Teething is the eruption of the primary set of teeth (baby teeth) through the gums.
Humans are born with two sets of teeth under the gums. Twenty of these are primary, or baby teeth. Occasionally a child is born with some primary teeth already visible, but more commonly, they begin to erupt around the middle of the first year. The timing of eruption is quite variable but tends to be similar among members of the same family. Generally, all 20 primary teeth have come in by two and a half years of age. Lower teeth usually come in before their upper counterparts. Incisors often erupt first (centrals, then laterals), followed by first molars, canines, and then two-year molars. An early or late pattern of getting baby teeth will sometimes correspond with a similar pattern of losing the baby teeth and getting the permanent teeth. Issues of spacing and orientation of these first teeth do not necessarily indicate that there will be a problem with the permanent teeth. Gaps and crookedness will often resolve.
Causes & symptoms
Many symptoms of teething are nonspecific and can occur for weeks or even months before the teeth actually appear. The teething child may be more irritable, particularly at night. Drooling is likely to become heavier when teeth are coming through, which can also cause the stools to become looser. The excess saliva may cause a rash around the mouth and chin, and produce coughing. Some children will run a low-grade fever , typically about 101°F (38.3°C). Commonly the baby will chew on fingers or other objects to relieve the discomfort. This may also include biting during nursing. The areas where teeth are coming through may appear swollen and red. Sucking can be painful for some babies, who may find nursing uncomfortable at the height of teething.
Occasionally, a small, dark blue area will form on the gums where a tooth is about to emerge. This is the result of a small amount of bleeding beneath the surface of the gums, and is not a cause for concern. It will generally resolve without any special treatment, but cold compresses may be used for comfort and to reduce swelling.
Babies may sail through teething with very little apparent discomfort, or may particularly struggle with certain circumstances. Sometimes the first teeth to erupt seem the most bothersome. The parents of other babies find that it is the large molars which cause the most problem, or groups of teeth coming in simultaneously.
Swollen gums combined with irritability are good clues to teething pain , but serious or long lasting symptoms warrant a visit to the health care provider. If the baby has a fever over 101 °F (38.3deg;C), teething is unlikely to be the cause. Even lower fevers that persist for three days or more should prompt a call to ask whether the baby needs to be seen. Teething is not usually associated with nasal discharge. Although babies that are cutting teeth sometimes pull at their ears, a combination of ear pulling, cold symptoms, and increased nighttime fussing could indicate an ear infection . If the child seems to be getting worse or there is any doubt that the symptoms are attributable to teething, professional advice should be sought.
Pressure on the areas where teeth are coming through can provide comfort for teething babies. Some babies appear to get relief from a gentle gum massage, or they may enjoy chewing on different textures of teething toys. Some types can be chilled or frozen, which can numb the tender gums a little. A clean damp washcloth placed in the freezer is an inexpensive substitute for a freezable toy and may be dampened with chamomile tea. Chilled foods or drinks can also do the trick, but parents should not use items that could become choking hazards.
Drool rashes are treated by keeping the affected area as free from saliva as possible, and using a mild skin cream. A diaper or wash cloth placed under the crib sheet where the baby's head rests will help to absorb the excess saliva and keep the face from being as wet.
Be sure to take care of primary teeth as they come in. A piece of moist gauze is an effective cleanser for baby's first teeth. To prevent dental caries, avoid letting children sleep with a bottle of anything but water. Milk and juice can pool in the mouth, coat the teeth in sugar, and result in decay. Sticky foods and other processed sugars also put teeth at higher risk for damage. A toothbrush will be a more effective cleaner than gauze once the molars come in, and can be used with plain water. Children who aren't yet able to spit out toothpaste residue can get an overdose of fluoride from swallowing fluoridated toothpaste.
Homeopathic tablets and gels, typically combination homeopathic remedies, are available for teething pain . They are nontoxic, and some find them invaluable in treating teething pain. Individual homeopathic remedies are also available based on the specific symptoms the baby is having. Consult a practitioner for assistance with the correct remedy and dose.
Slippery elm powder and infusion of German chamomile can be made into a paste to be applied to swollen gums. Some babies have also been permitted to teethe on peeled root of marsh mallow (no relation to the
confection) to soothe inflammation. Chamomile tea in double strength can be very soothing, especially at night.
Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) can be given to alleviate the swelling and discomfort of teething, particularly at night to allow less interruption of sleep. A healthcare provider can outline the appropriate dose and frequency. Topical gels with anesthetic ingredients are available, but they work only for a brief time and occasionally cause allergic reactions. They also cause numbness, which may be unpleasant to the baby.
Teething is an experience that every baby goes through, either with periodic discomfort or none at all. Fortunately, once all the primary teeth come in, it is over.
Teething pain cannot be completely prevented, but parental attentiveness to comfort measures can help the baby get through it with less distress.
Eisenberg, Arlene, Heidi Murkoff and Sandee Hathaway. What to Expect the First Year. New York: Workman Publishing, 1989.
Sears, William and Martha Sears. The Baby Book. Boston: Little, Brown and Company, 1993.
Greene, Alan. Dr. Greene's HouseCalls: Dealing with teething pain. http://drgreene.com/990703.asp (1999).