mouth in the first 30 days of life.  Sometimes natal teeth can be supernumerary, or extra teeth, but most of the time they are just regular baby teeth that have come in six months early.

What Causes Natal Teeth?

While the exact cause is not known, it is believed that the tooth simply develops in an abnormal position that is much closer to the surface of the gums.

A recent paper, a review of natal teeth says, “The exact [cause of natal teeth] is not known. Infection, febrile states, trauma, malnutrition, superficial position of the tooth germ, hormonal stimulation and maternal exposure to environmental toxins have been implicated as causative factors.”

How Common are Natal Teeth?

I looked at a variety of sources while researching before writing this article.  Some sources say that natal teeth occur in 1 in 6,000 births.  Other sources stated that the number was around 1 in 2,700.  All of those statistics simply came from reports that existed regarding births. However, when a group of researchers actually looked at 7,155 infants looking specifically for natal teeth, they found that 10 of them had natal teeth.  That gives us a prevalence of 1 in 716 births.

The real number is probably somewhere in the range of those three statistics.

2% of infants with unilateral cleft lip and palate are born with natal teeth and 10% of infants with bilateral cleft lip and palate have natal teeth.   Natal teeth are more common in females and children of certain American Indian tribes.

Certain cysts that form on the gums of babies, such as gingival cysts of the newborn and Bohn’s nodules may look similar to natal teeth, but it is important to know that unless the white thing your seeing is as hard as a tooth, it’s probably not a tooth.

Where Do Natal Teeth Occur?

85% of all natal teeth are lower central incisors, 11% are upper incisors, 3% are lower canines and molars, while 1% of natal teeth are upper canines and molars.

What Should You Do If Your Baby Is Born With Teeth?

Many parents are surprised to find that their baby already has teeth and wonder if they need to do anything.

Many times, parents don’t need to do anything.  They can simply relish the fact that they don’t have to go through the teething process for the natal teeth!

It’s not all roses though,there are a few different problems that can occur as a result of natal teeth.  I’ve listed them below with an explanation of what to do about them.

1 – Natal Teeth Can Cause Problems with Breastfeeding

Breastfeeding may be difficult and you may have to pump or mix formula and give it to your baby in a bottle.

McDonald & Avery’s Pediatric Dentistry textbook states, “A retained natal or neonatal tooth may cause difficulty for a mother who wishes to breast-feed her infant. If breast-feeding is too painful for the mother initially, the use of a breast pump and bottling of the milk are recommended. However, the infant may be conditioned not to “bite” during suckling in a relatively short time if the mother persists with breast-feeding. It seems that the infant senses the mother’s discomfort and learns to avoid causing it.”

2 – Natal Teeth Can Cause Ulcers on the Underside of the Tongue

Sometimes the natal tooth will be sharp and can cause an ulcer to form on the underside of the tongue.  This problem is known as Riga-Fede Syndrome.  In this case, the dentist can smooth off the sharp edge of the natal tooth or add a small amount of white filling material to smooth out the tooth.  Once the sharp edge of the tooth is gone, the ulcer usually resolves.

3 – Natal Teeth May Pose a Choking Hazard

While many natal teeth are fixed firmly into the jawbone, sometimes natal teeth are very loose.  In cases where natal teeth are very loose, some sources say that it is a good idea to have the natal teeth extracted.  Other sources say that there are no documented cases of a child choking on a natal tooth and that extracting it can be an emotionally difficult procedure for the parents.

I think that the most important thing to find out here is whether or not the natal tooth or teeth are extra teeth.  Dr. Pinkham’s pediatric dentistry textbook says that all extra (supernumerary) natal teeth should be extracted, while regular baby teeth that are natal teeth should be evaluated to see if they pose a choking hazard to the infant.


Natal teeth may occur more often than once per every thousand births.  They may not cause any problems, but they can cause ulcers on the infant’s tongue and problems with breastfeeding.  They can cause difficulty if they are loose as they may pose a choking hazard for the baby.

Do you have any questions about what to do when your baby is born with teeth?  Did your child have natal teeth?  Please share your comments, experiences, and questions in the comments section below.  Thanks for reading!

Supernumerary Teeth
Extra Teeth: Supernumerary Premolars | ©

Has your child ever come up to you and told you that they have an extra tooth growing out of their upper jaw behind their permanent teeth?  It’s probably more likely that you’ve been told that your child has an extra tooth, or supernumerary tooth (we try to make up complicated words!) as dentists like to call it.

If so, you’re not alone!  It is estimated that supernumerary, or extra teeth occur in 2% of Caucasian children, with an even higher frequency in those of Asian descent.

Below you can see an x-ray of a child with a supernumerary tooth.  The original x-ray is on the left, and I outlined the supernumerary tooth in green in the x-ray on the right.

Extra Teeth: Supernumerary Mesiodens Tooth

This particular extra tooth is called a mesiodens.  That means that it is right between the two upper middle front teeth.  Only about 25% of these teeth actually erupt into the mouth.  Most mesiodens teeth stay in the jawbone and never make it into the mouth.

What Causes Supernumerary Teeth?

Currently, it is believed that supernumerary teeth occur due to the continued growth of the tissue that forms teeth, known as the dental lamina.

Supernumerary teeth can be hereditary or they may be associated with one of two conditions: Gardner’s Syndrome and Cleidocranial Dysplasia.  Supernumerary teeth can also occur in people that don’t have those two conditions and in those withouta family history of supernumerary teeth.

How Common Are Extra (Supernumerary) Teeth?

It is estimated that supernumerary teeth occur in 0.1-3.8% of Caucasians.  They are even more common than that in people of Asian descent, although I couldn’t find any hard numbers.

Supernumerary Teeth are twice as common in boys as they are in girls.  Most supernumerary teeth form before the age of 20, although they are more commonly found with the permanent teeth rather than the baby teeth.

What are Supernumerary Teeth Called?

Extra teeth have a lot of names!  They are classified based upon where they are located and what they look like.

If an extra tooth is located in the middle of the two front teeth, it is called a mesiodens. If the extra tooth is located around the molar area, it is called a paramolar. If the extra tooth is located behind the wisdom teeth, it is known as a distodens.

If an extra tooth is shaped like another “normal” tooth, it is called a supplemental tooth.  If it is not shaped like a normal tooth, then it is known as a rudimentary tooth.  Rudimental teeth are then classified based on what they look like:

  • Conical Rudimentary Teeth look small or peg-shaped.
  • Tuberculate Rudimentary Teeth appear to be barrel-shaped and have more than one cusp.
  • Molariform Rudimentary Teeth look similar to premolar or molar teeth, but not enough to be called a supplemental tooth.

What Does a Supernumerary Tooth Look Like?

Supernumerary Teeth: MesiodensWhen I was out visiting my sister last summer, she told me that my nephew had to get an extra tooth removed.  She told me I could even take a picture and put it up on Oral Answers.

You can see my nephew’s supernumerary tooth to the right.  It was a mesiodens, since it was growing right between his front two teeth.  As you can see, the tooth doesn’t really resemble any particular tooth, it just looks like a cylindrical piece of enamel.

Where Do Supernumerary Teeth Occur?

Almost all (around 95%) supernumerary teeth occur in the upper jaw.  They mostly occur between the upper two front teeth.  After that, you are most likely to find a supernumerary teeth behind the wisdom teeth.

Interstingly, supernumerary teeth don’t always occur in the jaws.  Neville’s Oral Pathology textbook states, “Although most supernumerary teeth occur in the jaws, examples have been reported in the gingiva, maxillary tuberosity, soft palate, maxillary sinus, sphenomaxillary fissure, nasal cavity, and between the orbit and the brain.  The eruption of accessory teeth is variable and dependent on the degree of space available.”

As you can see, supernumerary teeth can pretty much occur anywhere in your head, although they are most likely to occur in your jaws like the rest of your teeth.

Do You Need to Have Supernumerary Teeth Removed?

Most dentists recommend removing supernumerary teeth because they can cause problems.  Regezi’s Oral Pathology textbook states:

The significance of supernumerary teeth is that they occupy space. When they are impacted, they may block the eruption of other teeth, or they may cause delayed eruption or maleruption of adjacent teeth. If supernumerary teeth erupt, they may cause malalignment of the dentition and may be cosmetically objectionable.

Because they can cause problems, it is generally a good idea to have supernumerary teeth removed.


If you have extra teeth, don’t be alarmed!  It is pretty common to have supernumerary teeth.  You can work with your dentist to figure out what your options are for removing the tooth and aligning your smile correctly.

Have you had a supernumerary tooth?  Do you have any questions about supernumerary teeth?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Baby Teething Gel and Methemoglobinemia
©Jandrie Lombard/

Imagine waking up in the middle of the night to an upset teething baby.  You stick some Orajel in the baby’s mouth and go back to bed for some sleep.  The next morning, you realize that your baby isn’t breathing.  Although rare, this can happen.

Teething BabyLast month, the FDA spoke out about a certain complication known as methemoglobinemia that can occur with Orajel and other popular baby teething gels on the market.

Methemoglobinemia occurs when hemoglobin (the protein in blood that carries oxygen) gets modified so that it can’t carry oxygen to the body as effectively.  Because we all need oxygen to survive, methemoglobinemia is a potentially fatal disease.

Any teething gel that contains benzocaine can cause methemoglobinemia.  This includes such brands as:

The complication that can occur with baby teething gels is due to the local anesthetic, benzocaine, which teething gels use to cause a numbing sensation in your teething baby’s gums.

In their warning, the FDA states: “Methemoglobinemia has been reported with all strengths of benzocaine gels and liquids, including concentrations as low as 7.5%. The cases occurred mainly in children aged two years or younger who were treated with benzocaine gel for teething.”

In case you’re wondering, the strength of benzocaine in Orajel Baby teething gel is 7.5%.  Here’s the Drug Facts label for Baby Orajel if you’d like to take a look.

Symptoms of Methemoglobinemia

If you’ve used a lot of teething gel on your teething baby, it’s important to look for the following symptoms, which can be a sign of methemoglobinemia:

  • Pale, grayish-blue skin, lips, and finger/toe nail beds.
  • Shortness of breath
  • Tiredness and fatigue
  • Rapid heart rate
  • Confusion
  • Headache
  • Lightheadedness

If you believe that your baby has methemoglobinemia, it is important to seek medical care immediately.

How to Prevent Your Teething Baby From Getting Methemoglobinemia

The best way to prevent your teething baby from getting methemogloginemia would be to simply not use teething gels.  The American Academy of Pediatric Dentistry says that you can simply massage your baby’s gums or give them a chilled teething ring.

Looking for more ways to calm your teething baby without using Orajel?  Check out the article, Eight Natural Teething Remedies to Help Your Teething Baby.


If you want more information about Methemoglobinemia and teething gels, you can check out this news release from the American Dental Association.

It is important to remember that any drug that you give your child can have serious side effects.  Make sure that you are an informed parent by learning about each drug you give your child – not just teething gels!

Do you have any questions, comments, or concerns about methemoglobinemia and teething gels?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Natural Teething Remedies
©Lucky Business/

Many parents aren’t comfortable giving their little teething babies teething gel, especially when they hear about the rare, but serious side effects that can occur. Back before teething gels were invented, many parents used natural methods to calm their teething babies. Fortunately, for those parents that don’t want to give their teething babies drugs, there are many natural teething remedies to choose from. The teething baby boy pictured to the left would be a great little spokesman for the natural teething baby association as he happily soothes his aching gums with a carrot. While I do list some natural teething remedies below, it’s pretty likely that I passed over some good ones.  If you know of a good, natural teething remedy that I didn’t mention, please write about it in the comments section below.

Eight Natural Teething Remedies to Help Your Teething Baby

1 – Teething Biscuits.  Many parents love using teething biscuits to calm their teething babies.  Be sure to choose a teething biscuit that is healthy for your little one.  When used in moderation, teething biscuits shouldn’t adversely affect your little one’s oral health.

Want to learn more about teething biscuits?  Read Teething Biscuits: A Natural Way to Calm Your Teething Baby.

