A baby’s first tooth is a significant developmental milestone that many parents eagerly anticipate. Alongside the joy and smiles, teething also comes with challenges such as irritability, drooling, and disrupted sleep. This phase, commonly known as teething, is a natural part of your baby’s growth. In this article, we explain what teething is, how to distinguish normal teething signs from potential health concerns, and how to manage your baby’s discomfort while laying the foundation for good health.

An Overview of Teething Syndrome

Teething is a natural and essential developmental stage, not a disease or illness, when a baby’s teeth begin to emerge. While teething is a natural part of growth, it may cause temporary discomfort such as sore or inflamed gums. The word ‘syndrome’ here does not refer to something pathological but rather a set of expected or usual characteristics.

Beyond the physical emergence of teeth, teething supports critical functions like speech and jaw development. Baby teeth play an essential role in chewing, early speech, and guiding the development of the jaw and alignment of permanent teeth. They serve as placeholders, ensuring proper alignment of permanent teeth as your child matures. Proper care of baby teeth supports long-term oral health and development.

Tooth Development Begins Before Birth

Tooth development starts before birth. Children already have all twenty primary or ‘Milk’ teeth formed beneath the gums by the time they are born. These teeth start developing during pregnancy, so the mother needs to stay healthy during this time. Sometimes, a baby is born with erupted teeth (natal teeth), which are uncommon but not dangerous. A dentist will then determine if any treatment is required.

The first teeth that develop are the ones at the lower front part of the mouth. The most common age at which a first tooth erupts is between 6 and 8 months, though it may occur as early as 3 to 4 months or as late as 12 to 16 months. These timings are within normal range, and you should not worry if the first tooth appears on your baby’s first birthday.

As soon as your baby’s first tooth appears, it is recommended that you take them to a dentist, preferably before their first birthday. This visit allows you to get guidance on how to care for your child’s teeth and lays the foundation for proper dental hygiene throughout the child’s life.

Signs and Symptoms of Teething

It is essential to note that teething can manifest in many different ways. Every child is unique, but parents should know the typical signs and symptoms and what may require a pediatrician’s intervention. Some signs and symptoms include the following:

Swollen, Red, or Sore Gums

When the teeth grow, the area may appear inflamed and reddened, which may be painful. This is one of the most frequent and painful teething symptoms that many parents experience with their children.

Drooling

It is also common for babies to drool a lot during teething. This is due to inflammation of the gums, which leads to excessive saliva production. While drool is not harmful, prolonged exposure can irritate the skin and cause rashes on the chin, cheeks, neck, or chest. Clean the area with a soft cloth and apply a bland emollient to reduce skin irritation.

Chewing or Biting on Objects

Infants often put their hands, toys, or other nearby items in their mouths. Chewing applies pressure that helps to ease gum discomfort. Provide them with safe teething items to chew on, which can help relieve their pain. Also, clean the teething items regularly to ensure they do not ingest germs.

Fussiness and Irritability

Teething often causes increased irritability, frequent crying, and difficulty being comforted. This is a natural response to the discomfort caused by emerging teeth. Some babies are fussier than others, and fussiness usually increases when the tooth is close to coming through.

Sleep Disruption

Babies often have trouble falling asleep or may wake frequently while teething at night. They may also have shorter naps during the day.

Decreased Appetite

If babies temporarily reduce their intake of solid foods while teething but continue to breastfeed or take formula, it is usually not a cause for concern.

Tugging at Ears or Rubbing Cheeks

Children may pull their ears or scratch their cheeks. This is a typical response to oral discomfort during molar development, especially when molars develop.

Mild Temperature Rise (Not a Fever)

Although parents sometimes report a slight temperature increase during teething, research shows that teething does not cause a true fever. Any elevated temperature should be monitored closely. However, teething does not cause fever in the strict sense of the term, which is 100.4°F/38°C and above. A high fever typically indicates an underlying illness unrelated to teething.

Disrupted Routines

Babies may become uncomfortable, crying more, sleeping less, eating poorly, or appearing unusually fussy. These changes are usually temporary once the tooth emerges or appears on the gum line.

Coughing or Gag Reflex

Excess saliva produced during teething can sometimes cause babies to cough or trigger a mild gag reflex. This is not harmful but should be monitored to ensure it is not due to illness or choking.

What Teething Does Not Cause

The following are some of the signs that are not related to teething:

  • High fever (over 100.4°F / 38°C)
  • Severe diarrhea
  • Vomiting
  • Persistent crying that cannot be calmed
  • Skin rashes that are not in the area around the mouth or the neck

These symptoms are not typically associated with teething and may indicate illness. If your baby has these symptoms, it is advisable to consult your doctor to determine whether there could be other complications, such as infections.

When to Seek Medical Advice

Parents should consult a doctor if the baby shows signs unrelated to teething or if they have concerns about the baby’s health.

Teething does not cause a fever above 100.4°F (38°C), and parents should consult a doctor if the fever is elevated. This common misconception can lead to neglecting proper treatment, and a doctor should check any fever above the normal range.

Diarrhea, vomiting, or other rashes (not just drool rash) are also not caused by teething. These may indicate an illness and should not be overlooked.

