Pediatric Dentistry


Authored By: Nayda Rondon 

Teething occurs when your child’s “baby” or “milk” (primary or deciduous) teeth break through the gum and start to grow in. Teething, or primary tooth eruption, usually begins around six months of age, but it is normal for teething to start at any time between three to 12 months of age.
The front teeth are the first to erupt at around six to eight months; the back teeth erupt between 18 and 24 months. Teething, sometimes referred to as “cutting teeth,” occurs until all 20 primary teeth are in place. This is normally around two years of age.

Normal Teething Sequence

Exactly when and how teething begins seems to be hereditary, does not have anything to do with the baby’s health, and tends to occur earlier in females than in males. However, if primary tooth eruption has not begun by 15 or 18 months, consult a pediatric dentist. While teething or eruption patterns vary greatly from child to child, primary teeth typically emerge in a specific sequence. The general eruption pattern is:

  • Two bottom front teeth (central incisors)
  • Four upper front teeth (central and lateral incisors)
  • Two lower lateral incisors
  • First molars
  • Four canines or eye teeth (on either side next to the upper and lower lateral incisors)
  • Remaining molars on either side of the existing teeth

When a child is five or six years old, the primary teeth start falling out because the permanent (secondary) teeth are erupting underneath them, pushing them out. The eruption of permanent teeth occurs in the same approximate manner and sequence as primary teeth. By about age 14, children have 26 permanent teeth, and at about age 16, four additional teeth called wisdom teeth or third molars.

Teething Symptoms

Experts disagree about whether teething actually causes symptoms — like fussiness, coughing, fever and diarrhea — or whether it is just a coincidence that these common maladies occur at the same time as teeth are erupting. While some lucky parents report no apparent negative side effects, many others maintain that their teething babies do suffer discomfort. 
If your child is showing discomfort during teething, the symptoms he/she may experience include:

  • Excessive drooling, which may lead to a rash on the face or chest
  • Gum swelling and sensitivity
  • Irritability or fussiness
  • Low-grade fever
  • Refusing food
  • Rubbing of ears and cheeks
  • Sleep problems
  • Urge to bite on hard objects

As a tooth erupts, a watery sac (eruption cyst) may develop. Eruption cysts are usually harmless and should be left alone. As a tooth pushes through the gum, it will eventually rupture the sac.
If symptoms develop during teething, they usually occur approximately four days before and up to three days after the tooth erupts. 
Mild teething symptoms that gradually improve should not cause concern. However, contact your pediatrician if your baby’s symptoms are severe or persist. Fever, diarrhea, frequent ear pulling, coughs and severe diaper rashes are not normal teething symptoms. You should be especially concerned if your child has a rectal temperature of 101 degrees Fahrenheit or higher (100.4 degrees Fahrenheit or higher for babies younger than three months). When in doubt, consult with your pediatrician to determine whether your baby is showing signs of a problem that requires medical attention.

Alleviating Teething Symptoms

There are several ways you can bring your child relief from teething symptoms, including:

  • Use a cold, wet cloth for your baby to suck as a way to soothe gums. Clean the cloth after each use.
  • Consider a pacifier, teething ring or other teething accessories and toys your child can chew. Make sure the object is big enough so it can’t be swallowed or break into small pieces. Stay away from liquid-filled rubber teething rings, which can break or leak, and do not freeze them to the point that they are frozen solid, as this may only aggravate sensitive gums.
  • Gently rub your child’s gums with a clean finger, a small, cool spoon or a wet gauze pad.
  • If drool causes a rash on your child's face or chest, wipe the drool away often with a soft cotton cloth, or gently dab petroleum jelly on the affected area.
  • If your child is eating solids, offer cold foods and liquids, like applesauce, pureed peaches or yogurt.
  • Give your baby a mild pain reliever that is labeled for his/her specific age, but NEVER without first consulting your pediatrician to see if it is all right to do so, and if so, what the right dosage should be.

Keep in mind that although many parents use topical gels and other teething remedies, many experts question how effective and safe these products really are. Before using any kind of medication or remedy, speak with your pediatrician about specific product safety, dosage and usage issues. If you are using medication to comfort your child, double check with your pediatrician to make sure there isn't another cause for his/her symptoms, such as a viral or ear infection.
There are a number of palliative treatments to avoid when alleviating teething symptoms, including:

  • Do not use teething powder or aspirin on your baby's gums. Breathing in small particles of either can cause lung problems. Aspirin should not be given to children because it has been associated with Reye's syndrome, a rare but potentially life-threatening disease.
  • Do not cut gums to make it easier for teeth to erupt, as this may lead to infection.
  • Do not give your baby any type of alcohol, as this may be harmful. Read medicine labels carefully to avoid products that list alcohol as one of the first ingredients.
  • Do not tie teething rings around your baby’s neck as they may pose a strangling hazard.
  • Do not let your baby fall asleep with a bottle. The milk or juice can cause tooth decay and dental plaque



The Creator in His wisdom, gave us two sets of teeth, knowing full well that many if us would not succeed with the one set of teeth. Most people, for a number of reasons, even have varying success with the second set and have to make do with substitutes which, thanks to advanced modern technology, are increasingly successful.