2 – Frozen Teething Rings. Cold items such as teething rings can alleviate the pain that a teething baby experiences.

Using a Carrot to Calm a Teething Baby3 -Frozen Carrots & Bananas. Frozen bananas are a sweet treat that can ease your baby’s sore gums.  If your baby chews on a frozen carrot, only small bits of carrot come off at a time.  Some parents don’t want to give their children frozen objects because they don’t want to inadvertently freeze their baby’s gums by giving them something so cold.  If you want to play it safe, just go with a cold carrot, as pictured above.

Important – Any time you give your baby something to eat, you must stay with them at all times to help prevent choking.

4 – A small, cold metal spoon. You can either keep some spoons in the refrigerator, or put a small metal spoon in a glass of ice water.  Your teething baby can then hold the spoon and bite down on it to help soothe their irritated gums.

5 – A cold, damp washcloth. Some parents have found that their baby enjoys chewing on a frozen damp washcloth or a cold, wet washcloth.

6 – Dried Fruit. Many parents advocate the use of dried apples to help ease teething troubles.  Any dried fruit that allows the child to chew can help alleviate teething problems.  Keep in mind that you should use dried fruit in moderation, as it can cause tooth decay.

Want to know which of the six kinds of fruit are bad for your child’s teeth?  Read Is Fruit Good or Bad For Your Teeth?  It Depends.

7 – Ice chips in a clean baby sock. Some parents have found that by putting small ice chips in a baby sock, and then tying off the sock, they can give their baby something cold without the risk of their baby’s gums getting too cold.

8 – Gently rub your baby’s gums with your finger.  I’ve tried this with my children and it seemed to help them, although my daughter has bit me before!  It didn’t hurt too much however due to the lack of teeth.  Holding your baby and massaging their gums with your finger can also provide comfort to your teething baby during this hard time.

Beware of Possibly Dangerous Natural Teething Remedies

The internet is an interesting place.  Almost anybody can say anything about any topic under the sun.  It is important to know that although teething does cause some irritation in your child, it’s probably a good idea to not use any unproven homeopathic remedies. Dr. Steven Pray, a professor at the College of Pharmacy at Southwestern Oklahoma State University has said, “Parents or caregivers should be cautioned against use of unproven and potentially dangerous teething remedies such as homeopathic teething tablets containing belladonna, coffee, magnets, tea tree oil, anise seed, clove oil, and cantharides.” Use your common sense when dealing with your teething baby.  Many parents simply look for a quick fix to their baby’s teething troubles, possibly putting their precious baby at risk.

What Do You Do to Help Your Teething Baby?

Do you have any other suggestions to help the parents that are reading this post be able to more effectively calm their teething baby?  Do you have any questions, comments, or concerns? I’d love to hear what you have to say in the comments section below – Thanks for reading!

Mamelons on Teeth Wear Down
©Ilya Andriyanov/

Last July, I wrote an article describing mamelons, which are the tiny bumps that appear on the edges of newly erupted permanent front teeth.  If you missed that article, you can read it here: Mamelons, the Bumps On Your Child’s Permanent Teeth.

Mamelons Wearing Off On a Young Soccer PlayerAs we get older, our mamelons will naturally wear off if our teeth fit together properly.  If you have an open bite or your front teeth don’t touch each other when you bite down, your mamelons probably won’t wear down and you might consider having a dentist smooth them down if you don’t like the way they look.

This post is simply a series of four photos of permanent teeth in various stages of having their mamelons worn off.  Don’t worry, we’ll take a close-up look at our soccer star pictured above in one of the photos below!

How Mamelons Look As They Get Worn Down

First, let’s take a look at three permanent teeth that are just starting to come in.  You can see how pronounced the serrated ridges (mamelons) on the upper left tooth and the lower middle teeth:

Mamelons on New Permanent Teeth

Mamelons Wearing Down on Teeth

To the right you’ll find a close-up on the teeth of our little soccer champ pictured above.  At his age, you can still see some slight serrations and bumps on his four front teeth.  However, the mamelons are almost worn away.  They are not nearly as pronounced as the mamelons on the picture above of the permanent teeth that are just poking through.

Here’s two pictures of adults that have worn down their mamelons:

Mamelons Worn Down

In the picture above, you can see that her upper front teeth are mostly flat.  Many front teeth still have small curves and grooves to them, but they are for the most part, pretty even.

The picture below is a picture of a young woman who has worn down her mamelons and her front teeth have the normal “flat” appearance on the incisal edge.

Mamelons Worn Off


Hopefully this article helped you understand a little more about the gradual process that mamelons go through as they get worn away.

If you don’t like your mamelons and you’re still pretty young, don’t worry – you’ll probably end up wearing them away soon enough!

Do you have any questions, comments, or concerns about mamelons? I’d love to hear what you have to say in the comments section below. Thanks for reading!

Age When Kids Can Brush Their Own Teeth
©Edyta Pawlowska/

Have you ever heard any of the following quotes regarding the age that kids should start brushing their teeth by themselves?

  • “My daughter could brush all by herself when she turned two years old!”
  • “Kids can brush alone when they can cut through a thick New York strip steak without any help.”
  • “They can brush alone when they are old enough to color in a coloring book and stay inside the lines.”
  • “They can be in charge of their own teeth when they are old enough to tie their shoes.”
  • “They’ll be able to brush by themselves when they can write in cursive.”
  • “They can brush their teeth alone when they’re old enough to hit a moving target 20 feet away with a paintball gun while standing on one leg.”

Age When Kids Can Brush Their Own Teeth

I might have made up that last one, but as you can see there’s a lot of confusion about the exact age at which a child can brush their own teeth and do a good enough job.

So when exactly are kids really old enough to brush their teeth all by themselves?  The answer really depends on a couple of other questions which we’ll go over first.

Are Younger Children Worse at Brushing Their Teeth?

Can Kids Brush Their Own Teeth When They Can Write?
Some Say That Kids Can Brush When They Can Write In Cursive

What if you could videotape people of different ages brushing their teeth and figure out at what age kids finally “get it” enough to remove the slimy layer of plaque from their teeth?

Two researchers decided to do just that.  They recorded a group of 5 year-olds, 11 year-olds, and 18-22 year-olds to see exactly how much plaque they removed when they brushed.  Here’s what they found:

  • 5 year-olds only brushed 25% of the surfaces of their teeth
  • 11 year-olds only brushed 50% of the surfaces of their teeth
  • 18-22 year-olds brushed 67% of the surfaces of their teeth

As you can see, as people get older, they appear to be able to clean their teeth better.  Interestingly, only developmental age has been shown to be associated with how well people brush their teeth.  The older they are developmentally, the better they brush.  The textbook Dentistry for the Adolescent and Child by McDonald & Avery states, “Although both chronologic and developmental ages were found to be predictors of plaque removal ability, only developmental age demonstrated statistically significant predictive power.”

As children get older, they develop better dexterity and hand-eye coordination.  If we strictly went by the information in the study above, we probably wouldn’t even trust 18 year olds to brush their teeth by themselves!  Maybe, brushing has more to do with learning the right brushing technique rather than getting older.

For example, what if someone tried to teach the 5 year-old to brush?  Wouldn’t they be able to brush by themselves if they knew what they needed to do?

Can Younger Children Be Taught to Brush Their Teeth Better?

Recently, a group of researchers tested some new technology geared at helping small children learn how to brush their teeth better.  They created a technology known as Ubicomp that uses computers to help children learn how to brush their teeth utilizing the Playful Toothbrush. Here’s what they found:

“After using the Playful Toothbrush for five consecutive days, kindergarten children exhibited significant improvement in effectiveness of teeth cleaning, increased number of brushing strokes, longer brushing time and more thorough brushing coverage in teeth areas.”

You can read a PDF file of the complete study to learn more about the technology used and how it improved the kindergarteners’ brushing skills.

So At What Age Can Kids Brush Their Own Teeth?

Ultimately, there isn’t one answer that will cover every child.  Each child is different.  Of the three pediatric dentistry textbooks I read while researching for this article, I found that two of them glossed over this question, which demonstrated to me that it is a difficult question to answer.  The textbook Dentistry for the Adolescent and Child by McDonald & Avery was the only one that alluded to an age when kids can brush their own teeth.  The authors state:

“Although children in the preschool age range begin to demonstrate significant improvements in their ability to manipulate the toothbrush, it is still the responsibility of the parent to be the primary provider of oral hygiene procedures.  All too often, parents of these children feel that the child has adequately achieved the skills necessary to clean the teeth.  It is important to stress to the parents that they must continue to brush their child’s teeth.”

They believe that children 3-6 years old still lack the fundamental skills necessary to brush their own teeth.  In the next section dealing with children ages 6 to 12, they state:

“The 6- to 12-year stage is marked by acceptance of increasing responsibilities by the children.  The need to assume responsibility for homework and household chores tends to occur during this time.  In addition, the child can begin to assume more responsibility for oral hygiene.  Parental involvement is still needed.  However, instead of performing the oral hygiene, parents can switch to active supervision.  By the second half of this stage, most children can provide their basic oral hygiene (brushing and flossing).  Parents may find they only need to brush or floss their child’s teeth in certain difficult-to-reach areas of the mouth or if there is a compliance problem.  Parents do need to actively inspect their child’s teeth for cleanliness on a regular basis.”

The magic age at which kids can brush their own teeth seems to be sometime between the ages of 6 and 9.


Since every child is different, you will need to individually figure out when your child is ready to begin brushing without any help.  A good way to do this is to use plaque disclosing tablets or solutions.  These plaque disclosing agents turn the plaque on your child’s teeth a different color so that it is easy to visualize and remove.  As long as your children are removing almost all o the color-stained plaque from their teeth, they are able to brush by themselves.

I currently have very young children who are eager to do things independently.  Rather than letting toothbrushing become a battle every night before bed, I have the following deal with my kids: They get to brush first and then I tell them I’m going to “check to see if they got everything clean” as I help them finish up.  My wife and I plan to continue doing this for a few more years.  Once they are a little bit older we will likely start using plaque disclosing tablets more regularly.  When we begin to notice that they are removing much of their plaque independently then we will transition to letting them brush by themselves.

Do you have any questions or comments about the age when a child can begin brushing their own teeth?  Please join in the discussion by leaving a comment below.  I’d love to hear about what you’ve done to help your child brush all alone, at what age you got your child to brush, and if they ended up getting any cavities after they took over their oral hygiene routine.

Thanks for reading!

Teething Biscuits Natural Teething Remedy
©Dave Clark Digital Photo/

Many parents are looking for a way to help soothe their teething baby that doesn’t involve smearing a numbing gel such as Orajel on their gums.  Teething biscuits are just one of many alternatives and have been around for quite some time.

Does Your Teething Baby Need Teething Biscuits?

Baby Teething BiscuitThe short answer to this question is no.  Your baby does not need teething biscuits.  Certain babies may not be ready for solid foods such as teething biscuits.  As a parent, you know your baby better than anyone else and can probably make the best decision as to whether or not teething biscuits are right for your child.  Here are a few advantages to teething biscuits:

1 – Teething biscuits can soothe your baby’s gums and satisfy the urge that your child has to bite during teething (one of the 10 symptoms of a teething baby)

2 – Teething biscuits help your child learn to feed him or herself.

3 – Teething biscuits can provide valuable nutrition to your child that may be difficult to obtain while the child is teething.

My wife and I gave teething biscuits to our daughter during her teething episodes.  We found that some of them made a mess, but overall they helped ease our daughter’s teething troubles.

Where to Buy Teething Biscuits

Baby Mum Mum Rice Rusks Teething BiscuitsYou can find teething biscuits at pretty much any grocery store or at an online retailer such as Amazon.  A few popular types to consider are:

Make Your Own Teething Biscuits

If you’d rather not pay retail prices, it may be cheaper to make your own teething biscuits at home, not to mention that you’ll know exactly what you are feeding your baby. has this page with some good teething biscuit recipes and it tells you what ingredients are safe to use for your baby.


Teething biscuits certainly aren’t the only natural way to help your teething baby.  In my next teething article I’ll go into detail about the many other natural ways to help pacify your teething child.

