At what age do children's primary teeth typically start erupting?

Primary Teeth Eruption Timeline in Children

Primary teeth typically begin to erupt at around 6 months of age, with most children having all 20 primary teeth by age 3 years. 1

Normal Eruption Timeline

The eruption of primary teeth follows a relatively predictable pattern:

• Initial eruption: Around 6 months of age 1, 2
• First teeth to erupt: Usually the lower central incisors (bottom front teeth)
• Completion of primary dentition: By approximately 3 years of age 2
• Maxillary incisors (upper front teeth): Typically present from 12 months to 6 years of age 1
• Exfoliation (loss) of maxillary incisors: Usually occurs between 5-7 years of age 1
• First permanent molars: Begin erupting around 5-6 years of age 3

Common Symptoms Associated with Teething

Teething can be accompanied by various symptoms that may cause discomfort:

• Fever: Occurs in approximately 16% of teething children 4
• Drooling: Present in about 12% of teething children 4
• Diarrhea: Seen in approximately 8% of teething children 4
• Combinations: Fever-drooling (15%), fever-diarrhea (8%), drooling-diarrhea (6%) 4
• Other symptoms: Sensitive and painful gums, mouth ulceration, feeding difficulties, lack of sleep, and crying 2

These symptoms are most prevalent during the eruption of primary incisors and tend to decrease as children get older, with significantly fewer symptoms in the 25-36 month age group compared to younger children 4.

Oral Health Considerations

Early childhood caries (ECC) is a significant concern that can affect newly erupted teeth:

• Definition: Tooth decay in any primary tooth in a child younger than 6 years 1
• Causative organism: Primarily Streptococcus mutans 1
• Window of infectivity: Children typically acquire S. mutans between 19-31 months of age 1
• Risk factors: Poor oral hygiene, prolonged bottle or breast feeding, frequent consumption of sugary drinks/snacks 1

Recommendations for Parents

First Dental Visit

• American Academy of Pediatric Dentistry (AAPD): First oral examination should occur within 6 months of the eruption of the first primary tooth but no later than 12 months of age 1
• American Academy of Pediatrics: Recommends initial dental evaluation at 24 months of age 1

Home Oral Care

• Begin cleaning the child's gums before teeth erupt
• Start brushing teeth as soon as they appear
• For children under 3 years: Use a rice grain-sized amount of fluoridated toothpaste 1
• For children 3-6 years: Use a pea-sized amount of fluoridated toothpaste 1
• Parents should assist with brushing until the child develops adequate manual dexterity (usually around age 6) 1

Managing Teething Discomfort

• Cold teething rings can provide relief 2
• Over-the-counter treatments such as analgesic and anesthetic gels may help relieve pain and inflammation 2

Preventive Measures

Fluoride

• Community water fluoridation has been associated with a 40% reduction in caries 1
• Fluoride supplementation should only be prescribed when drinking water has suboptimal fluoride levels 1
• Caution with fluoride use is important as excessive fluoride during tooth development (particularly at ages 15-30 months) can cause enamel fluorosis 1

Dietary Recommendations

• Limit frequency of fermentable carbohydrates 1
• Avoid prolonged bottle or breast feeding, especially during sleep 1
• Reduce consumption of sugar-containing drinks and high-frequency sugary snacks 1

Monitoring for Complications

• Watch for signs of dental caries, which can develop rapidly in primary teeth
• Monitor for signs of pulpal necrosis in traumatized teeth, which may appear as gray discoloration or gingival abscess 1
• Be alert for potential signs of child abuse in children under 5 years with unexplained or unusual oral/dental trauma 5

By understanding the normal eruption pattern and implementing appropriate preventive measures, parents can help ensure optimal oral health for their children during this important developmental stage.