Baby's first teeth: teething, brushing, fluoride and the first dental visit without false remedies

Short answer: a baby's first primary teeth most often appear between 4 and 7 months, although earlier or later eruption can still be normal. As soon as a tooth breaks through the gum, an adult should clean and brush it with a small soft toothbrush and a very small amount of age appropriate fluoride toothpaste. Teething can cause drooling, tender gums, an urge to chew, irritability and sometimes a slight temperature increase, but it does not explain a high fever, significant diarrhoea or a baby who looks genuinely unwell.

The topic sounds simple, yet parents receive surprisingly contradictory advice. Different fluoride concentrations are still recommended on different French pages, amber necklaces are marketed as natural remedies, numbing gels are offered without enough caution and eruption calendars are sometimes treated as rigid developmental standards. This guide therefore separates four questions: what normal teething can look like, what can relieve discomfort safely, what genuinely helps prevent tooth decay and what calls for medical or dental advice.

This information mainly concerns otherwise healthy infants and young children. Oral malformations, chronic disease, medicines affecting teeth, disability that makes brushing difficult or a high caries risk may require individual follow up. A dentist is the appropriate professional to adapt fluoride advice, assess a lesion and examine a tooth that looks unusual.

When do a baby's first teeth usually appear?

French Assurance Maladie states that the first tooth most often erupts between 4 and 7 months. A first tooth at 3 months can occur, while some healthy children are considerably later. The 20 primary teeth appear progressively and are generally present before age 3.

The eruption chart is therefore a reference rather than a competition. Two babies of the same age can have very different numbers of teeth without either one being “behind”. Lower central incisors are often among the first to appear, but the exact sequence varies.

A chart is useful when it helps parents anticipate toothbrushing or understand temporary discomfort. It becomes unhelpful when every tooth is compared with a theoretical week. If no tooth appears well beyond the usual range or you notice an unusual shape, colour or gum appearance, a dentist or the clinician following the child can review the situation.

What is actually happening during teething?

Primary teeth develop inside the jaws and gradually move until they pass through the gum. This process can make the local area swollen, sensitive or painful. Babies often want to chew because pressure against the gum can temporarily reduce discomfort.

Teething does not begin only at the moment a white point becomes visible. Prospective research has found some mild symptoms to be more common during several days around tooth emergence. This helps explain why a baby may be irritable before parents can actually see the tooth.

Responses vary widely. Some babies seem barely bothered. Others drool heavily, chew everything and sleep less well for a few days. One tooth can be difficult while the next appears almost unnoticed. If crying becomes hard to interpret, our guide to why babies cry helps place teething among other common causes instead of attributing everything to teeth.

Which symptoms are compatible with teething?

Assurance Maladie lists tender or swollen gums, increased drooling, an urge to chew, irritability, sometimes reduced appetite and disrupted sleep among possible teething signs. Red cheeks or irritation around the chin can occur because of frequent saliva on the skin.

A slight rise in temperature may occur, but it is risky to attribute every fever to teeth. French public guidance states that teething does not cause fever above 38 °C, deterioration in general condition or diarrhoea. A systematic review of primary tooth eruption and fever did not establish significant fever as a reliable normal teething symptom.

The practical message is simple: a baby who drools and chews while otherwise remaining well may indeed be teething. A baby who is listless, significantly febrile, vomiting, breathing abnormally or having substantial diarrhoea should be assessed for another cause rather than dismissed with “it's just the teeth”. For genuine digestive changes, our guide to infant bowel habits, gas and digestion helps separate digestive symptoms from a coincidence with teething.

Table: likely teething or another problem to look for?

The simplest relief: gentle pressure on the gum

With clean hands, gently rubbing the gum with a finger or clean damp cloth can help some babies. The pressure should remain gentle. The goal is not to “push the tooth through” and there is no benefit in pressing hard enough to cause pain.

A clean teething ring that meets relevant safety standards can also be offered after refrigeration. Assurance Maladie advises against freezing the ring because an object that becomes extremely cold and hard can injure the gum. It also recommends avoiding liquid filled rings that could leak if damaged.

If the child is developmentally ready for solid food, a cool food appropriate to their feeding stage may feel soothing. Our guide to complementary feeding explains that every food must still be appropriate for choking risk. A hard raw piece of food is not a teething toy.

Why amber teething necklaces are a poor choice

Amber necklaces and bracelets are sometimes marketed as if contact with the skin could reduce teething pain. There is no strong clinical evidence of a useful analgesic effect. There are, however, clear mechanical risks: strangulation from the necklace and choking if a bead comes loose.

Assurance Maladie advises against teething necklaces. The US Food and Drug Administration has also reported deaths and serious injuries associated with teething jewellery. Calling an object “natural” does not make it safe around an infant's neck.