I also want to add a caution that any solid objects near your child’s mouth do pose a choking risk so you should always supervise them if you decide to give them teething biscuits.

Have you ever given teething biscuits to your teething child?  Do you have any questions, comments, or stories to share about teething?  I’d love to hear what you have to say in the comments section below.  Thanks for reading!

Cavities In Baby Teeth: Do They Need Fillings?
©Ilya Andriyanov/

A lot of parents wonder if it’s really necessary to have their children get fillings in their baby teeth.  Since baby teeth just end up falling out, why not let the cavity fall out with the baby tooth rather than paying to have a dentist remove the cavity?

Many people assume that baby teeth aren’t that important since they quickly get replaced by permanent adult teeth as a child grows.

Fillings Baby TeethEven though they do end up falling out, baby teeth are important!  When they’re healthy, they can help children eat healthy foods.  When baby teeth get infected, they can damage the permanent teeth developing under them and in severe cases they can cause brain infections.  If you missed my earlier article, you can read it to learn five reasons why baby teeth are important.

Now that you understand why baby teeth are important, let’s talk about whether or not baby teeth need fillings.

Should You Get Cavities in Baby Teeth Filled?

When thinking about getting cavities in baby teeth filled, there are a couple of main things to think about: How much use your child will get out of the filling and how big the cavity is.

First, let’s talk about how much use your child will get out of the filling.  The book Pediatric Dentistry by Pinkham says, “A carious primary molar in a 6-year-old is a problem; a loose carious mandibular incisor may not be if it is about to exfoliate.”

If a tooth is about to fall out (or exfoliate if you want to speak in fancy dental terms), then your child probably wouldn’t get much use out of a filling in that tooth.

The other main factor to look at is how big the cavity is.  Although dentists recommend treating cavities when they are small, sometimes a cavity can be so small that it can repair itself under the right circumstances!

In the book Paediatric Dentistry, the authors discuss the question of whether or not to treat baby teeth.  One of their points supporting not getting fillings in baby teeth says, “Remineralization can arrest and repair enamel caries. It has long been known that early, smooth surface lesions are reversible. In addition, it is now accepted that the chief mechanism whereby fluoride reduces caries is by encouraging remineralization, and that the remineralized early lesion is more resistant to caries than intact enamel.”

If the cavity is small and has just started, there is a chance that it can repair itself through the process of remineralization.

Keep in mind that this repair will probably NOT occur unless your child’s diet and oral hygiene dramatically improve!  There’s a reason that your child started to get a cavity and if nothing is done to change the habits that started the cavity, then the cavity will probably get worse.

If you don’t think you will alter your child’s diet or oral hygiene, then it’s probably a good idea to have the dentist put a filling in the baby tooth while the cavity is small so that the cavity doesn’t get bigger.

On the other hand, if the cavity is small and you are willing to work really hard at improving your child’s diet and oral hygiene, then the cavity can remineralize.  In this case, there there’s no need to get a filling in your child’s baby tooth.


When considering a filling in your child’s baby tooth, it is important to think about how much longer the tooth will be in the mouth and the size of the cavity.  If the tooth will be falling out soon, it may not be necessary to get a filling.  If the tooth won’t fall out for a couple of years, then it’s probably a good idea to get a filling in your child’s baby tooth.

Most dentists will be able to give you a good idea as to whether or not your child would benefit from a filling in a baby tooth or if it’s really not necessary.

Do you have any questions or comments about fillings in baby teeth?  I’d love to hear them in the comments section below. Thanks for reading!

Teething Baby Symptoms
©Ozgur Coskun/

Did you know that 5,016 children died from teething in just one year in Wales and England? The year was 1839. Since many babies died around the age of teething, most people simply assumed that it was the teething that killed them. Luckily we’ve come a long way since then — we now know that babies don’t die from teething!

We’ve also discovered that teething really doesn’t cause a lot of the symptoms that we’ve traditionally thought. For example, teething doesn’t cause a high fever.

Teething can be a very painful process for your little loved one.  Often, as parents it is easier for us to focus on how our infant’s teething affects us, such as disrupting our sleep, interrupting a peaceful day, or getting in the way of things we want to get done.

It is important to understand what your child is going through.  Try to imagine what it would feel like if there were tiny knives under your gums pushing their way into your mouth – it probably would be kind of painful and irritating.  It’s that irritability that kicks off our list of 10 signs of a teething baby.

10 Signs & Symptoms of a Teething Baby

A Teething Baby1 – Irritability and pain were reported by parents in this survey to be the most common symptoms of their teething babies.

2 – Waking up in the middle of the night and not sleeping well is another very common symptom that my wife and I experienced most with our little girl.  Our son really didn’t seem to have very much trouble with teething other than when he got his first tooth.

3 – Not wanting to eat solid foods is an understandable symptom of teething because their gums hurt so bad that the thought of chewing on some food probably doesn’t sound too good.

4 – Biting things.  You may notice that your child seems to want to bite a lot of things.  Our kids would never bite the teething toys that we got them.  Interestingly enough, the very expensive crib from Babies ‘R Us that my wife just had to get now has lots of bite marks on the top railing, a permanent reminder of the times when our kids were teething!  Our daughter would also often remove the pen from my shirt pocket and start biting it.

5 – Increased salivary flow and drooling.  You may notice that your child starts producing more saliva which causes them to drool more when they are teething.

6 – Rubbing their gums.  Babies will sometimes try to rub their gums to alleviate the pain.

7 – Ear rubbing was a common finding among teething babies.

8 – A mild fever has been found to occur during teething, but it’s important to keep in mind that major fevers are not associated with teething.  If your child has a really high fever, chances are that something else is causing it.

9 – A rash on their face – While a rash on your baby’s face can be a symptom of teething, rashes anywhere else on their body haven’t been found to be associated with teething.

10 – Sucking on things.  You might find your child sucking on their fingers more than before or sucking on random objects around the house that then become covered in drool!

Further reading: If you’d like to read more about teething, you can check out the book Paediatric Dentistry, read this study about real teething symptoms, or read this survey that parents answered about teething.

Will Your Teething Baby Have All of These Symptoms?

It’s almost certain that your baby will not have all of the symptoms mentioned above.  This study that appeared in the official journal of the American Academy of Pediatrics states that not one of the above symptoms was present in more than 35% of teething babies.

Most teething babies will get a few of the symptoms that are mentioned above, so you can use the teething symptoms above as a loose guideline to see if the symptoms your baby has are normal during teething.

What Symptoms Have You Noticed In Your Teething Baby?

While the ten symptoms above were shown to be associated with teething in a scientific paper, science is always changing as we learn and discover more.

Have you noticed any teething signs and symptoms in your baby that aren’t mentioned above?  Do you have any questions about teething?   I’d love to hear your comments and questions in the comments section below.  Thanks for reading!

Why Your Child Has a Dark Tooth
©Tatyana Vyc/

If you have kids, you know that they can get themselves into a lot of interesting accidents.  Many times when kids get a head injury they knock out a tooth.  Other times, they simply hit the tooth really hard and injure it.

It has been estimated that 8-30% of kids under 7 suffer an accident that injures one of their baby front teeth.

Dark Tooth - Tooth DiscolorationAny time a tooth suffers an injury, there is a possibility that it may turn a different color.  If you’re wondering what it means if your child’s tooth has turned pink, red, gray, black, brown, or yellow, then you’re the reason I wrote this article!

Tip – I will use words like pulp, dentin, and enamel in this article. If you don’t know what those mean, you might want to brush up on The Anatomy of a Tooth.

When Your Child’s Tooth Turns Dark (Gray, Brown, or Black) After a Tooth Injury

When blood leaks out of blood vessels after a tooth injury, blood by-products such as iron can make their way into the small tubes inside the dentin layer of the tooth.  As the blood breaks down, it can make the tooth appear to be gray, dark gray, brown or even black.  This color change doesn’t usually occur until 2-3 weeks after the tooth has been injured and can occur after a tooth has turned red (see below.)

The book Paediatric Dentistry by Welbury states that “although the reaction is reversible to a degree, the crown of the injured tooth retains some of the discoloration for an indefinite period.  In cases of this type, there is some chance that the pulp will retain its vitality, although the likelihood of vitality is apparently low in primary teeth with dark gray discoloration.”

Basically, the author is stating that even if a tooth has a dark color, it may still be able to return to health.  Some experts have said that the darker the discoloration, the more likely it is that the nerve of the tooth has died.  For example, this study “found that 33 of 51 traumatized teeth with gray-black discoloration were necrotic.”  However, other experts state that the shade of darkness doesn’t reflect the health of the pulp.

If your child’s tooth has turned dark, the best thing to do is to have your child’s dentist look at it.  If there are other signs that the tooth is dead such as swelling or an infection that shows up on the x-ray, then your child’s dentist will probably choose to do something about it such as performing a root canal treatment or removing the tooth.

If there is no sign of infection in a dark tooth, the dentist may choose to not do anything and let the tooth eventually fall out on its own when the permanent tooth is ready to take on its role in the mouth.  A study by Sonis showed that 72% of darkened teeth fell out normally without any bad effects on the permanent tooth.

Also, if there are no other signs of infection, this study showed that there is no need to do a root canal.  The researchers concluded that “Root canal treatment of primary incisors that had change their color into a dark-gray hue following trauma with no other clinical or radiographic symptom is not necessary as it does not result in better outcomes in the primary teeth and their permanent successors.”

When Your Child’s Tooth Turns Red or Pink After a Tooth Injury

If a tooth is going to turn red after an injury it can turn red shortly after the injury, or it can wait anywhere from a few weeks to months before it begins to turn a pinkish red color.

Red and Pink Teeth Immediately After the Injury

If a tooth turns red shortly after being traumatized, it usually means that the blood vessels inside the pulp broke.  When the blood vessels rupture, blood leaks inside the whole pulp area of the tooth resulting in a reddish pink color.  This condition is known as pulpal hyperemia.

Sometimes pulpal hyperemia is difficult to detect.  You may have to shine a light on your child’s tooth and look at the tongue side of the tooth with a mirror to detect this color change.

The pink/red color may take a long time to go away or it may never go away and the tooth may start to darken to a shade of gray.

Red and Pink Teeth Weeks after the Injury

As a result of trauma, sometimes cells inside the tooth start eating away at the hard layers of the tooth through a process called internal resorption.  These cells are called odontoclasts and in certain cases they can eat away to the outside of the tooth within a few short weeks.  The tooth looks pink because as the pulp layer of the tooth gets bigger, its red color more easily shines through the thin layer of remaining tooth structure.

A man named James Howard Mummery first noticed this “pink spot” that appears on teeth, which is why it is typically referred to as pink tooth of Mummery.  Pink tooth of Mummery can start occurring anywhere from a few weeks to months after a tooth is injured.

These teeth are usually kept until the crown of the tooth is dissolved.  Then the tooth root can either be removed or it can be left to get dissolved spontaneously as the permanent tooth comes into your child’s mouth.

When Your Child’s Tooth Turns Yellow After a Tooth Injury

The dentin layer of a tooth under the enamel is normally a yellow color.  If a tooth reacts to an injury by laying down a lot more dentin, it is known as pulp canal obliteration (Also called calcific metamorphososis, progressive canal calcification or dystrophic calcification.)

The increase in the amount of dentin and the concurrent decrease in the amount of pulp gives the tooth a yellow, opaque color.

The book Pediatric Dentistry by Pinkham states that “although pulp canal obliteration is a pathologic process, it has no known deleterious effects and therefore does not necessitate any treatment except follow-up.”

It is important to regularly follow-up with your child’s dentist about any teeth that have turned yellow after an injury.  The book Paediatric Dentistry by Welbury notes that “a small percentage [of yellow teeth] demonstrate pathologic change many years after the injury.”


Many times parents want to rush treatment when their child’s tooth changes color.  It is important to understand that “in the primary dentition of a healthy child, color change alone does not indicate a need for pulp therapy or extraction of the tooth (Pinkham.)”

