Teething

Teething is a normal process of the teeth coming up through the gums into the mouth. Teething does not cause fever, ear infections, runny nose, or diarrhea. Children should not use teething gels, prescriptions for lidocaine, or homeopathic teething tablets. All of these can be harmful to young children. Other comfort measures are safer and more effective.

Teething is the normal process of teeth pushing through the gums into the oral cavity. Teething is obviously common; every child will get teeth! Some children are more bothered by it than others; however, there are many myths and misconceptions about teething as well. If your child is bothered by teething, there are simple things you can do to make your child feel better. There are dangers to the common teething remedies and they are no longer recommended.

The average age of first tooth is 6 months, with a range of 3 to 12 months for the first tooth; however, the timing can vary and they seem to have a mind of their own. In fact, many children do not get any teeth until after 12 months old. This does not stop them from being able to eat table food around 9 months old. The teeth can come in in any order and at any time. It should be noted that all babies start to drool and chew on things around 3-4 months old; this does not mean they are teething. It is simply a normal part of infant development.

Despite popular opinion, teething does not cause fever, runny nose, or diarrhea. We have known this for years; however, recent research has shown that the only symptoms caused by teething are irritation of the gums, fussiness, and drooling. There may be temperature elevation in some children but it does not rise to the level of fever, and some children may have looser stools. Some children have or seem to have ear pain and rub their ears when they have gum irritation. Why the myths? Babies lose the antibodies they received from their mother through the placenta around 4-6 months old and they become more susceptible to common viral infections. The fussiness and fever and other symptoms during infancy are caused by viral infections that happen to occur at the same time as teething.

The primary teeth usually erupt in the following order:

  • Two lower central (middle) incisors (the two in the very front middle), around 6-9 months
  • Four upper incisors (the four in the front middle), around 8-12 months
  • The other two lower central incisors, around 9-12 months
  • Four first molars (two on top and two on bottom), around 12-18 months
  • Four canine teeth (“eye teeth”, the pointed ones), around 15-24 months
  • Four second (“two year) molars, around 24-30 months

Baby teeth are important! Start cleaning them as soon as they appear, with either a washcloth or baby toothbrush. You can start using a tiny amount of fluoride toothpaste at 6 months old. Learn more about caring for your baby’s teeth.

What are the symptoms?

  • Chewing more than normal
  • Drooling more than normal
  • Mild gum irritation or fussiness
  • A swollen area on the gum, may be red or bluish or bleed a little, especially molars at later ages
  • Decreased appetite or desire for sucking
  • Biting on things
  • The drooling may lead to rash on face
  • It may cause decreased sleeping but this is probably not very common
  • It can cause pulling or rubbing the ears and acting like ears hurt, due to the gum irritation.
  • Teething does not cause fever or runny nose. It might make the stools loose, but this is likely due more to diet changes while teething. It does not cause diaper rash.

What should I expect?

Children show symptoms for a day or two until the tooth breaks the surface. Studies have shown that symptoms tend to last only 1-3 days. Then the child feels better and the tooth continues to come out of the gums into the mouth.

How is it treated?

  • Chewing. The best treatment is to chew on something cold, like a chilled wet washcloth or chilled teething ring. Non-chilled items may work just as well for your child. Teething biscuits can be used in babies old enough for table food.
  • Gum massage. You can rub the gums with your finger or something cold for a few minutes if it seems to help.
  • Pain-relieving medication. Occasionally, acetaminophen (if older than 3 months) or ibuprofen (if six months or older) can be given if your child is particularly fussy, especially around bedtime. Ibuprofen probably works better than acetaminophen.
  • You may want to avoid spicy or salty foods in older children who are cutting teeth.
  • Do not use teething gels containing benzocaine. They can cause dangerous side effects in infants and toddlers.
  • Never use a prescription for lidocaine from a doctor for teething. Doctors should not prescribe lidocaine for teething; it can be dangerous or fatal.
  • Homeopathic teething tablets should NOT be used. See here for a discussion of homeopathy. Homeopathy is not same thing as natural or herbal. It is the giving of small doses poison to stimulate the body to cure the problem. In 2010 the most popular homeopathic teething tablets were recalled because there was too much poison in the tablets and some babies were poisoned. They seem to work because the main ingredient is lactose, which is milk sugar, which does calm babies. But the other ingredients are not safe and are based on a false theory.
  • There is no evidence, or basis in scientific theory, that amber necklaces will help teething. There is probably no harm from the amber; however, necklaces have led to strangulation in young children.

What complications should I look for?

Besides fussiness and maybe a little lost sleep or not feeding quite as well for a day or two, there are not really any complications.

When should I seek further care?

If your child has extreme fussiness, is not eating, has runny nose, fever, or diarrhea, don’t just say it is teething, but see your baby’s doctor. Teething does not cause those symptoms.

Summary

Teething is universal though some children seem to be more bothered by it than others. It does not cause fever, runny nose, or other symptoms of illness. It can be managed with chilled teething rings or washcloths, massage, and occasionally ibuprofen or acetaminophen. Teething gels and tablets are dangerous in young children and are not recommended.

Resources/More Information

Homeopathic Teething Tablets and Gels: FDA Warning – Risk to Infants and Children (9/30/2016)

FDA Safety Alert: Do Not Use Lidocaine for Teething Pain (6/26/2014)

Do Teething Babies Need Medicine on Their Gums? No (FDA Consumer Update) (9/4/2015)

References

Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics 2000; 105:747. PubMed 10742315

Massignan C, Cardoso M, Porporatti AL, et al. Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis. Pediatrics 2016; 137:e20153501. PubMed 26908659 DOI:10.1542/peds.2015-3501

Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Paiva SM. Prospective longitudinal study of signs and symptoms associated with primary tooth eruption. Pediatrics 2011; 128:471. PubMed 21824888 DOI:10.1542/peds.2010-2697

Wake M, Hesketh K, Lucas J. Teething and Tooth Eruption in Infants: A Cohort Study. Pediatrics 2000;106:1374. DOI:10.1542/peds.106.6.1374

Last updated 10/4/2016
Published 9/9/2014