The same principle applies more broadly: nothing offered for chewing should contain small detachable pieces, and no necklace should be left around a baby's neck as a pain treatment.

Numbing gels: distinguish self medication from professional prescribing

French public guidance advises parents not to apply anaesthetic teething gels on their own. A baby can swallow the product and some local anaesthetics can interfere with swallowing or cause serious toxicity if too much is used. The FDA specifically warns against benzocaine or viscous lidocaine products for teething pain in infants and young children.

A separate 2025 French professional dental document notes that some dental gels may be prescribed with precise dosing instructions. These messages are not necessarily completely contradictory. The consumer warning is about unsupervised use of unsuitable numbing products, whereas a professional document describes a specific product being prescribed in a defined clinical setting.

For parents, the safest rule is not to buy and apply a numbing gel without advice. If discomfort seems to require medicine or a topical product, ask a pharmacist, doctor or dentist which product is appropriate for the child's age and exactly how it should be used.

Paracetamol: do not turn every tooth into routine medication

Teething does not automatically require medicine. When a child is genuinely uncomfortable, paracetamol may be considered according to age, weight, the product leaflet and professional guidance. Paediatric dosing is weight based and should not be estimated with an ordinary household spoon.

Avoid alternating several pain medicines without advice. Non steroidal anti inflammatory medicines have specific precautions, including dehydration and suspected chickenpox. Aspirin should not be given to a child without medical direction.

A baby who seems to need pain relief repeatedly for many days deserves reassessment. Ear infection, mouth lesions or another illness may be responsible for the pain rather than ongoing tooth eruption.

Brushing starts with the first tooth, not with school

A primary tooth can develop decay from the time it is exposed in the mouth. Current Assurance Maladie guidance therefore recommends cleaning and brushing from eruption. Its page updated in July 2026 recommends a small soft toothbrush, a smear of fluoride toothpaste and brushing by the parent in the morning and evening.

The 2025 French child health record gives the same general message: oral hygiene begins when teeth erupt, with fluoride toothpaste twice daily. It describes a smear of toothpaste up to age 3, followed by a pea sized amount up to age 6.

At the beginning, the exact duration does not need to become a battle with a moving infant. The practical goal is to clean the available tooth surfaces regularly and build a routine. The adult performs the brushing because an infant clearly does not have the motor skills to clean teeth effectively.

Which fluoride toothpaste should you use when French sources do not all say the same thing?

This is one of the most confusing parts of infant oral health advice in France. A detailed Assurance Maladie page about primary teeth still reproduces older recommendations suggesting toothpaste at or below 500 ppm fluoride before age 3. The related HAS recommendation is old and itself relies on advice dating from 2008.

In contrast, the French Union for Oral Health, UFSBD, has updated its recommendations and in its 2025 table recommends a smear of 1,000 ppm fluoride toothpaste from the first teeth, twice daily, with the amount adapted to age and caries risk. UFSBD explicitly notes that older French low concentration guidance is no longer aligned with international evidence. The American Academy of Pediatric Dentistry also recommends a tiny smear of fluoride toothpaste as soon as teeth erupt.

The general Assurance Maladie brushing page updated on 6 July 2026 avoids specifying one infant concentration. Instead it recommends fluoride toothpaste at a concentration appropriate for age and advises asking a dentist. Given this coexistence of French documents written at different times, this guide does not present an old threshold as if there were no professional disagreement.

Practical approach: brush from the first tooth twice daily with a very small amount of fluoride toothpaste. To choose the exact concentration, check the product's age guidance and ask a dentist, especially when caries risk is higher. If following the UFSBD 2025 professional recommendation, the concentration is 1,000 ppm with only a smear before age 3. The small quantity matters because young children swallow some toothpaste.

Why fluoride helps, and why more is not automatically better

Regular topical fluoride helps enamel resist acid attacks and supports remineralisation. The preventive value of fluoride toothpaste is well established, and paediatric dental organisations recommend its use from the first teeth.

In a very young child, the aim is repeated contact with a useful amount of fluoride while limiting ingestion. Excessive chronic fluoride exposure while teeth are developing can contribute to dental fluorosis. This is why the amount on the toothbrush is tiny and toothpaste should be stored out of reach.

Fluoride drops or tablets should not be added automatically. They require assessment of the child's other fluoride sources and individual caries risk.

Do you need to clean the mouth before the first tooth?

Before eruption, there is no exposed tooth at risk of dental caries. Some parents like to wipe the gums gently with a damp cloth to familiarise the baby with mouth care. This can be done carefully, but it does not replace toothbrushing once a tooth appears.

There is no need to apply toothpaste to toothless gums simply to “start fluoride early”. The key transition is eruption of the first tooth.