Basically, if your child’s baby tooth has changed color, often the best treatment is no treatment.  As long as an infection doesn’t develop, simply waiting it out and seeing what happens could mean that your child doesn’t have to go through unnecessary dental treatment.  And that’s a good thing, especially after they’ve already been through a traumatic tooth injury.

Do you have any stories, questions, or comments about tooth discoloration?  Do you still have a question that I didn’t answer?  Feel free to write your thoughts in the comments section below so that we can all learn from each other – Thanks for reading!

Submitted Photos

Krista from The Muminator blog shared the following photos of her daughter after she had an accident in 2012:

Here’s a photo not too long after her daughter was playing on the furniture and fell:

Dark Tooth Following Traumatic Accident

Here’s a photo a few weeks after that.  The tooth continued to get darker:

Dark Tooth Continues to Get Darker Following Accident

And a final photo of the tooth returning almost back to its normal color:

Dark Tooth Getting Light Again Following Accident

You can read all about her daughter’s experience on this thorough blog post that she wrote about the entire experience.

The following photo is from Jennifer, who has left some very informative comments below regarding her daughter’s dark tooth.  She states:

Its not white completely but is a lot better than what it was… The left side of the photo is around 3-4 weeks after the trauma.. and the right side of the picture was taken a few days ago, around 8 weeks after the trauma, It has also moved back into alignment a bit more as well, as it was knocked back with a blunt blow.
Dark Tooth Turned White Again

If you have a photo of your child who had an injury that caused a tooth to discolor, please send them to me using this form and I can post them here to help others who are going through this same experience.

Does Teething Cause a Fever in Teething Babies?
©Sokolova Maryna/

There are so many symptoms that are attributed to teething that many parents think that they’re child is almost always teething!  Traditionally, “academic research” has found that teething doesn’t really cause a fever, while many parents and caregivers that are actually taking care of teething babies report that they definitely do get fevers during teething.

Where does the truth lie?  Do teething babies really get fevers?  I decided to find out.

Does Teething Cause a Fever?

Does Teething Cause a Fever?This is a tricky question and in order to answer it, we need to define exactly what a fever is.  If we define a fever as a temperature above 102º, then the answer is usually pretty clear that teething does not cause a major fever over 102 degrees.

But, when we define a fever as a smaller temperature rise, say a temperature of 100º for example, the answer is not so clear-cut.

A study that appeared in the journal Pediatrics followed 494 different tooth eruptions.  They found that “mild temperature elevation” was associated with teething, but a high fever of 102º degrees and above was not associated with teething.

Another study followed 46 healthy infants while they were teething.  20 of them had a fever within a few days of cutting their first tooth while only 7 of them had a fever a couple of weeks before their first tooth poked through their gums.  Although it would appear from these results that teething is associated with a fever, they had some cautionary advice:

From the data presented here it would seem that the ‘granny’s tale’ that infants cut their teeth with fever is supported. We would like to stress the danger in attributing fever to teething without ruling out other pathology. Children are teething from about 6 months to 6 years and therefore can easily be found to be teething when ill from other causes. Only the eruption of the first tooth is a clear landmark and so this study limited itself to the period before its emergence. We are intrigued by our finding and have no explanation to offer at this stage for the observation.

We were taught as students to listen to parents; grandma seems also to have had something to tell us.

From the two studies above, it may appear that teething does cause a mild fever in some children.

The last study I would like to share followed 90 different tooth eruptions. They analyzed the data in many different ways, but in the end they couldn’t find an association between fevers and teething:

A possible association between teething and fever was investigated in several ways…A graph of mean z score temperatures for the 28 days either side of an eruption day showed no trends toward raised or rising temperature near eruption days. Two separate logistic regression analyses adjusting for age were performed to examine possible associations between toothday status and fever. In the first, high fever was compared with no fever, whereas in the second low fever score was compared with no fever.  Neither analysis indicated a relationship between tooth eruption and fever.

The last study failed to find any association between fevers and teething.

Conclusion – Does Teething Cause Fevers?

The few studies that we do have on this subject give us mixed answers.  There are a few things that we can say for sure:

1 – Children get lots of fevers.  It could be that the fevers that they get around the time that they are teething are simply by coincidence.

2 – If your child is sick while teething, don’t just assume that it is due to the teething.  It’s always best to get a definitive answer from a doctor.

3 – Teething doesn’t cause fevers, but some teething babies may experience a slight rise in temperature around the time when they are teething.

I hope that answers some of your questions about teething and fevers.  If you have any questions, comments, or teething stories to share, feel free to leave them below in the comments section.  Thanks for reading!

How Long Does Teething Last?
©Olga Vladimirova/

If you’ve had a child, then you probably know how teething affects kids — and parents!

When it comes to teething, many parents want to know at what age teething starts and how long it will last.  While I can’t give you an exact answer as to when your child will start teething and for how long, I can point out some general guidelines.

The Age When Babies Start Teething

The average baby’s first tooth pokes through their gums right around the age of six to ten months.  Since all baby’s get their first tooth at a different age, it may help to give a general outline of when to expect all 20 of your baby’s teeth.  I mostly used the data from the ADA’s Primary Tooth Eruption Chart (PDF) and have put the average age in months when each event occurs (shown in parentheses) below as well.

Around  4 to 10 months your baby will get their first teeth, the lower front two teeth, the lower central incisors.  (~8 months)

Two months later the two upper front teeth (central incisors) will come into your baby’s mouth. (~10 months)

One month later, the upper lateral incisors will come in. (~11 months)

Two months later, the lower lateral incisors will come in. (~13 months)

Three months later, your baby’s first molars will come in on the top and on the bottom. (~16 months)

Three months after that, your baby will get the upper canine teeth. (~19 months)

One month later, your baby will get the lower canine teeth. (20 months)

Seven months later, your baby will get their lower second molars. (27 months)

Two months later, your baby will complete their baby teeth by getting their upper second molars. (29 months)

Age Babies Start Teething

As you can see, your baby will constantly be getting new teeth over the course of about two years.  It’s important to understand that while your child will keep getting new teeth during this time, they won’t be teething the entire time.  Teething refers to the process by which a tooth erupts through the gums into the mouth.  This process can include some pain and discomfort, usually during the period of time before you actually see the tooth emerge from the gum.

Now that you know when to expect all 20 of your baby’s teeth, let’s discuss teething in greater detail.

How Long Does Teething Last?

In the late 1990’s, a survey was sent out to many parents asking them about various aspects of their children’s teething habits.  One question that I noticed in particular asked the parents how long their babies had teething symptoms for each tooth that came into their mouth.  Aside from a few parents that said their children didn’t experience any teething symptoms (I wish I could say that!), here’s what the rest had to say about how long teething lasted for their kids:

How Long Does Teething Last?

As you can see, the results are all over the place.

If you do a quick search on the internet, you come up with many interesting stories, some of which claim that teething takes over 6 months!  Take a quick look at the following comment that user chrellis_26 said on the BabyCenter website:

“My son started the teething process at about three and a half months, he was ten months old when he finally got one tooth. Lately, now at fifteen months, it can take days or weeks of irritable behavior before a tooth comes in.”

I think the reason that there are so many differing opinions on this issue is because many people attribute fevers and other unexplained irritable behavior to teething.  For example, some people believe that teething can cause a high fever and diarrhea – both of which are teething myths (stay tuned for a teething myths article in the future!)

The real process of teething can cause some inflammation in the gum tissue as the tooth pokes through.  Personally, I believe that teething would normally last from about 1-7 days per tooth.  Several months of teething pain seems a bit far-fetched.  The only authoritative quote I could find on this subject comes from the book Paediatric Dentistry, edited by Richard Welbury.  It states:

“Inflammation of the gingival tissues before complete emergence of the crown may cause a temporary painful condition that subsides within a few days.”

Sometimes babies can get multiple teeth at the same time, so it may seem like teething is taking forever, especially when you’re waking up at all hours of the night to comfort your little bundle of teething joy.


To sum it up, teething will be occurring over and over from a week or so before your baby gets their first tooth and until a week or so before your child gets their last baby tooth — right around the age of 2 ½.

Do you have any questions about teething or any experiences to share?  I’d love to hear about them in the comments section below.  Thanks for reading!

Baby Teeth and Adult Teeth Differences
©Timothy W. Stone/

Have you ever noticed that baby teeth look like they’re whiter than adult teeth?  Or maybe you knocked out a baby tooth when you were a child, but when you had a similar accident when you were older, your permanent tooth got chipped rather than getting knocked out.

The two scenarios above can be explained by the differences between adult and permanent teeth.

Baby Teeth and Permanent Teeth Comparison

There are many differences between baby teeth and permanent teeth, but before I get into all of the differences, take a look at the photo above of the little girl swimming.

Now, take a closer look at her teeth in the photo below:

Baby Teeth and Permanent Teeth Comparison

In the picture to the left, there are six permanent teeth that are visible.  Can you spot them?

They are the two top front teeth, the two bottom front teeth, and the two molars on the bottom in the very back of her mouth.

These permanent teeth stand out in more ways than one.  I’ll cover all these differences between baby teeth and permanent teeth below.

As you read, feel free to refer back to this picture to get a visual representation of some of the more noticeable differences that I talk about below.

The Differences Between Permanent Teeth and Baby Teeth

1 – The enamel and dentin are thinner in baby teeth, and the pulp is bigger relative to the rest of the tooth. This means that if your child gets a cavity, it will travel much faster to the nerve of the tooth. This is one more reason why it’s important to take your child to the dentist before they turn one year old and get routine checkups thereafter.

Not sure what enamel, dentin, and pulp are?  Read my previous article about the anatomy of a tooth.

2 – Permanent teeth are more yellow than baby teeth. Take a quick look at the picture above and you’ll see that the six permanent teeth that are visible  don’t look nearly as white as the other baby teeth.

3 – Baby teeth have shorter roots – because of this they aren’t anchored as well into the bone and may fall out more easily if your child falls on a hard step or hits their mouth on the coffee table.  The shorter roots also give the permanent teeth more room to develop underneath the baby teeth and make it easier to dissolve the roots of the baby teeth when the permanent teeth are ready to come into the mouth.

Find out what to do when a baby tooth gets knocked out.

4 – Baby teeth fall out – If you take good care of your adult teeth you can keep them for your entire life.  Just because baby teeth fall out, it doesn’t mean that they aren’t important.  If you’ve been staying up late at night pondering this question, click the following link to find out why baby teeth are important.

5 – Permanent teeth have mamelons.  Mamelons are the small bumps that give the permanent incisors a serrated look when they first come into the mouth.  If you look closely at the girl in the picture above, you can see the little bumps on the edges of her four permanent front teeth.  Mamelons quickly wear away as long as the teeth fit together properly.

Learn more about what mamelons are and what to do if you still have them as an adult.


As you can see, there are definitely some differences between adult and permanent teeth. These differences can not only affect the appearance of the teeth, but can also affect what happens to a tooth when you suffer an injury to the mouth.

Do you have any questions about baby teeth or permanent teeth? I’d love to hear what you have to say in the comments section below! Thanks for reading.

Age that a Child Needs a Frenectomy
©Gerard Koudenburg/

One of the topics that I get emailed about most often is labial frenectomies.  Not long ago, my sister called me asking me whether or not her daughter should get a labial frenectomy.  The dentist had noticed it at one appointment and said that she may have a gap between her front teeth if a frenectomy wasn’t done.

My sister never got back to the dentist.  At the following appointment, the dentist never mentioned that her daughter needed a frenectomy.

Overall, it seems like orthodontists and general dentists are recommending frenectomies more and more often. Is there a sound reason for performing all of these recommended frenectomies?  Should little children get frenectomies to avoid possibly having a gap between their front permanent teeth?  I’ll answer these questions and more in the article below.

At What Age Should a Child Get a Labial Frenectomy?

At What Age Does a Child Need a Labial Frenectomy?

