Teething in babies: symptoms, sequence, when it starts and how to soothe it

When does it start?

Babies vary widely: some cut the first tooth at 3–4 months, others after 12 months. If no tooth has appeared by 12 months a dental check is appropriate; there is usually nothing wrong, but rare conditions are picked up early. Early or late eruption has nothing to do with intelligence or development.

Eruption sequence of the primary teeth

There are 20 primary teeth in all. At around age 6 the first permanent molars erupt behind the primary teeth without any primary tooth falling out; they are often mistaken for baby teeth and neglected.

Symptoms

• More drooling, with redness on the chin and neck from saliva
• Swollen, red gums, sometimes a bluish blister (eruption cyst; usually opens by itself)
• Putting everything in the mouth, an urge to bite
• Fussiness, disturbed sleep, reduced appetite
• A slight rise in temperature (not above 38 °C)

What should not be blamed on teething

High fever, diarrhoea, vomiting, rash, cough and constant crying are not signs of teething. Because this period coincides with the fall in antibodies passed from the mother and the age when everything goes in the mouth, infections are common; symptoms should not be attributed to teeth and delayed — see the paediatrician.

Safe ways to soothe

1. A cold teething ring: A silicone ring chilled in the fridge (not the freezer) or a clean, cold cloth.
2. Gum massage with a clean finger: Gentle pressure soothes.
3. Cold food: Cold yoghurt or fruit purée for babies on solids.
4. Wiping saliva and moisturising: Prevents chin irritation.
5. Painkiller: For marked distress, paracetamol at the dose advised by the paediatrician; don't start it on your own.

Not recommended

• Teething gels (containing lidocaine or benzocaine): Serious side effects have been reported in babies; use is restricted in many countries.
• Amber / teething necklaces: Choking and strangulation risk; no proven benefit.
• Frozen teething rings: Can cause cold injury to the gums.
• Honey, sugary foods or sugar in the bottle: Cause early childhood caries; honey carries a botulism risk under age 1.

Care from the first tooth

• As soon as the first tooth appears, clean twice a day with a rice-grain smear of fluoride toothpaste and a soft baby brush. Pea-sized from age 3.
• A night bottle or falling asleep at the breast leads to rapid decay of the upper front teeth ("bottle caries"); give only water at night.
• Don't lick the dummy or spoon before giving it to the baby; caries bacteria pass from mother to child.
• The dummy should be given up by 2–3; prolonged thumb-sucking and dummy use affect jaw development.

The first dental visit

After the first tooth erupts, and no later than age 1. The aim is as much to inform the family and let the child get used to the setting as to examine. More: A child's first dental visit and Paediatric dentistry.