In the beginning there are just gums, but, from about three to six months, teeth begin to emerge and teething continues until the “baby” teeth are through by about the age of 3 years. Some fortunate babies have no problems with this teething period, whilst others become irritable and difficult to pacify. They cry a lot, want to be held all the time and dribble constantly.

What can you do to erase this discomfort?

  1. Pressure and a firm massage with a clean finger can ease the pain.
  2. A teething ring, rusk or peeled carrot can be your saving grace. Biltong can be handy, but not too often because if its saltiness. Be careful of anything unhygienic or objects that may splinter or break in the mouth causing choking, especially if your baby has enough teeth to bite off bits of carrot or biltong, and of course, avoid anything that may become lodged in the throat.
  3. Gel or liquid-filled teething rings are designed to be put in the fridge (not the freezer) and these will cool and soothe sore gums.
  4. Sugar-free teething gel applied to the sore area will soothe and numb the gum. It is often helpful to apply the gel 15 minutes before meals. If teething pain is particularly severe and keeping your baby awake, paracetamol syrup will help, but remember that teething will go on for quite a long time so it’s not advisable to rely on this.
  5. Homeopathic infant remedies such as Chamomilla or Pulsatilla powders can be given as directed by your homeopath.
  6. Aromatherapy. Add 1 or 2 drops of chamomile or lavender oil to a vaporizer and place in your baby’s room.

Warning: if your baby cries persistently, is off her feeds and is generally displaying symptoms of being unwell, you should not always assume that this is “only” teething. For example, your child may complain of earache because the pain being transferred along the nerve feels as if it is coming from the ear. However, the most likely cause is that there is an ear infection and you should consult your doctor. Also high temperatures, diarrhoea, convulsions or vomiting are not caused by teething and should be treated by your doctor.

In the next couple of issues we will cover the various common oral conditions that afflict us and the treatments that are available in a modern dental practice. If you have any topics you would like addressed, or questions answered, please correspond with us at 49 Victoria Road, Camps Bay, or phone / fax us on 021-438-1710

Dr P Brogneri


And then there were teeth…..

The first teeth to appear at about seven months are the primary incisors and these are followed by the first set of deciduous molars. By approximately two years old, all twenty of the “baby” teeth are present and tooth brushing should be part of your child’s daily routine.

The mouth has a natural bacterial flora, consisting of about five hundred different types of bacteria. Bacterial build up on teeth is termed “plaque”, and even though it looks like the remains of yesterdays’ lunch, it actually consists of saliva, normal oral bacteria and minute particles of food. All three of these have to be present for bacteria to form. Saliva and bacteria are inherent in the mouth, but food particles can be easily removed after meals by brushing or flossing. Plaque formation, and the problems caused by it, namely caries and periodontal disease, can be largely prevented by regulating the intake of various foods and practicing good oral hygiene.

Caries (tooth decay) is the most common disease in the world, and is caused by plaque that accumulates on the teeth. If plaque is not removed it absorbs calcium and hardens on the teeth forming calculus or tartar, which breaks down sugars and releases acid as a breakdown product, thus softening the tooth enamel and allowing bacteria and acids to penetrate the surface. The tartar (or calculus) cannot be removed by brushing and must be removed by your dentist using special instruments. If left untouched the plaque will continue the decay process unhindered leading to teeth that are sensitive to cold and sweet things. Untreated, the caries will penetrate deeper into the dentine causing teeth to become heat sensitive. Once bacteria penetrate the pulp (nerve) chamber, spontaneous pain will occur and there is a possibility of an abscess forming.

Rather than let your children suffer with toothache, start the habit of brushing their teeth after every meal, or at least in the morning and evening; restrict their intake of sugary or acidic foods; and introduce them to the dentist once all their “baby” teeth are through at two years old.

Dr P Brogneri

Remember the Tooth Fairy

Tooth Fairy

Losing your baby teeth is a real sign that you are
growing up Very soon, new, grown up teeth will take
the place of the teeth you have lost. While you are
waiting, the Tooth Fairy may pay you a visit.

When you lose a tooth, you may be so excited
that you forget about the Tooth Fairy! Don’t
worry, it is not too late to see if she will visit you.
as soon as you remember, put the tooth into a shoe
next to your bed when you go to sleep. It’s a good idea to
tell other people in your family that you have done
this, so that they are not surprised if they hear
the flapping of the Tooth Fairy’s wings in the night.

The Tooth Fairy is rather shy. She is very happy
to help children everywhere, but she doesn’t like to be
seen herself. So make sure that you shut your eyes
tight and go to sleep as soon as you can. If she sees
that you are awake or just pretending, the
tooth Fairy may decide not to visit you this time.
sometimes the Tooth Fairy is very busy indeed. As she says herself,
she is only a little fairy and she cannot fly very fast. If it
seems that she has forgotten you, leave your tooth in your
shoe for a few days. She will certainly try to come soon.

What should you do if you lose a tooth you can’t find it?
don’t worry! Ask a grown-up to help you write a little note for
the Tooth Fairy explaining what has happened. Put that into
the shoe next to your bed – she is sure to understand.

Most important of all. Don’t forget that the Tooth
Fairy will be able to tell if you have been taking care of
your teeth properly. When she is very busy, she first visits
children who clean their teeth carefully.
Make sure you are one of those, wont you?