A few months ago, I had a conversation via email with a reader who we’ll call Amy.  Her daughter was only 16 months old and the doctor that she went to recommended that her 16 month old daughter get a labial frenectomy.  Here’s what Amy wrote in one of her emails to me:

Our doctor told us that her gum needed to be cut at some point before her back teeth came in and before the permanent teeth came in to help with the space.  She has not had any problems with it before like pain or trouble talking. To make the story different to me, is that the doctor that did the surgery was a ear, nose and throat doctor. I always had a dentist do the work on me.

I am not sure if this has anything to do with it but we live in a very small town and area. I have talked to many people and they all acted like this was a common thing to do even on toddlers and infants. So I am a little confused with their responses and yours.

I found Amy’s email slightly troubling as I hadn’t ever heard of frenectomies being performed in such young children unless their frenum is so thick that they have trouble eating/speaking or it is causing them pain.

After combing through a few different textbooks, I found a few quotes that I think are worth sharing.  Dr. Pinkham’s book Pediatric Dentistry states the following (I put the important points in bold text – and FYI a diastema is a space between the front teeth):

“Recent trends justify significantly fewer maxillary labial frenectomies.  These procedures should only be performed after it has been shown that the frenum is a causative factor in maintaining a diastema between the maxillary central incisors.  This cannot be determined until after the permanent canines have erupted.  Therefore a maxillary labial frenectomy prior to the age of 11 or 12 is probably not indicated.”

The book Paediatric Dentistry, edited by Richard Welbury echoes Dr. Pinkham’s pediatric dentistry book.  It says, “Parents are often concerned about spacing of the upper incisors, and they can be reassured that it will often reduce as the permanent upper canines erupt…There is some disagreement about the role of frenectomy in the treatment of diastemata, but it is very rarely indicated in the mixed dentition stage and is probably best carried out during active orthodontic treatment.”

Dr. Pinkham’s book states that a frenectomy is probably unnecessary before a child is 11 or 12 years old.  Paediatric Dentistry says that a frenectomy is very rarely done in the mixed dentition (before all of the baby teeth have fallen out – around 11-12 years of age.)

Both of these authoritative books in the field of pediatric dentistry agree that a frenectomy shouldn’t be done, except in rare circumstances, before a child is 11 years old.

Labial Frenectomy After Braces

A labial frenectomy can be done after the gap between the front teeth is closed with braces.  To learn more about this topic, read the article Is a Labial Frenectomy Necessary After Braces?

When Should a Child Get a Frenectomy Before They are 11 Years Old?

There may be some situations where a frenectomy should be performed in a child who is younger than the 11 to 12 years old recommended above.

The book Carranza’s Clinical Periodontology says that “A frenum becomes a problem if the attachment is too close to the marginal gingiva.  Tension on the frenum may pull the gingival margin away from the tooth.  This condition may be conducive to plaque accumulation and inhibit proper toothbrushing.”

The book Pediatric Dentistry also states that if “the frenum attachment exerts a traumatic force on the facial attached gingiva of a permanent tooth (an uncommon situation)” then a frenectomy can also be performed.

Obviously, other valid reasons to perform a labial frenectomy earlier are if the frenum is causing the child pain or making it difficult to speak or eat.


To recap, a child should only get a frenectomy after the permanent canines have come in and after closing the gap between the front two teeth.  This means that a frenectomy should normally only be performed when a child has turned 11 or 12 years old.

A child may need to get a frenectomy earlier if the labial frenum:

  • Makes it difficult for the child to keep their teeth clean
  • Is pulling on the gums causing them to recede
  • Causes the child pain
  • Makes it difficult for the child to eat or speak

Have you had your children get labial frenectomies?  Has your child’s dentist recommended a labial frenectomy before the age of 11?

I’d love to hear about your stories involving frenectomies in the comments section below.  Thanks for reading!

What to Expect at Your Child's First Dental Visit
©Khakimullin Aleksandr/

A couple of weeks ago I wrote about the age when your child should go to the dentist for the first time.  Many people think that taking your child to the dentist before they are one year old is too early.  They wonder what a dentist could possibly do with such a young child.

First Dental VisitOne of the main reasons that we like to see children at such a young age is so that we can catch small problems before they turn into large catastrophes.  The American Academy of Pediatric Dentistry has said, “Unrecognized dental disease can result in exacerbated problems which lead to more extensive and expensive care, whereas early detection and management of oral conditions can improve a child’s oral health, general health and well-being, and school readiness.”

I think some of the reasons that parents don’t bring their children into the dentist by age 1 is because they don’t know why they should and they have a fear of the unknown.  Hopefully this article will provide information to alleviate both of those concerns.  If you’re wondering what a dentist will do at your child’s first dental appointment, you’ve come to the right place!

What to Expect at Your Child’s First Dental Visit

The first dental visit can be composed of a few different parts, depending on how your dentist conducts appointments with children on their first dental visit.  A few things that your child’s dentist is sure to do is to look inside of your child’s mouth, introduce the child to the dental environment, and give oral health information to the parents.

Your Child’s First Dental Visit: Looking Inside the Mouth

Your child’s dentist will be able to take a quick look inside of your child’s mouth.  The dentist probably won’t use the dental chair.  An often-used method of examining very young children is to have the child lay down in the parent’s lap with the child’s head resting in the dentist’s lap.

During this brief examination, the dentist will look for a variety of things, including making sure that:

  • All of your child’s teeth are coming in properly and at the right time.
  • The tongue and tissues inside of the mouth are developing properly.
  • There are no early problems with the temporomandibular joint (TMJ)
  • Your child’s teeth are healthy and cavity-free (Now may be a good time to make sure that you’re not causing cavities on your child’s teeth!)
  • There are no developmental anomalies with any dental structures (such as extra teeth or fusion and gemination)

Your Child’s First Dental Visit: Introducing Your Child to the Dental Office

Pediatric dentists are specially-trained in the area of helping children become acquainted with the dental office.  They know how to help your child get comfortable with the unfamiliar sights and sounds of the dental office.

Also, the dentist will note any behavior issues that your child may have in the dental office so that the dentist can be helpful and accommodating at future dental visits.

Your Child’s First Dental Visit: Getting Oral Health Information

Your child’s dentist will be able to give you valuable information regarding the oral health of your child.  This can include discussing your child’s diet and pinpointing any foods or feeding habits that can be detrimental to your child’s dental health.  Your child’s dentist may let you know how “at risk” your child is to develop cavities based on you kid’s oral hygiene and diet.

Also, if you haven’t been getting enough Oral Answers in your life, then your child’s dentist can help you understand why baby teeth are important.

Lastly, your child’s dentist is here to help you!  If you have any questions at all about caring for your precious little one’s baby teeth, your child’s dentist will be able to answer them for you.

Questions About Your Child’s First Dental Visit?

If you have anything to say about this article or have any questions about your child’s first dental visit, please feel free to drop me a line by filling out the comment form below.  Thanks for reading!

When Should Child Go to Dentist for First Time?
©Khakimullin Aleksandr/

It has been said that although your baby may not be ready for a dental visit at one year of age, your baby’s teeth are ready.

However, even if you take your child to the dentist on their first birthday, you may be taking them later than is recommended by the American Academy of Pediatric Dentistry and the American Dental Association.

At What Age Should You Take Your Child to the Dentist for the First Time?

Age When Baby First Goes to DentistAt my dental school, we follow the guideline from the American Dental Association that a child should have his or her first dental visit within six months of getting their first tooth, or before they turn 1.  Whichever comes first. So if your little girl gets her first tooth at 4 months, it is recommended that she visit the dentist no later than six months later, which would be at 10 months.

I have included the official statements below from both the American Dental Association and the American Academy of Pediatric Dentistry on when a child should visit the dentist for the first time.

The American Dental Association on When a Child Should First Visit the Dentist

Here’s what the American Dental Association has to say on the topic of when a child should first visit the dentist:

The Association urges parents and guardians, as a child’s first tooth erupts, to consult with their dentist regarding:

1 – Scheduling the child’s first dental visit. It is advantageous for the first visit to occur within six months of eruption of the first tooth and no later than 12 months of age, and

2 – Receiving oral health education based on the child’s developmental needs (also known as anticipatory guidance).

The American Dental Association recommends that a child visit the dentist within six months of getting their first tooth, but definitely before their first birthday.

The American Academy of Pediatric Dentistry on When a Child Should First Visit the Dentist

First Dental VisitThe American Academy of Pediatric dentistry recommends that a child should first see the dentist by their first birthday.  Here’s what they say on their website:

“First visit by first birthday’ sums it up. Your child should visit a pediatric dentist when the first tooth comes in, usually between 6 and 12 months of age. This visit will establish a dental home for your child. Early examination and preventive care will protect your child’s smile now and in the future.

The American Academy of Pediatric Dentistry’s policy is similar to the American Dental Association’s statement.  The AAPD ‘s policy says to go by the first birthday or when the first tooth comes in.  Pretty much any time between 6 and 12 months is a good time for your child to visit the dentist for the first time.

What Will the Dentist Do at the First Dental Visit?

The dentist will simply examine your child and give you advice on how to better take care of your child’s oral health at the first dental visit.  Of course, the exam does depend on how comfortable and cooperative your child is.

One of the best methods of examining children is to have the parent and dentist sitting down facing one another.  The parent then holds the child’s body in his or her lap and the dentist holds the child’s head in his or her lap.  This is known as “knee-to-knee dentistry” and has proven to be a good method to put children at ease while allowing the dentist to check for early cavities and oral developmental problems.

What Should You Do If Your Dentist Won’t See Your Child This Early?

As you can imagine, some dentists are comfortable with toddlers and some dentists aren’t.  When I eventually graduate and become a dentist, I plan to treat patients of all ages and will refer extremely complicated patients to pediatric dentists, who are trained in the behavioral management of young children.

I found a really interesting letter written by Milton Houpt, the chair of the Department of Pediatric Dentistry at the New Jersey Dental School.  It was a letter to the editor in the dental journal Pediatric Dentistry.

In it he talked about how his granddaughter recently turned one and needed to find a pediatric dentist.  Rather than seeing her himself, he decided to find a younger pediatric dentist so that his granddaughter could develop a good relationship with her dentist.  Upon calling the office, he was rather disappointed.  Here’s how he relates what happened:

What I thought would be a routine call became, to my dismay, a great disappointment.  This is what I was told: “We don’t see children until they are at least two and a half or three years of age.  The parents in my practice are upscale.  They would not let me examine their children if they were crying.  And if I wouldn’t examine the child, how could I charge a fee?  I couldn’t charge just for giving advice.  And I am not going to see infants free of charge.

As this case demonstrates, not all dentists are willing to see children before their first birthday.  They may not be comfortable seeing and charging for a dental visit for young children (as in the above case) or they simply may be stuck in the way they’ve always done things, which is to wait until the child is between the ages of 3 and 6 to first see them.

I believe the case above is an exception to the rule.  From what I have read on the internet in various forums, it does seem that there are some dentists who are not willing to see a child until they turn 2 or 3 years old.  If this is the case, it might be a good idea to find a pediatric dentist in your area that specializes in oral health care for children.

Conclusion – Should a Baby Really Go to the Dentist Before They Turn One?

All of the major organizations in the United States that have a vested interest in the oral health of children (the ADA, AAPD, and the AAP) recommend that a child go to the dentist before age one.  This wasn’t always the case — up until around 10 years ago, I believe that the American Academy of Pediatrics still recommended age 3, but they have since changed their policy to more closely mirror that of the two dental associations.

If you’ve made it this far, you’re probably wondering if YOU should really take your baby to the dentist.  From what I have observed, most 12 month-old kids that come to my dental school are the ones whose parents are taking good care of their teeth.

Even if you take great care of your child’s teeth, it is still a good idea to take them to the dentist because it helps them get acclimated to being in a dental office and can help you discover any previously unknown oral risks (such as having pits on some teeth that could make them more susceptible to getting cavities) that your child faces.  Also, you will probably learn something new about how to take care of your child’s teeth and can find out if you’re causing your child to develop tooth decay.

Not sure why you should take care of your baby’s teeth since they fall out?  Find out why baby teeth are important!