Primary teeth really matter

Because they eventually fall out, primary teeth are sometimes treated as less important. They are essential for chewing, contribute to speech and help maintain space for the developing permanent teeth. Deep caries can cause pain, infection and feeding difficulty long before a tooth would naturally be lost.

Early childhood caries is a multifactorial disease. A recent systematic review found that risk involves multiple factors including sugar exposure, oral hygiene, family context and previous dental disease. It would be misleading to reduce caries to one food or one imperfect brushing session.

Sugar and frequency: think in repeated exposure opportunities

Plaque bacteria use fermentable sugars and produce acids that attack enamel. Frequency matters because repeated snacks and sweet drinks create repeated acidic periods in the mouth.

Assurance Maladie advises against putting a child to bed with a bottle of milk, juice or another sweet drink and against letting a child carry a sweet drink around for prolonged periods. Once teeth are present, long contact with sugars during sleep is particularly relevant because saliva flow decreases at night.

During complementary feeding, water remains the reference drink outside age appropriate milk feeds. So called teething biscuits are not required to relieve gums and French guidance advises against them because they add sugar exposure without proven pain relief.

Should parents avoid sharing a spoon or licking a dummy?

French oral health guidance advises against tasting a child's food with the same spoon and against licking a dummy to “clean” it. Some bacteria associated with dental caries can be transferred in saliva.

This does not mean parents need to become anxious about every family contact. The advice is mainly aimed at repeated habits that are easy to avoid. The parent's own oral health matters too, so looking after adult teeth contributes to a healthier household environment.

When should the first dental visit happen?

UFSBD recommends a first dental visit within six months after the first tooth erupts and no later than the child's first birthday. The American Academy of Pediatric Dentistry gives the same general timing for establishing a dental home.

This first visit is not about performing unnecessary treatment on a healthy baby. It allows the dentist to examine the mouth, assess caries risk, demonstrate brushing, discuss fluoride, feeding and habits such as dummy use, and help the child become familiar with the setting before a painful problem occurs.

If the first birthday has already passed without a dental visit, it is not “too late”. Simply arrange an appointment at the next reasonable opportunity.

What if the baby refuses toothbrushing?

Cooperation varies enormously at this age. A baby may open their mouth one evening and resist the next. Brushing remains an adult responsibility, but the routine can be made more predictable.

• Choose a time when the child is not already exhausted or very hungry.
• Use the same short routine each day.
• Let the baby hold a second toothbrush while you use the cleaning brush.
• Position the baby securely with the head supported and good visibility of the mouth.
• Keep the process brief but complete rather than turning it into a long negotiation.
• Do not replace brushing with dental wipes once several teeth have erupted.

The goal is not independent brushing at age one. The French child health record reminds parents that an adult performs brushing for young children. Independence develops gradually over several years.

What if a tooth looks stained, broken or unusual?

A chalky white spot close to the gum can sometimes be an early sign of demineralisation. A brown mark, cavity, broken tooth or pain with eating deserves a dental appointment. The earlier decay is identified, the more straightforward preventive or conservative options can be.

A tooth injured in a fall should also be assessed if it is very loose, bleeding, changes colour or interferes with eating. Do not try to reimplant an avulsed primary tooth yourself in the way that may be considered for some permanent teeth.

When should you seek prompt advice for supposed teething?

Assurance Maladie advises medical review when teething pain is substantial, temperature rises above 38.5 °C, other symptoms are present or the child does not seem like themselves. In a very young infant, any fever requires particular caution according to age and usual medical guidance.

Also seek advice if the child refuses fluids, shows signs of dehydration, vomits repeatedly, has significant diarrhoea, has difficulty breathing, is unusually drowsy or if the pain appears to come from an ear or another part of the mouth.

A common error is missing an infection simply because the child's age matches the age when teeth often erupt. Age coincidence is not a diagnosis.

Key points

• The first tooth often appears between 4 and 7 months, with wide normal variation.
• Drooling, chewing, gum tenderness and irritability can accompany eruption.
• High fever, significant diarrhoea or a generally unwell baby should not be attributed to teeth.
• Simple safe comfort measures include gentle gum massage and a clean refrigerated, not frozen, teething ring.
• Amber necklaces add risk without proven pain relief.
• Numbing gels should not be used as unsupervised self medication in babies.
• Fluoride toothbrushing begins with the first tooth and is performed by an adult.
• French sources have not all been updated at the same pace on fluoride concentration; UFSBD 2025 recommends 1,000 ppm using only a smear before age 3.
• A first dental visit can be arranged within six months of the first tooth and by around age one according to paediatric dental organisations.

Frequently asked questions

At what age does the first tooth appear?

