Teething refers to the process of new teeth rising or erupting through the gums.
- Teething can begin in infants as young as 2 months of age, even though the first tooth usually does not appear until about 6 months of age. Some dentists have noted a family pattern of "early," "average," or "late" teethers. Children who have not gotten the first tooth by 18 months should be evaluated by the child's doctor. Usually, the first tooth to erupt is one of the lower, central incisors. Some children will have a pattern of the serial eruption of their teeth. Others will have multiple dental eruptions at the same time. As the tooth penetrates the gums, the area may appear slightly red or swollen over the tooth. Sometimes a fluid-filled area similar to a "blood blister" may be seen over the erupting tooth.
- Some teeth may be more sensitive than others when they erupt. The first tooth to erupt may be the most sensitive. Sometimes, the larger molars cause more discomfort due to their larger surface area that can't "slice" through the gum tissue as an erupting incisor is capable of doing.
- Most children have a complete set of 20 deciduous teeth (known as baby teeth or milk teeth) by 30 months of age.
What Are Teething Symptoms and Signs?
Many children have little or no problem with teething, while others may have significant discomfort. Usually, the pain with teething comes and goes and may seem to ease after several minutes. Teething symptoms are not well defined, and parents, as well as care providers, often attribute symptoms to teething, which may not be accurate. Some of the symptoms of teething can be attributed to the dental follicle (sac containing the developing tooth) and the release of inflammatory agents during the tooth eruption.
- Teething may cause the following symptoms and signs:
- Increased drooling
- Restlessness or decreased sleeping due to gum discomfort
- Refusal of food due to soreness of the gum region
- Fussiness that comes and goes
- Bringing the hands to the mouth
- Mild rash around the mouth due to skin irritation secondary to excessive drooling
- Rubbing the cheek or ear region as a consequence of referred pain during the eruption of the molars
- Teething has not been shown to cause the following:
- High fever (especially over 101 degrees)
- Diarrhea, runny nose, and cough
- Prolonged fussiness
- Rashes on the body
Top Problems in Your Mouth
When Should Someone Seek Medical Care for Teething?
Because teething is so common and other symptoms such as fever, fussiness, colds, and diarrhea are also common, both conditions may often occur at the same time. Teething may not be causing these symptoms. Other illnesses or disorders (for example, viral infections) are much more likely to be causing fever, fussiness, nasal congestion with cough, and diarrhea. It is important to contact a doctor if these or other symptoms seem concerning. Do not assume that they are just from the teething.
Teething should not require emergency care. If there is concern that something other than teething may be causing symptoms, contact a health-care professional.
How Do Health-Care Professionals Assess Teething?
The diagnosis of teething is made based on the presence of the characteristic signs and symptoms.
Are There Any Home Remedies for Teething?
- Often, the infant's gums feel better when gentle pressure is placed on the gums. For this reason, many doctors recommend gently rubbing the gums with a clean finger or having the child bite down on a clean washcloth.
- If the pain seems to be causing feeding problems, sometimes a different-shaped nipple or use of a cup may reduce discomfort and improve feeding.
- Cold objects may help reduce the inflammation, as well. Using teething rings can be helpful. Veteran parents have discovered the usefulness of refrigerated wet washcloths, cold pacifiers, spoons, frozen bagels, or frozen bananas. Be careful to avoid having prolonged contact with very cold objects on the gums. Also, never put anything into a child's mouth that might cause the child to choke.
- Use of pain medications: Some controversy surrounds the use of pain medicines for teething.
- While some parents endorse topical medications, studies have not consistently shown their benefit. In May 2011, the FDA issued a warning urging avoidance of oral medications containing a topical anesthetic called benzocaine. Benzocaine is the primary ingredient found in many over-the-counter teething gels, lozenges, and sprays. The FDA warning points out an association with a rare but extremely serious complication called methemoglobinemia. This side effect substantially limits the ability of red blood cells to transport oxygen throughout the body. This development may produce a side effect spectrum from serious to lethal. Individuals who develop methemoglobinemia will become pale, short of breath, confused, and lightheaded. A rapid heart rate is also common. Such an adverse reaction may develop upon first exposure or after several exposures to benzocaine. Any individual who displays such symptoms after exposure to benzocaine should seek immediate medical attention at the closest emergency department. A medication can be used to reverse these side effects.
- Medicines that are taken by mouth to help reduce pain: Acetaminophen (Children's Tylenol) or ibuprofen (Children's Advil or Motrin) may also help with pain. Ask a health-care professional for advice regarding the use of these and other medications. Caution should be taken not to overmedicate for teething. The medicine may mask significant symptoms that could be important to know about. Do not give children products containing aspirin.
- Homeopathic remedies and other home remedies are used widely, but there is limited research into their true effectiveness. These include the use of clove oil, licorice sticks, fennel, green onion, olive oil, ginger root, and chamomile.
What Is the Prognosis for Teething?
Teething is normal. Most infants and children eventually get all 20 primary teeth, which fall out and are replaced by 32 permanent teeth.
Reviewed on 10/22/2018
Medically reviewed by Margaret Walsh, MD; American Board of Pediatrics
Markman, Lisa. "Teething." Pediatrics in Review 30.8 Aug. 2009.
United States. U.S. Food and Drug Administration. "FDA Drug Safety Communication: Reports of a Rare, but Serious and Potentially Fatal Adverse Effect With the Use of Over-the-Counter (OTC) Benzocaine Gels and Liquids Applied to the Gums or Mouth." Apr. 7, 2011. <http://www.fda.gov/Drugs/DrugSafety/