Most parents take their child to the pediatrician a total of seven times during their first year of life (at 5 days, 2 weeks, 2 months, 4 months, 6 months, 9 months, and 12 months of age.)  These visits are routine checkups where a professional makes sure your child is developing properly and answers your questions.  A visit to the dentist before they turn 1 will be similar to these routine medical checkups, only the focus will be on your child’s teeth and gums.  And just think, you only need to take your child to the dentist one time before they turn 1 to ensure they are growing a happy, healthy smile!

Do you have any questions about your child’s first dental visit or how to find the right dentist for your child’s first dental visit?

Leave any questions or comments below in the comments section and I’ll get right back to you.  Thanks for reading!

Teething: How a Baby's Gums Look While Teething
©Sergey Novikov/

A few years ago, my wife and I kept thinking that our son was getting his first tooth.  He eventually got it, but there were many times when it looked like his first tooth would be coming in and it didn’t.  It’s important to know that the first tooth usually comes in around six months of age.

Since a baby’s first tooth is often anxiously awaited by parents and often takes longer than expected to poke through, I decided to post a couple of photos of a young baby that were taken before and after his first tooth came in — just five days apart.  This will show you what you might see if a tooth is close to making its debut!

Teething: Baby's First Tooth

The photo on the left was taken five days before the photo on the right.  In the photo on the left, you can see that there is a little bump on the gums where the lower tooth will come in.  In the photo on the right, you can see that the tooth finally poked through into the baby’s mouth.

What a Baby’s Gums Look Like When They Are Teething

Here’s a close-up of the image on the left.  You can clearly see that the gums are raised up slightly where the new tooth will be coming in.

Teething Baby's Gums

What a Baby’s First Tooth Looks Like

Here’s a close-up of the image on the right, that shows the baby’s tooth finally poking up through the gums:

Teething Baby's First Tooth

Take a look at Teething Baby Pictures to see more pictures of baby teeth coming in.


It’s important to keep in mind that the appearance of the gums isn’t the only indication that your baby’s first tooth is about to poke through.  Here are some other signs and symptoms of a teething baby.

If you have any questions or comments regarding your teething child, feel free to leave them in the comments section below.  Thanks for reading!

Importance of Baby Teeth

Have you ever wondered why we have baby teeth?  It’s kind of interesting that we are born with permanent limbs and other body parts, but the first teeth we have are only temporary.

You, like many parents, may have even wondered the following:

Why should I take care of my child’s baby teeth?  They’re just going to fall out someday and can’t I just make sure that we take better care of the permanent teeth?

A common misconception among parents is that the baby teeth are “practice teeth” and therefore aren’t important.  To be honest, if your child has a lot of cavities and ends up losing their baby teeth early, this will probably affect their permanent teeth.

Let me explain some of the reasons why baby teeth are important.

Why Baby Teeth Are Important

Baby Teeth are Important1 – The baby teeth are placeholders for the permanent teeth. The body naturally loses baby teeth in a certain order to allow enough room for the permanent teeth to come in.  If the teeth fall out earlier, you disrupt this order and there may not be enough room for the permanent teeth.  Luckily, a dentist can make an appliance called a space maintainer or spacer that will make sure there’s enough space for the permanent tooth to come in.

To learn more about space maintainers, read What a Space Maintainer is and Why Your Child Might Need One.  If you want to see how a space maintainer might look inside of your child’s mouth, you can see a picture in my article What a Space Maintainer Will Look Like In Your Child’s Mouth.

2 -Cavities in baby teeth can cause infections that can harm your child and damage the developing permanent teeth. If the baby teeth are damaged, the damage isn’t isolated to the baby teeth.  When a cavity reaches the pulp (the nerve) inside the tooth, it enters the bloodstream and can cause an infection.  Usually the infection stays around the root of the tooth, but it can spread to other places in the body.  The infection can cause a swelling in the cheek area or rarely it can spread to the brain, as in the tragic story of Deamonte Driver.

If a baby tooth gets a cavity that infects the pulp inside the tooth, it can cause an infection at the end of the tooth that is close to the developing permanent teeth.  There is some evidence that has shown that inflammation in the root area of baby teeth can damage the permanent teeth.

3 – Baby teeth allow the child to develop good oral hygiene habits. It is much easier to teach a child the right brushing and flossing habits when they are young than it is to retrain an older child who has had bad habits for years.  While I don’t like to consider the baby teeth to be “practice teeth”, I do think parents should use the time before their children’s permanent teeth come in to teach them how to take care of their teeth.  If this is done, there will be fewer problems with the child’s permanent teeth because the child will know how to take care of them.

4 -Unhealthy baby teeth can cause a child to have low self-esteem. The most common place for cavities in children is in between the front teeth.  If a little boy or girl has to walk around with brown spots on their front teeth, it can make them self-conscious and decrease their sense of self-worth.

5 – They help children eat nutritious food. That may not seem like a very big deal, but the American Academy of Pediatric Dentistry has noted that kids with lots of cavities may be severely underweight due to pain when they try to eat.  Painful eating can cause them to lose the desire to chew foods and may cause them to choose foods that aren’t very nutritious.  The American Academy of Pediatric Dentistry has also noted that nutritional deficiencies during childhood can impact cognitive development.

Although having healthy teeth to chew food may not seem too important, it can help ensure adequate development of your child.


I can’t stress enough the importance of taking care of your child’s baby teeth.  Keep in mind that cavities are caused by bacteria, and tooth decay is a serious disease — the most common disease in children!

Luckily we do get two sets of teeth, but it is important to take care of both sets!

If you know anyone who doesn’t understand the importance of baby teeth, please consider sharing this article with them.  If you have any questions, comments, or anything that I might have left out above about the importance of baby teeth, please leave a comment below. Thanks for reading!

When Will My Baby's First Tooth Come In?
©Aliaksei Smalenski/

Many parents wait with anticipation to finally see their baby’s first tooth poking through the gums.  A baby getting his or her very first tooth can be an exciting and sometimes tiring experience for both baby and parents.

When does the average baby get their first tooth?

Baby's First Tooth

When Does a Baby’s First Tooth Erupt?

The average baby’s first tooth comes into their mouth right around the age of 6 months. The first tooth is usually a lower front tooth.

What If My Baby Doesn’t Have Any Teeth at 6 Months?

Some parents may wonder if something is developmentally wrong with their child if they haven’t gotten their first tooth by the time they’ve reached six months of age.

Keep in mind that six months is just an average.  Some babies are born with teeth already in their mouth.  These are known as natal teeth.

Many babies don’t get their first tooth until they are almost one year old.  My son didn’t get his first tooth until he was about 10 months old.  Today, he’s a bright, intelligent little boy!

Conclusion – Just Relax!

In conclusion, if you’re baby’s first tooth hasn’t come in by the age of six months, rest assured that your baby is most likely normal.  The average age that a baby’s tooth comes in is six months.  Many baby’s get their first tooth after this, and some get them before.  If you do have concerns, you can always call your family dentist to see if an appointment should be made.

Do you have any questions or comments about baby teeth or teething?  Please leave them in the comments section below.  Thanks for reading!

Adult Teeth Coming in Behind Baby Teeth

Many parents become alarmed when they look in their child’s mouth and see the permanent teeth growing behind the baby teeth.  What went wrong?  Aren’t the permanent teeth supposed to grow under the baby teeth and push them out?

Rest assured, permanent teeth coming in behind baby teeth is not an emergency!

Ordinarily, as the permanent teeth push up, the roots of the baby teeth dissolve and the baby tooth eventually falls out, allowing the permanent teeth to come in.  Sometimes, the baby teeth don’t want to leave the mouth, and the permanent teeth come in right behind them.  This condition is technically known as lingually erupting mandibular incisors and more commonly known as shark teeth or simply permanent teeth coming in behind baby teeth.

In this article, I’ll talk about why shark teeth happen, how common shark teeth are, whether or not they’re serious, and what your dentist or pediatric dentist can do to treat shark teeth.  I’ll even sprinkle in a couple of pictures so you can check to see if this is what is happening with your child.

Here’s a close-view of the lower jaw of a child with his permanent lower incisors coming in behind his baby incisors.  The child’s parent commented that hours after this picture was taken, one of the baby teeth fell out.  So sometimes the body can even correct the problem on its own!

Shark Teeth - Permanent Teeth Coming In Behind Baby Teeth

Why Permanent Teeth Grow In Behind The Baby Teeth

The book Pediatric Dentistry by Jimmy Pinkham states that “the cause of ectopic and lingually erupting incisors is not well established.”

There are a few guesses as to why shark teeth occur.  Some dentists believe that this occurs because the roots of the baby teeth don’t get dissolved like they normally should and the permanent teeth have nowhere else to go, so they just come into the mouth where there is the least amount of resistance.

Other dentists say that the permanent teeth start growing in behind the baby teeth because there is too much crowding in the lower jaw.

Another theory says that because the permanent teeth develop behind the baby teeth, this is simply a slight deviation from normal and they just didn’t make it as far forward as they should have.

I think that all of these are good explanations as to why this phenomenon occurs.  I personally think that all three are possible explanations and any of them might be true for a specific individual.

How Common/Serious Is It to Have Permanent Teeth Grow In Behind The Baby Teeth?

This study by Gellin states that permanent teeth growing in behind baby teeth is a fairly common condition, occurring in about 10% of all children.

Luckily, many times shark teeth will resolve on their own with the baby teeth eventually falling out.  Sometimes, they don’t resolve on their own.  So far, in less than a year of actually working in the clinics at dental school , I’ve seen two patients who are close to 20 years old that still had baby teeth in front of some of their permanent teeth.

One young woman has decided she will probably get braces because the baby tooth that hung around in her mouth caused a bit of crowding and now her teeth aren’t aligned very well.  Sadly, she never had this corrected when her permanent tooth first came in.  Most of the time, your dentist will be able to correct shark teeth before it becomes a problem.

Here’s a picture of a little boy named Evan.  If you look closely, you’ll see that he has two permanent teeth coming in on the bottom with two baby teeth still hanging around.  His mom stated that the day after this picture was taken, Evan lost one of the teeth.

Shark Teeth: Permanent Teeth Coming In Behind Baby Teeth

The two photos in this article show that many times, shark teeth can resolve on their own.  However, if they don’t, there are certain things a dentist can do to resolve the problem.

How a Dentist Can Help Manage Permanent Teeth Coming In Behind Baby Teeth

If your child’s shark teeth don’t resolve on their own within a couple of weeks, it would be a good idea to have your dentist take a look at what’s going on.  Your child’s dentist will be able to remove the baby teeth from your child’s mouth if needed, and this usually resolves the problem.

If the dentist has removed the baby teeth and there is still not enough room for the permanent teeth to move forward and assume their permanent position in the mouth, then your dentist may perform a procedure known as disking where the dentist slims down some of the remaining baby teeth by removing a bit of enamel from them.  This procedure should allow enough room for the permanent teeth to move into their final position.

In another article on this same topic, a pediatric dentist, Dr. Dean Brandon states “Often teeth come in pairs, so if one tooth is not coming in correctly its partner on the other side won’t either.”

It’s important to make sure that all of the teeth have enough room to come into the mouth and line up just right so that your child can have a straight smile that allows for efficient chewing.


Keep in mind that shark teeth really aren’t abnormal.  It happens to approximately 1 in 10 children.  Most of the time, shark teeth will resolve without intervention (i.e. the baby tooth will fall out and the permanent tooth will assume its proper position).  If they don’t, your dentist can assess the situation and remove the lingering baby tooth if it is necessary.

If you have any questions or comments, feel free to leave them in the comments section below and I’ll respond.  Thanks for reading!

Rockport Harbor Maine Dental Association

My wife and I traveled up to Maine this past weekend to attend the Maine Dental Association’s annual conference.  Since Maine doesn’t have very many dentists, they are trying to attract dental students to go and practice there after they have graduated.  It was really pretty (see the end of this post for some pictures), and they might have won us over…  but we’re still not quite sure where we’ll end up in 2012 when I graduate.  I’ll get to the links now, but scroll down to the end if you want to see some of the pictures we took in Maine.