Most often between 4 and 7 months, but a tooth can appear earlier or later. Sequence and pace vary considerably between children.

Can teething cause a temperature of 39 °C?

No. A temperature that high should not be attributed to teeth. French guidance states that teething does not cause fever above 38 °C. Another cause should be considered according to the child's age and condition.

Can teething cause diarrhoea?

Significant diarrhoea is not considered a normal teething symptom in French guidance. It can coincide with eruption, but persistent or substantial diarrhoea should be assessed as a separate problem.

What kind of teething ring is safest?

Choose a product that meets relevant safety standards, is easy to clean and has no small detachable parts. A solid ring is preferable to one that can leak. It can be refrigerated but should not be frozen hard.

Can I give a raw carrot for chewing?

Not to an infant who cannot safely manage that texture. A hard piece can break off and cause choking. Food offered during teething still needs to match the child's complementary feeding skills.

Do amber necklaces work?

There is no strong evidence of useful pain relief, while strangulation and choking are recognised risks. They are not recommended.

Can I use a teething gel?

Do not use a numbing gel on your own. Ingredients such as benzocaine or lidocaine can be dangerous in young children. If a healthcare professional recommends a specific product, follow the exact product and dose prescribed.

When should toothpaste be introduced?

From the first tooth according to current guidance, using a very small amount of fluoride toothpaste with a concentration appropriate to age and caries risk.

Should a baby use 500 ppm or 1,000 ppm fluoride toothpaste?

French documents are not fully synchronised. Older recommendations still reproduced on some public pages suggest up to 500 ppm before age 3, while UFSBD now recommends 1,000 ppm with only a smear from the first teeth. Ask a dentist to align concentration with current guidance and the child's caries risk.

How much toothpaste should be used before age 3?

Only a tiny smear, not a strip covering the brush. The 2025 French child health record uses the “smear” reference up to age 3, helping limit swallowing.

Do I really need to brush one tiny tooth twice a day?

Yes. Brushing begins at eruption even when only one tooth is present. The routine can be brief and is carried out by the adult.

Should a baby rinse after toothpaste?

An infant cannot rinse and spit reliably. Use only the tiny amount recommended and follow the dentist's advice for the chosen toothpaste.

When should the first dental appointment be?

UFSBD and AAPD recommend planning it within six months after the first tooth appears and no later than around the first birthday.

Does a decayed baby tooth need treatment if it will fall out?

Yes. Caries can cause pain, infection and feeding difficulty and can affect the space needed for permanent teeth. Disease in a primary tooth should not be ignored.

Why avoid a sweet bottle at bedtime?

Saliva flow decreases during sleep. Prolonged contact between teeth and milk, juice or another sweet drink increases exposure to sugars and bacterial acids, which favours caries.

My baby is one and has no teeth. Is that serious?

Late eruption can still be an individual variation. Mention it to the doctor or dentist, particularly if there are other growth or developmental concerns, so the mouth and overall context can simply be checked.

Conclusion

First teeth do not require a cupboard full of remedies or a day by day eruption schedule. Most teething discomfort can be managed with simple measures: comfort, gentle gum pressure, a safe teething object and attention to the baby's general condition. Symptoms that look like genuine illness should not be blamed on teeth.

Prevention begins at the same time as the first tooth: adult assisted brushing, a tiny amount of appropriate fluoride toothpaste, fewer repeated sugar exposures and an early dental visit. Fluoride is a good example of why the publication date of guidance matters. When an older public page and a newer professional recommendation give different concentrations, it is better to explain the difference and choose according to current dental advice than to hide the discrepancy.

Verified sources and bibliography

1. Assurance Maladie, Comprendre les poussées dentaires, 20 June 2024, accessed 7 September 2026. French source.
2. Assurance Maladie, Les symptômes de la poussée dentaire, accessed 7 September 2026. French source.
3. Assurance Maladie, teething relief and when to seek advice, accessed 7 September 2026. French source.
4. Assurance Maladie, Comment bien se brosser les dents ?, updated 6 July 2026. French source.
5. French Ministry of Health, Child Health Record, 2025 edition, oral health section.
6. UFSBD, fluoride concentration recommendations for toothpaste, 2025. French professional guidance.
7. American Academy of Pediatric Dentistry, Policy on Early Childhood Caries, revised 2025.
8. US Food and Drug Administration, Safely Soothing Teething Pain in Infants and Children, accessed 7 September 2026.
9. Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review, 2022.
10. Association between Fever and Primary Tooth Eruption: A Systematic Review and Meta analysis, 2017.
11. Khan et al., A systematic review of caries risk in children under 6 years, 2024.

General information based on guidance available on 7 September 2026. It does not replace examination by a doctor or dentist, particularly for fever, deterioration in general condition, significant pain or a dental lesion.