What is Teething / Baby's First Tooth?
Teething is the term used to describe the eruption or appearance of milk or baby teeth in the oral cavity. During eruption, the teeth that develop and mature in the jawbone slowly pass through the bone and then through the gums finally appearing in the mouth. The milk teeth start appearing in an infant’s oral cavity around the age of 3-4 months, beginning with the appearance of the lower incisors and the entire process of teeth growth is completed by the age of 30-36 months with the appearance of the lower 2nd molars.
Some variation in the eruption time and pattern is considered normal and should not alarm parents. However in case there is a delay of more than 6 months in the appearance of a particular tooth, parents should visit the pedodontist.
Teething is medically referred to as "dentition difficilis," which is the Latin term for pathologic dentition or difficult dentition, as teething is often associated with a variety of complaints such as pain and fever. However the term is not completely accurate as teething is a physiological (normal) phenomenon, which is experienced by all infants and is accompanied by varying degree of discomfort. This phenomenon has been associated with a variety of myths such as diarrhea, fever, rashes, seizures or bronchitis. It is important to know the facts and separate the facts from fiction.
Milk Teeth Eruption Timetable:
| Upper Teeth | Eruption | Shedding |
| Central Incisor | 8-12 Months | 6-7 Years |
| Lateral Incisor | 9-13 Months | 7-8 Years |
| Canine (Cuspid) | 16-22 Months | 10-12 Years |
| First Molar | 13-19 Months | 9-11 Years |
| Second Molar | 25-33 Months | 10-12 Years |
| Lower Teeth | Eruption | Shedding |
| Central Incisor | 6-10 Months | 6-7 Years |
| Lateral Incisor | 10-16 Months | 7-8 Years |
| Canine (Cuspid) | 17-23 Months | 9-12 Years |
| First Molar | 14-18 Months | 9-11 Years |
| Second Molar | 23-31 Months | 10-12 Years |
Symptoms of Teething
A variety of signs and symptoms have been attributed to the process of teething. However the signs and symptoms vary from infant to infant. The discomfort associated with the teething/eruption of any tooth is believed to last for a period of about 8 days. Three days before the tooth pierces the gums and 5 days after it has appeared. Some of the conditions that are commonly associated with the process of teething are:
- Irritability: As the tooth starts appearing through the gums it may cause some pain and discomfort, causing the child to become irritable. This is more so when the first teeth erupt or when molars appear.
- Biting: The Baby may start biting on objects; this act helps relieve some amount of discomfort.
- Crying without a reason: The infant may cry excessively without the parent being able to find a reason.
- Drooling: The saliva production increases in response to the irritation that the erupting tooth is causing; this may cause the infant to drool.
- Fever: Some infants may experience a low-grade fever, however if the fever lasts for more than 2 days or if the temperature exceeds 38°C one must consult the doctor.
- Not sleeping well: The infant may not be sleeping well due to the discomfort associated with teething.
- Rubbing cheeks: The infant will be seen rubbing cheeks, which is a sign of pain and discomfort that is associated with teething.
- Flu like symptoms: No cause and effect relation has been established between flu and teething, however, the infant may show flu like symptoms due to a decreased immunity. In case of fever, a paediatrician has to be consulted.
- Swollen gums: Seen at the site where the tooth is appearing.
What to do when the Child is Teething?
It is important to understand that you can only help relieve the symptoms of the infant. However teething as such is a normal process and every parent should be prepared to deal with it. The strategies to manage teething are of 2 types:
a) Pharmacological
b) Non-pharmacological
Pharmacological Strategies:
The pharmacological strategies employ drugs to help relieve the pain and discomfort associated with teething, it is however important to keep in mind that drug intake should only be resorted to after consultation with a physician. Commonly prescribed painkillers are:
Paracetamol also known as acetaminophen helps relieve the pain and fever that is associated with teething. It can be given in a dose of 15mg/kg every 6-8hrs. However caution is required while medicating the child, as an overdose can cause liver and kidney damage.
Ibuprofen belongs to the same family of drugs as paracetamol. However, it has more severe side effects.
Lignocaine and Benzocaine are topical anesthetic agents. These agents are rubbed with a finger on the site where the tooth is erupting; they penetrate into the mucosa and help relieve the pain and discomfort.
Non-pharmacological Remedies:
The following are few non-pharmacological remedies for teething:
Teething rings: Teething rings are made up of approved plastic, an infant while teething loves to chew on hard material. A teething ring can alleviate some of the symptoms the infant is experiencing.
Cuddle therapy and distraction: Holding the child and trying to distract them with other activities such as walks and drawing can help relieve the discomfort.
Hard Food/ cold food: Certain hard foods such as biscuits can be given to the infant to chew. However, make sure it is not too hard as to cause gum soreness. Cold food can also help in relieving some of the soreness.
Cold damp cloth: Holding a cold damp cloth over the cheeks for a few minutes where the tooth is erupting can also help relieve the discomfort.
Myths Associated with Teething
Teething does not cause flu, diarrhoea, fever, rashes, seizures or bronchitis. Various studies have repeatedly shown that these conditions have no correlation with teething. In case the infant shows signs of the same, the parents should immediately visit the pediatrician.
Aspirin should not be prescribed to young children as it causes Reye’s syndrome, which is a potentially lethal condition associated with kidney, liver and brain damage.
In case of a high fever, consult the pediatrician immediately.
Over the counter drugs or alternative medical remedies should not be administered as the side effects associated with them are not documented. They could do more harm than good.