Oral Answers Featured in Glamour Magazine’s Blog

Oral Answers LinksRecently, an Oral Answers article, Don’t Treat Your Teeth Like Tools was the subject of a blog post on the Glamour Magazine Vitamin G blog – check it out here.

The author, Sarah Gio, commented that “dental health has never been so interesting!”  Hopefully you agree.

Are Dental Sealants Safe for Your Children?

A recent study showed that dental sealants, a thin layer of plastic placed over teeth to keep the bacteria from causing a cavity, can release a chemical called bisphenol-A (or simply BPA.)  BPA has been linked to cancer, diabetes, early-onset puberty, and obesity.  For more on bisphenol-A, you can read this information page from USA Today.

Here’s the American Academy of Pediatrics said in their statement on the BPA issue:

” On the basis of the proven benefits of resin-based dental materialsand the brevity of BPA exposure, we recommend continued usewith strict adherence to precautionary application techniques.Use of these materials should be minimized during pregnancywhenever possible. Manufacturers should be required to reportcomplete information on the chemical composition of dental productsand encouraged to develop materials with less estrogenic potential.”

Other media outlets also reported this story.  You can read what CNN wrote, what USA Today wrote, and what MSNBC wrote.

For now, it is accepted that the cavity-preventing benefits of dental sealants outweigh the risks posed from a BPA exposure.

Practicing Dentistry Without a License

Frank Cerebino wrote an entertaining article in Florida’s Palm Beach Post regarding the recent surge in arrests of people practicing dentistry without a license.  I’ve noticed this trend, but didn’t think much of it until reading his article.  Here’s a quick excerpt:

Doing dental work without a license has to be one of the least appealing crimes.  If I were going to impersonate a white-collar professional, a dentist would be somewhere near the bottom of the list, certainly ahead of a proctologist, but not by much.

Here’s a news report of someone practicing dentistry without a license, another one here, and one last one.

Pictures from Our Trip to Maine

Here’s a few pictures we took on our trip to Maine for the Maine Dental Association’s yearly conference.

In the picture below taken in Glen Cove, ME, you can see Clam Cove on the right, and the West Penobscot Bay on the left which leads to the Atlantic Ocean.

Clam Cove in Glen Cove, Maine

We took this picture on Highway 1 in Maine as we were driving over one of the many bridges.

Going over a Bridge on Highway 1 in Maine

We love seeing the leaves change colors in the fall:

Maine Autumn Leaves on the Trees

Here’s one more view of Clam Cove and the West Penobscot Bay

Another View of the Bay from Glen Cove, Maine

We loved the beautiful scenery and the wide open spaces in Maine!  It was a welcome break from dental school in the crowded city!

If you have any questions or comments, feel free to leave them in the comments section below.

Tetracycline Teeth Staining Cause and Treatments
©Gordana Sermek/

When I was a little boy, I remember seeing my brother in the bathroom trying to bleach his teeth.  He tried many different formulations of bleaching agents to try to remove the staining on his teeth.

Tetracycline Teeth StainingI asked him about it recently, and he told me he wasn’t sure how it happened.  We suspected that my mom unknowingly took some sort of antibiotic that stained his teeth when she was pregnant with him or that he had taken something as a kid.  He couldn’t remember.

Tetracycline Teeth Staining Close-Up ViewThen, I called my mom.  She said that she didn’t take anything during her pregnancy and the discoloration came from a drug that was prescribed to him at a young age.  Whatever the reason, nobody likes to have discolored teeth.

To the right is a close-up view of the same patient in the photo above.  As you can see, the tetracycline has changed the color of his teeth.

Tetracycline Tooth Staining

Tetracycline can stain the teeth anywhere from a bright yellow shade to dark brown.  Usually the staining starts out as a yellow color.  Over time, as the tooth is exposed to light, a chemical reaction occurs and the yellow turns to a dark brown color.  For this reason, many people with tetracycline tooth staining have brown teeth in front (the teeth that are exposed to the most light) and yellow teeth in the back (where not as much light reaches.)  Under ultraviolet light, tetracycline staining can appear bright yellow.

However, it’s not just tetracycline that stains the teeth – there are many other drugs as well.

Other Drugs That Cause Staining of Teeth

Many of tetracycline’s homologues (similar drugs) are all associated with discoloration.  Chlortetracycline, demethylchlortetracycline and oxytetracycline can all cause brown/gray/yellow staining of the teeth.

Ciprofloxacin is an antibiotic that can be given intravenously to infants for treatment of a Klebsiella infection.  It can stain the teeth a green color, but the staining is usually more mild than tetracycline staining.

Minocycline hydrochloride is an antibiotic used to treat acne and rheumatoid arthritis.  It is believed that minocycline binds to the tooth and then oxidizes it, producing a discoloration.  Minocycline is able to stain teeth even after they are fully developed, unlike the tetracycline family of antibiotics and ciprofloxacin.


Tetracycline can cross the placental barrier and incorporate into the developing tooth.  It should be avoided (if possible) by mothers who are pregnant and also in kids until they are at least seven or eight years of age.

The book Oral Pathology: Clinical Pathologic Correlations by Regezi says the following about how tetracycline staining is caused:

Because tetracycline can cross the placenta, it may stain primary teeth if taken during pregnancy. If it is administered between birth and age 6 or 7 years, permanent teeth may be affected. Only a small minority of children given tetracycline for various bacterial diseases, however, exhibit clinical evidence of discoloration. Staining is directly proportional to the age at which the drug is administered and the dose and duration of drug usage.

Since there are many other antibiotics available that are as effective as tetracycline without the discolored teeth as a side-effect, tetracycline is usually not prescribed to children except in rare circumstances.  Your doctor will be able to explain the reasoning if your child is ever prescribed tetracycline.

Treatment of Tetracycline Stained Teeth

It is very difficult to treat internal staining of teeth because it affects the dentin layer underneath the enamel.

For an overview of the layers of the teeth, check out this article on the anatomy of a tooth.

There are a variety of ways to treat tetracycline stained teeth depending on the severity of the staining.  The most conservative is bleaching the tooth.  If the tooth has undergone root canal treatment, it may be more effective to use an internal bleaching technique where the dentist puts a bleach inside the tooth to bleach it from the inside out.  Internal bleaching is not possible with teeth that have not undergone root canal treatment because there is still living pulp inside the tooth where the bleach would be put.

If bleaching doesn’t work, there are more invasive treatments.  The dentist can shave off the outer layer of the tooth and put an aesthetically-pleasing tooth-colored filling on the front-facing surface of the tooth.

Another treatment option is putting veneers (a thin layer of tooth-colored porcelain) over the teeth.

The most drastic treatment would be to cut around the whole tooth and put an aesthetic crown over the tooth.  This may end up being the most aesthetic option for severe tetracycline-stained teeth, but it is also the most expensive.  I believe my dental school would charge somewhere around $500 for this procedure, which means it is probably near $1,000 if you get it done in private practice.


I hope this article helped you to better understand why antibiotics stain the teeth and what you can do to prevent it.

Are your teeth stained due to a medication such as tetracycline?  Have you done anything about it?  Don’t hesitate to share your experience in the comments so others who have the same problem can see what worked for you.

If you have any questions or comments, go ahead and leave those in the comments section below as well.  Thanks for reading!

I want to thank Dr. James R. Donley, DDS for kindly allowing me to use his photos (the bottom two photos) in this article.

Double Tooth Gemination and Fusion
©Rachel Inbar

Many parents wait with great excitement and anticipation for the eruption of their baby’s first tooth.  Sadly, baby teeth don’t always look quite right.  This can cause extreme worry among parents.  Pictured to the left is one such scenario of a baby’s two upper teeth.  The tooth on the left is a “double tooth” while the one on the right is normal.

Double teeth are two teeth that are joined together by dentin or even by the pulp.  If you’re not sure what dentin and pulp are, take a look at the layers of a tooth.

There are two scientific terms for teeth that appear to be two teeth stuck together as one tooth: gemination and fusion.

Teeth Stuck Together: What is Gemination?

Tooth Twinning / Gemination - Close Up ViewGemination is when one developing tooth has split off into two distinct teeth that remain attached to each other and develop together.  Gemination comes from the latin word geminus which means twin.  You can think of gemination as two “twins” that are permanently attached.

When you count the geminated tooth as one tooth, there are a normal number of teeth in the mouth.  Rachel’s son (shown in the pictures) was shown to have gemination because he has all of his other teeth when you count the “double-tooth” as one tooth.

Teeth Stuck Together: What is Fusion?

Fusion is when two different developing teeth have joined together to create one tooth.  You can think of it as two teeth fusing together.  Gemination and fusion look very similar.  Sometimes the only way to tell them apart is to count the number of teeth.

When you count the fused teeth as one tooth, the person will be missing one tooth.

How Common Are Double Teeth?

Tooth Gemination
The same boy pictured above, a year or so later.  This boy has gemination. He has all four upper incisors including the double tooth. If he only had three upper incisors including the double tooth, it would be fusion.

Gemination and fusion have been reported to occur in the baby teeth in anywhere from 0.5% to 2.5% of Caucasian children.  It is more common in Asian children, where it has been reported to occur sometimes in excess of 5% of Asian kids.

Gemination and fusion occur most commonly in the upper front teeth.  However, it can also occur on the lower teeth as well.  As a general rule, if a double tooth is located in the upper teeth, it is probably gemination and if the double tooth is found in the lower teeth, then it is probably fusion.

Above and to the right, you can see the same boy’s twinned tooth now that he has gotten a little older.

Can Gemination and Fusion Happen with Permanent Teeth, Too?

Gemination and fusion do occur in permanent teeth, although it is not nearly as common as in baby teeth.  It reportedly occurs in one out of every 250 people.

Can Gemination and Fusion Cause Any Problems?

Gemination and fusion in the baby teeth can cause crowding, atypical spacing between the teeth, and can cause problems with or delay the eruption of the permanent teeth underneath.

Because of this, when a double tooth is found, you should have your dentist monitor the permanent teeth underneath it to ensure that they come in normal.  Sometimes, your dentist will have to remove the double tooth in order to allow the permanent tooth to erupt normally.

Rarely, there are no permanent teeth located under fused double teeth.  Your dentist will be able to provide more information about the permanent teeth through a simple x-ray.

One thing to watch out for is the propensity for fused and geminated teeth to have deep grooves between the “two” teeth.  This groove can be very susceptible to developing cavities as it is hard to get a toothbrush all the way down in the crevice to clean it properly.  You may want your dentist to put a sealant in this groove to help prevent a cavity.

How Are Gemination and Fusion Treated?

Sometimes, your dentist will be able to shave down and smooth the double tooth so that it doesn’t appear very obvious to the casual observer.  I say sometimes because the anatomy of twinned teeth can be complex.  If the pulp (click here to learn about the different layers of the tooth) is too close to the surface, then the dentist won’t be able to shave down very much of the surface.

Very rarely, the dentist may be able to surgically divide the teeth.  This often works best with fusion because both teeth usually have their own separate pulp chambers and root systems.  In any case, when surgically dividing the teeth, both teeth will need to have root canal treatment performed on them, which can end up being quite costly.

When Rachel gave me permission to use the photos of her son, she told me the following:

In case you’re curious – no one really notices it at all, even though it was obvious to me that we’d be constantly bombarded with questions about it. Maybe when he’s a little older (he’s almost 2-1/2 now).

Since kids will most likely lose all of their front teeth by the time they’re 9, you may elect to do nothing about the double tooth unless it’s a huge cosmetic concern.  Shannon W, one of the commenters on Rachel’s original post said to just “enjoy it’s cuteness”…and that may very well be sound advice!

Conclusion & Further Reading

For the record, I got my facts (the statistics) about gemination and fusion from this book: Oral and Maxillofacial Pathology by Neville.  If you want to read more on double teeth, that book is an excellent source.

Do you have any questions or comments about double teeth?  Do you or your child have double teeth?  If so, what did you do, if anything, to treat it?

Please share your experiences in the comments section below, so we can all learn from them.  Thanks for reading!

Updated Photos

Here’s a photo that Rachel recently shared with me showing her son with the double tooth still doing well a few years later!