Other symptoms that call for medical attention include:

  • Crying that cannot be comforted and does not cease after a short while.
  • Refusing both food and fluids is another warning sign that requires medical attention.
  • Symptoms that persist for several days without signs of a tooth emerging may indicate another underlying health issue.
  • The baby is less active, weak, or sickly than is normal for a baby of that age.

These symptoms may point to an underlying medical condition that requires prompt evaluation to avoid complications like dehydration.

Managing Teething Discomfort

Teething can be uncomfortable for babies, but several gentle methods can help soothe them. Parents should consult pediatricians and rely on clinically recommended methods while avoiding products identified as unsafe by health authorities.

At-Home Soothing Techniques

Gum Massage and Cold Relief

Gently applying pressure to a baby’s gums can help soothe discomfort. Use a clean finger or a gauze pad dipped in warm water to massage the gums for approximately two minutes. This counter-pressure often provides relief.

Cold items are also helpful. Provide a cold, not frozen, washcloth, spoon, or teething ring. These should be cooled in the refrigerator, not the freezer; frozen items can be too hard or cold and may injure a baby’s sensitive gums. For babies over 12 months, cool foods like bananas or peeled cucumbers may help; just supervise your child closely to avoid choking.

Safe Teething Toys

  • Recommended Materials

Choose teething toys made of food-grade silicone, which are firm enough to soothe gums and preferred by many infants. Choose products that do not contain BPA and are safe for the baby to handle. Textured teething rings can provide extra comfort and stimulate gum development.

  • Items to Avoid

Avoid liquid-filled teething rings, as they can leak or break under pressure, posing a choking or ingestion hazard. Do not use teething rings with small parts or decorations that may easily come off and pose a choking risk. Frozen teethers are too rigid and may injure a baby’s gums. Avoid battery-operated or latex toys unless specifically designed and labeled as safe for infants.

Products and Remedies to Avoid

Parents should be careful when choosing teething remedies because some products harm the child's health.

Food and Drugs Administration (FDA) Warnings

The FDA has issued warnings against certain teething products linked to serious health risks in infants, including rare but severe outcomes. These products are available in stores and online, but they are unsafe and should be avoided.

Teething Necklaces and Bracelets

Do not use teething jewelry such as amber, wooden, silicone, or marble. These pose choking and strangulation hazards. There have been fatal incidents linked to teething jewelry, including one involving an amber necklace worn during a nap. According to the American Academy of Pediatrics, avoiding any jewelry for babies is best.

Benzocaine Gels

Orajel or Anbesol, containing benzocaine, should not be used. According to the FDA, benzocaine gels have been linked to methemoglobinemia, a rare but serious condition that reduces oxygen levels in the blood.

Homeopathic Teething Tablets

Some homeopathic teething tablets, particularly those containing belladonna, have been found by the FDA to contain inconsistent or toxic levels of ingredients and have been linked to serious adverse effects, including seizures. Avoid these entirely.

Oral Care in Relation to Teething and Post-Teething Period

It is recommended that the baby’s mouth be cleaned even before the first tooth appears and that the baby continue cleaning more diligently once teething begins.

Pre-Tooth Eruption Hygiene

Start gently cleaning your baby’s teeth with a soft brush or cloth and water as soon as the first tooth appears, or by 12 months at the latest. This removes milk sugars and bacteria and helps your baby become accustomed to oral hygiene.

Brushing After First Tooth Emerges

As soon as the first tooth emerges, begin brushing your baby’s teeth twice a day with a small, soft-bristled infant’s toothbrush. For children under 3, use a smear of fluoride toothpaste about the size of a grain of rice. For children aged 3 to 6, use a pea-sized amount. Parents should monitor their children to make sure they brush correctly and do not use too much toothpaste containing fluoride.

Importance of Fluoride

Fluoride is a mineral that helps to strengthen tooth enamel and protect against cavities by aiding the remineralization process. It can be found in toothpaste, fluoride gel or solution applied by dentists and other professionals, and fluoridated water. In case your child’s water source does not contain fluoride, a doctor may advise on the use of supplements.

Introduction to Flossing

It is recommended to start flossing as soon as two adjacent teeth are touching. Toothbrush bristles cannot reach between the teeth, and therefore, flossing helps to avoid getting cavities in those spaces. Parents should help their children floss, usually starting at the age of 2-3 years old.

Teaching Dental Hygiene

Children between the ages of 3 and 6 can begin brushing their teeth with adult supervision. They should learn how to rinse with water and brush for two minutes. Parents should assist their children in brushing until around age 7 or 8, when the child has developed sufficient motor skills to brush properly. Dental checkups are essential for monitoring growth and catching any emerging issues early.

Find a Pediatric Dentist Near Me

Teething is a normal developmental stage, and some babies may experience symptoms such as sore gums and increased fussiness. This phase can be safely managed with gum massages and chilled teething aids. However, avoid teething necklaces and benzocaine gels. Also, you should begin cleaning your baby’s gums early and use fluoride toothpaste to start brushing as soon as the first teeth emerge. By staying informed and using safe, soothing methods, you can help your child go through the process of teething more comfortably.

To support your child’s long-term oral health, schedule their first dental visit with Northridge Advanced Dentistry by calling us at 818-701-3010. Our experienced pediatric dentists will assess your child’s dental development, offer personalized teething advice, and guide you on proper oral care techniques from the very start.