What is Teething?
Teething is a process in which a tooth pierces through the gum and appears in the mouth. Babies are born with all 20 primary teeth below their gum line and they start to appear between 6 and 12 months.
In rare cases, newborn babies are found to have teeth on the day of their birth called natal teeth. It occurs 1 in 2000 - 3000 live births.
Natal tooth is often loose and usually removed by the dentist as it may affect breastfeeding and eliminate the aspiration risk.
When does Teething Start?
Teething usually starts when a baby is between 6 and 8 months old but some do not show any teeth till 8 months. If teething starts later, it is usually normal there is no need to worry.
Signs and Symptoms of Teething in Babies
Symptoms usually occur before the appearance of teeth in the mouth. It also differs from one baby to another and most commonly includes the following:

- Swollen and painful gums
- Fussiness and crying
- A slightly raised temperature (less than 101 F)
- Gnawing or wanting to chew on hard things
- Lots of drool, which can cause a rash on their face
- Coughing
- Rubbing their cheek or pulling their ears
- Bring their hands to mouth often
- Refusal of food due to pain and discomfort
- Reduced sleep and niggles often due to pain
Teething can be painful, but it doesn’t make babies sick. Diarrhea, vomiting, rashes on the body, a higher body temperature, and congestion are not typical signs of teething. Consult with a pediatrician if the baby’s gums are bleeding or any pus or swelling is noticed.
Teething Pattern
The order in which different tooth appears in the mouth can differ for every baby and may be based on family history. But most of the time, the following pattern is seen:
- The lower front two teeth come in first, followed by the opposite top two teeth and the two on either side.
- Next, come the two on either side of the bottom front teeth, then the first molars appear.
- The teeth in front of the first molars are next, and the back molars are the last ones to come in.

All 20 baby teeth will eventually be in place, usually by 3 years. However, if there has been no appearance of teeth till 9 months then it is best to visit a pediatric dentist.
Tips to Ease Teething Discomfort
- Wipe the baby's face with a cloth to remove the drool and prevent a rash.
- Give a cool object to chew on, such as a firm rubber teething ring, cold pacifier, spoon, or a clean wet washcloth.
- Try offering a hard, unsweetened teething cracker or cold soft foods such as yogurt (if your baby is eating solids).
- For babies older than 6-9 months, offer cold water from a sippy cup.
- Gently massage the gums with a clean finger. If the teeth haven’t come in yet, you can let babies bite the finger.
- Try dipping fingers in cold water and massaging gums before each feeding to avoid babies from biting nipples while nursing.
- If a bottle seems to help, fill it only with water. Formula, milk, or juice can cause tooth decay.
- If a child is 2 years or older, teething gels and preparations rubbed on the gums may help the pain for a short while. Be careful not to use too much. Do not use these remedies if your child is younger than 2 years old.
Relief with Medications
If baby is clearly uncomfortable, talk to a pediatrician about giving a dose of pain relievers such as acetaminophen (Tylenol) or ibuprofen to relieve discomfort.
You can also apply a teething gel. However, avoid gels that contain choline salicylate and benzocaine. These are not safe for infants, since they can reduce the levels of oxygen in the blood.
General oral pain relief gels are not suitable for children.
Remedies to Avoid
Never put anything in the baby’s mouth that is not specifically approved to help soothe teething. Even some products described as teethers or teething aids aren’t safe choices, including ones:
- Teethers filled with liquid that can tear and spill.
- Teethers are made up of breakable material, like plastic, that can lead to choking and from harmful substances, like lead.
- Do not tie a teething ring or any other object around the child's neck.
- Do not place anything frozen against the child's gums.
- Never cut the gums to help a tooth grow in because this can lead to infection.
- Avoid teething powders.
- Do not rub alcohol on the baby’s gums.
- Do not use homeopathic remedies. They may contain ingredients that are not safe for infants.
How to Care of Baby’s New Teeth

- Until teeth start to come in, clean baby’s gums with a wet washcloth or piece of gauze at least once a day.
- Once they have teeth, clean your baby’s mouth the same way at least twice a day. After the feeding is a good time for this.
- After their first birthday, start to use a soft-bristled baby toothbrush with water and a small amount of toothpaste that doesn’t have fluoride in it.
- A pediatrician will monitor your baby's teeth for decay and decide if a referral to a dentist is needed before one year.
The American Dental Association and the American Academy of Pediatric Dentistry recommend scheduling a child's first dental visit at or near his or her first birthday. Regular childhood dental care helps to set the stage for a lifetime of healthy teeth and gums.
References:
- Tips for helping your teething baby - https://www.nhs.uk/conditions/baby/babys-development/teething/tips-for-helping-your-teething-baby/
- What is teething? - https://www.stanfordchildrens.org/en/topic/default?id=teething-90-P01873
- Safely Soothing Teething Pain and Sensory Needs in Babies and Older Children - https://www.fda.gov/consumers/consumer-updates/safely-soothing-teething-pain-and-sensory-needs-babies-and-older-children
- CKS is only available in the UK - https://www.nice.org.uk/cks-uk-only
Latest Publications and Research on Teething
- Impacted teeth: Their place is in the dental arch. - Published by PubMed
- An Unusual Tooth Shedding with Internal Resorption: A Case Report. - Published by PubMed
- New Function of RUNX2 in Regulating Osteoclast Differentiation via the AKT/NFATc1/CTSK Axis. - Published by PubMed
- Orthodontic treatment with passive eruption and mesialization of semi-impacted mandibular third molar in an adult with multiple dental losses. - Published by PubMed
- Greater caries-free survival of first permanent molars: findings from a 7-year follow-up evaluation of a community-based oral health preventive program. - Published by PubMed
Citations
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