Double Tooth

And a closeup of the double tooth:

Double Tooth Closeup

Extra Pictures of Tooth Twinning

Here’s an image of Deb’s son showing:

Gemination Tooth Twinning

You can read about his experience in this comment and this follow-up comment below.

If you would like to submit photos of twinned teeth, you can use this comment form or send me an email OralAnswers[at]gmail[dot]com.  Thanks!

I want to thank Rachel Inbar for allowing me to use two pictures of her son with a “double tooth” for this article.  Rachel runs a fertility blog and allows couples to share their fertility stories online.

Do You Cause Your Child's Cavities?
©Sergey Nivens/

It’s sad to see a two year old child with horrible teeth.  At such a young age, children don’t really understand oral hygiene.  Many times, poor oral hygiene in a toddler is the result of parents who don’t understand oral hygiene.  Since most cavities are preventable, this topic fascinates me.  With children of my own,  I have done quite a bit of research on the oral hygiene of toddlers.

The American Academy of Pediatric Dentistry publishes various “policy papers” which inform the world the status of their position on certain issues.  In their paper entitled Policy on Early Childhood Caries (ECC), they spell out five mistakes that parents make that can have a detrimental effect on the oral hygiene of their children.

I’ll list those five mistakes and talk about what you can do as a parent to avoid hurting your child’s teeth.

Smiling Toddler Girl With Teeth

Five Mistakes That Can Give Your Child Cavities

1 – Putting infants to sleep with a bottle that contains sugar. Pretty much any drink that you would give your child to lull them to sleep contains sugar.  Fruit juice and milk both contain sugars that can cause plaque to fluorish and eat away their teeth.

If you must put your child to sleep with a bottle, the only safe beverage to fill it with is water.

2 – Breast feeding on-demand after your baby’s first tooth comes in. The book Pediatric Dentistry by Pinkham states the following:

Infants who are breastfed truly “on demand” may suckle 10 to 40 times in a 24-hour period and are at risk for the consequences of prolonged acid production.  Nevertheless, many feel that the benefits of breastfeeding outweigh any harmful effects.  Dentists should advise mothers who breastfeed on demand to clean their infant’s teeth frequently, verify that systemic fluoride intake is optimal, and monitor dietary habits carefully.

Each time your baby eats, you expose his or her teeth to the harmful acids that plaque produces.  By setting a schedule to feed your baby, you can drastically reduce the opportunities that bacteria have to cause trouble in your child’s mouth.

3 – Not weaning your child from a bottle after they turn one. The American Academy of Pediatric dentistry says that “Parents should be encouraged to have infants drink from a cup as they approach their first birthday.  Infants should be weaned from the bottle at 12 to 14 months of age.”

When a child drinks out of a cup, they can drink the same quantity of liquid much more quickly than if they were drinking out of a bottle.  By not weaning your toddler from a bottle or sippy cup, you will increase the amount of time that their teeth are exposed to the sugar in their drinks, and increase their risk of getting cavities.

Although it may seem impossible to have your one-year-old child drink out of a cup, it is possible with the right training.   My wife and I began training our daughter to drink out of a small glass when she was 9 months old.  Her first glass was actually a shot glass with a small amount of water.  [Note: Neither my wife nor I drink alcohol, so we bought shot glasses for this very purpose.]  She still used this sippy cup to drink out of as well, but we gradually introduced a real glass, helping her at first.  After a while, she started to catch on.

Now, at fourteen months of age, she can independently drink out of this glass without spilling.  You might wonder why we used a real glass since it is breakable, but after she saw what happened when you drop it on the floor (which we promptly cleaned up) she hasn’t dropped another one!

4 – Habitually giving your child sugar-containing liquids in a bottle or no-spill training cup.

A paper by the American Academy of Pediatrics entitled The Use and Misuse of Fruit Juice in Pediatrics states:

It is prudent to give juice only to infants who can drink from a cup (approximately 6 months or older). Teeth begin to erupt at approximately 6 months of age. Dental caries have also been associated with juice consumption.  Prolonged exposure of the teeth to the sugars in juice is a major contributing factor to dental caries. The AAP and the American Academy of Pedodontics recommendations state that juice should be offered to infants in a cup, not a bottle, and that infants not be put to bed with a bottle in their mouth.  The practice of allowing children to carry a bottle, cup, or box of juice around throughout the day leads to excessive exposure of the teeth to carbohydrates, which promotes development of dental caries.

5 – Giving your child between-meal snacks and prolonged exposures to foods and juice or other beverages containing fermentable carbohydrates.

The Vipeholm Study was able to show us that it’s not just the amount of sugar that someone eats, but also the frequency with which the sugar is consumed that can cause tooth decay.

If you’re not sure what the Vipeholm Study is, you can read the article The Vipeholm Study: Learning About Dental Cavities.

If you can decrease the number of snacktimes that your child has per day, you will decrease the number of times that their teeth are weakened by the acidic by-products of plaque.


By following the above tips, you can ensure that your child will have healthy teeth.  Healthy teeth are valuable to a child’s self-esteem and overall health.  Following these tips can also start a habit of healthy eating that will remain with them throughout their life.

Do you have any questions or comments about your baby’s dental and oral health?  Please leave them below in the comments!

Bumps front Teeth Mamelons
©Jaimie Duplass/

Have you ever noticed the little bumps on a brand new permanent front tooth in your child’s mouth?

Mamelons on Lower Front Permanent TeethSometimes parents think that their children’s teeth have something wrong with them when they first notice these serrated edges on their kids’ front teeth.

Fortunately, there is nothing abnormal about these bumps and grooves.  They are completely normal — so normal, in fact, that there is a special name to describe these bumps: mamelons.  They appear due to the way that the permanent teeth develop.

The Serrated Bumps on the Permanent Incisors Are Mamelons

All teeth develop from what are called lobes.  Deep down under the gums, the different lobes all grow together, each one forming a different part of the tooth.  On the front teeth, the incisors, there are three lobes that come together to form the front of the tooth.  You can visualize where these lobes joined together by looking at the mamelons.  There was a front lobe on the left, one in the middle, and one on the right.

Here’s a close-up of the above photo displaying the mamelons in greater detail:

Mamelons Large View
The three bumps on the lower middle front teeth are known as mamelons. They appear on all newly erupted permanent incisors.

Why Don’t Adults Have Mamelons On Their Front Teeth?

Usually mamelons are only present for a short time.  Since they are uneven and rather thin, they tend to wear away pretty quickly as the child uses his or her new permanent teeth to chew their food.  Interestingly enough, not long ago, I screened a new patient for treatment at the dental school and noticed that he still had his mamelons present.

Mamelons can still be found on the front teeth of some adults when their teeth don’t come together in the way that they should.  For example, if someone bites together and their front teeth don’t touch, then the mamelons won’t ever contact their opposing teeth.  Because they don’t contact their opposing teeth, they don’t have a chance to get worn down (unless you’re chewing rocks, but then you’d probably have more to worry about than just keeping your mamelons!)

Adults who still have their mamelons and don’t like their appearance can go to any dentist and have them smooth them out for a more aesthetic look.


If your child has bumps on their front teeth, don’t be alarmed!  It’s completely normal to have these bumps on permanent front teeth — it would be abnormal to not have them.

If you have any questions or comments about mamelons – the serrated edges on the front permanent teeth, please leave them in the comments section below.

How Spacers Space Maintainers Look In Your Child's Mouth
©Jaimie Duplass/

A few months ago, I wrote an article detailing why it would be necessary for a child to get a space maintainer.  A space maintainer is commonly referred to as simply a spacer.

A Child That Has Lost a Tooth PrematurelyIn the picture to the left, you can see how the lower teeth of a six year old child might appear with a missing baby tooth — the first molar.  Let’s say that this kid didn’t brush his teeth a lot and ended up needing his first molar extracted because of a large cavity that couldn’t be fixed.

If the dentist simply removed that tooth and sent the child home, that kid’s permanent tooth would probably never come in!

Under normal circumstances, all of the teeth in the mouth exert pressure on each other, which holds them in their proper position. When a tooth is lost, the teeth next to the lost tooth will move into the lost space since the lost tooth can no longer exert its pressure on the adjacent teeth. Also, the teeth above the lost tooth will erupt a little more to fill in the space below.

The picture below shows what happens if a space maintainer is not placed after a baby tooth gets extracted.

Tooth Loss - The Space Fills In
When a tooth is lost, the teeth around it are eager to fill in the empty space

Why Teeth Move

Many people wonder why teeth want to move to fill in the gap when a neighboring tooth is extracted.  Here’s an analogy to illustrate why teeth move.

Large CrowdLet’s say there’s a giant crowd of people waiting in line for the chance to read the latest article on Oral Answers.  Now suppose that one person decides he’s sick and tired of waiting and decides to leave.  When he leaves, there is a small opening in the crowd where he used to be excitedly waiting.  Does the crowd leave that space open?  No!  The people that were waiting right next to the space where that guy used to be waiting move to fill it in the empty space that he left behind.

That’s pretty much how it works in the mouth.  When there’s an empty space, teeth move to fill it in.

A Space Maintainer Maintains The Old Space

A space maintainer will conserve the space left by the extracted tooth.  That way, when the permanent tooth starts to grow into the mouth, there will be lots of room for it to fit in perfectly.

Here’s a space maintainer that I made during my pediatric dentistry lab earlier this year.

A Birds Eye View of a Space Maintainer - Spacer
Here is a top view of a band and loop space maintainer.

Here’s another view:

A Dental Space Maintainer - Spacer
A side view of a space maintainer. This is how the space maintainer would look if you were sitting on the inside of your child’s cheek.


If a space maintainer is not used, the jaw may never grow to its full potential and consequently it might not have room for all of the permanent teeth, necessitating the removal of some teeth along with orthodontic treatment (braces).

Do you have any questions or comments about space maintainers (spacers)?  Leave them in the comments below and I’ll get back with you!

Baby Tooth Knocked Out Child
©Paul Binet/

What should you do when your child comes to you crying with a bloody mouth and a tooth in their hand? A normal reaction to this scenario is panic. However, if you know what steps to take, you could prevent permanent damage to your child’s teeth.

What to Do When a Baby Tooth Gets Knocked OutThe American Dental Association estimates that by the time kids graduate from high school, one in three boys and one in four girls will have suffered some sort of traumatic injury to their teeth. Also, baby teeth are a lot easier to knock out than permanent teeth because their crowns (the top part of the tooth that is visible in the mouth) are a lot longer than their roots (the bottom part of the tooth that’s hidden under the gums.)

Most caring parents wonder what they should do when their child knocks out a tooth. It is critical that parents are informed so they do not inadvertently damage the permanent tooth that is developing underneath the baby tooth in their child’s mouth.

A couple of days ago, I wrote about the steps you should take when a permanent tooth gets knocked out. With permanent teeth, you want to put them back in the socket as soon as possible. However, when you are dealing with a baby tooth you may not want to put it back in because you could end up damaging the permanent tooth that is still developing below your child’s gum-line.

Spacer Space Maintainer Teeth
©Tatyana Vyc/

Whenever a tooth is lost, the teeth on either side of it move towards the empty space to try to fill it in.

SA Red Headed Boy with Baby Teethometimes this can be a good thing, like if your orthodontist has to extract a tooth due to crowding.  After the tooth is extracted, the teeth adjacent to it move together and line up perfectly to create a beautiful smile.

Other times, this movement can be a bad thing.  Let’s say a little boy named Johnny with baby teeth and his six year molars lost his baby second molar (the second tooth from the back after the six year molars have come in) because he had too many cavities in it and it was too far decayed to try to put a filling in it.  The six year molar (the last tooth – at the very back of the mouth) would move forward to fill that space.

The problem is, Johnny has a permanent tooth right under that baby second molar that may not be able to come into his mouth if the six year molar has moved forward to fill that space.  This permanent tooth may give up trying to come up into Johnny’s mouth and may never come into his mouth, but just stay lodged deep within his jaw.  It could also try to force its way out sideways and cause big problems for Johnny (and his parents who are paying the bill!)