Teething

Is my baby teething?

A baby’s first tooth usually appears between 8 and 12 months of age. Many symptoms, such as gum irritation, irritability, loose stools, and drooling, have been associated with teething, but none are particularly reliable. Some babies have no symptoms and others are a little bothered for a few days. Families who feel they need to relieve their baby’s discomfort can let the baby chew on cold teething rings or wet face cloths, or rub the baby’s gums with a clean finger. Medication can be dangerous and are not recommended. Teething necklaces may contain bacteria and also pose a strangulation risk. Teething does not cause high fever, vomiting, diarrhea, major irritability, or a sudden change in breastfeeding patterns.

A) The history of teething

Vintage advertisement for cocaine-based teething drops. Clearly, this could be very dangerous to a baby and should never have been sold.

Two thousand years ago, the Greek doctor Hippocrates claimed that teething caused crossed eyes, fever, seizures, and death. This belief continued until the late 19th century. Up to half of all baby deaths from the 16th to the 19th centuries in France were wrongly blamed on teething (Markman 2009).

Treatments for teething likely contributed to the deaths of many babies and included (Dally 1996; Markman 2009):

  • Feeding rabbit brains to the baby.
  • Giving medication to cause vomiting or diarrhea.
  • Giving cocaine, opiates, lead, mercury, honey, or salt.
  • Cutting or blistering the gums.
  • Placing leeches on the gums.

These treatments would have caused dehydration, poisoning, or infection.

Concerns over teething remain today.

B) Signs of teething

Some babies have no symptoms of teething and others are a little bothered for a few days. Many symptoms have been associated with teething, but none are particularly reliable. Teething symptoms can include:

On average, a baby’s first tooth erupts at 8 to 12 months of age. Teething problems are unlikely before this time. A very small number of babies are born with one or more teeth (natal teeth). All of the baby's first teeth are present by 33 months (Li 2017; Markman 2009). 

Erupting teeth are easily felt with your finger; they are very hard and appear on the ridge of the front gums.

C) Treatment of teething

1) Appropriate treatment

If you feel you need to relieve your baby’s discomfort, consider using direct treatments such as:

  • Allowing the baby to chew and suck on:
    • Cold teething rings.
    • Cold, wet facecloths.
  • Rubbing your baby’s gums with your clean finger.

2) Treatment that can pose a risk to the baby

Medications for teething are not recommended, as they can be dangerous.

Some parents use teething necklaces. Amber necklaces, in particular, have been popular, but these may contain bacteria that can infect the baby (Machet 2016). They pose a strangulation risk, and testing has shown they may not release if a baby becomes caught (Cox et al. 2017; Soudek and McLaughlin 2018). They may also injure the baby’s mouth or teeth.

D) Misdiagnosing teething

Babies often have tiny white bumps on their gums and on the roof of the mouth that some parents mistake for teeth. They are normal, do not cause pain, and should be left alone. 

While some babies may drool more when teething, many babies start to drool from the age of one month, well before the age of teething.

The second six months of life brings many changes for babies. They may feel frustrated when they are close to attaining new milestones or anxious when separated from their caregivers. They may be in more contact with others, increasing the risk of infection and illness. All of these may cause unhappiness and none are related to teething. 

The diagnosis of teething can lead to a sick baby not receiving care. Teething does not generally cause:

  • Fever (temperature of more than 38°C or 100.4°F) (Memarpour 2015)
  • Vomiting
  • Diarrhea
  • Major persistent irritability
  • A sudden change in breastfeeding patterns

Babies with these signs should be seen by their health-care providers

References

Cox C, Petrie N, Hurley KF. Infant Strangulation from an Amber Teething Necklace. CJEM. 2017 Sep;19(5):400-403
 
Dally A. The lancet and the gum-lancet: 400 years of teething babies. Lancet. 1996 Dec 21-28;348(9043):1710-1
 
Machet P, Lanotte P, Giraudeau B, et al. Amber necklaces: reasons for use and awareness of risk associated with bacterial colonisation. Eur J Dermatol. 2016 Dec 1;26(6):580-585
 
Li RX, Hu Y. [A cross-sectional survey on the patterns of primary teeth eruption in 2 581 children]. Zhonghua Er Ke Za Zhi. 2017 Jan 2;55(1):37-41
 
Markman L. Teething: facts and fiction. Pediatr Rev. 2009 Aug;30(8):e59-64
 
Massignan C, Cardoso M, Porporatti AL, et al. Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis. Pediatrics. 2016 Mar;137(3):e20153501
 
Memarpour M, Soltanimehr E, Eskandarian T. Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies. BMC Oral Health. 2015 Jul 28;15:88
 
Soudek L, McLaughlin R. Fad over fatality? The hazards of amber teething necklaces. Paediatr Child Health. 2018 Apr;23(2):106-110
 
Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: A cohort study. Pediatrics. 2000 Dec;106(6):1374-9