Teething

Overview

Teething is the normal process in which your baby's first set of teeth (primary teeth) break through the gums (erupt). Teething usually begins at around 6 months of age, but it is different for each child. Some children begin teething at 3 to 4 months, while others do not start until age 12 months or later. A total of 20 teeth erupt by the time a child is about 3 years old. Usually teeth appear first in the front of the mouth. Lower teeth usually erupt 1 to 2 months earlier than their matching upper teeth. Girls' teeth often erupt sooner than boys' teeth.

Your child may be irritable and uncomfortable from the swelling and tenderness at the site of the erupting tooth. These symptoms usually begin about 3 to 5 days before a tooth erupts and then go away as soon as it breaks the skin. Your child may bite on fingers or toys to help relieve the pressure in the gums. He or she may refuse to eat and drink because of mouth soreness. Children sometimes drool more during this time. The drool may cause a rash on the chin, face, or chest.

Teething may cause a mild increase in your child's temperature. But if the temperature is higher than 100.4 F (38 C), look for symptoms that may be related to an infection or illness.

You might be able to ease your child's pain by rubbing the gums and giving your child safe objects to chew on.

What to Expect

Primary teeth are usually known as "baby teeth." Usually, the first primary tooth comes in (erupts) at about 6 months of age, although it can be as early as 3 months or as late as 1 year of age. In rare cases, a baby gets a first tooth after the first birthday. By age 3, most children have all 20 of their primary teeth.

Primary teeth usually erupt in a certain order:

  1. The two bottom front teeth (central incisors)
  2. The four upper front teeth (central and lateral incisors)
  3. The two lower lateral incisors
  4. The first molars
  5. The four canines (located on either side next to the upper and lower lateral incisors)
  6. The remaining molars on either side of the existing line of teeth

Secondary, or permanent, teeth usually begin replacing primary teeth around 6 years of age. Permanent teeth erupt in roughly the same sequence as primary teeth. Usually, a permanent tooth pushes the primary tooth out as it erupts.

Symptoms

Many times you might not know that your baby has a new tooth coming in until you see it or hear it click against an object, such as a spoon. But some babies are fussier than usual when they are teething. This may be because of soreness and swelling in the gums before a tooth comes through. These symptoms usually begin about 3 to 5 days before a tooth erupts and go away as soon as the tooth breaks through the gum.

Babies may bite on their fingers or toys to help relieve the pressure in their gums. They may also refuse to eat and drink because their mouths hurt.

Many babies drool during teething, which can cause a rash on the chin, face, or chest.

Teething may cause a mild increase in your child's temperature. But if the temperature is higher than 100.4°F (38°C), look for symptoms that may be related to an infection or illness. Severe or ongoing symptoms should be closely watched and discussed with your doctor.

Mild symptoms that get better usually are nothing to worry about. Do not hesitate to call your doctor any time you have concerns about your child's teething. It is also a good idea to talk to your doctor if your child has unusual tooth development, such as late eruption of the first tooth. Tooth development issues usually resolve on their own or are easily treated.

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When to Call a Doctor

Home treatment usually helps relieve minor teething symptoms such as discomfort, drooling, and irritability. But talk to your doctor if your child has other symptoms that become severe or last longer than a couple of days.

Also, talk to your doctor about any other teething concerns, such as if your child:

  • Is age 18 months and has not had any teeth come in.
  • Has visible signs of tooth decay.
  • Has permanent teeth coming in before the primary teeth are lost, resulting in a double row of teeth.
  • Has a small jaw or a birth defect of the mouth or jaw, such as cleft palate.
  • Has any facial injury that has damaged a tooth or gums.

Routine Checkups

All children need early and regular dental care. During well-child visits the doctor will check your child's dental health. A visit to a dentist is recommended within 6 months of when your child's first tooth comes in but no later than your child's first birthday.footnote 1

Some parents may worry about their child's first visit to the dentist's office. You can make a trip to the dentist more positive for your child if you choose their dentist carefully. Talk to your child about what to expect. If you want, use books that are meant to help a young child prepare for the first dental exam. If you have concerns about how your child will behave, talk to your dentist before scheduling the visit. Your dentist may allow your child to come in once or twice before being examined. These types of visits help prepare your child and often make him or her more comfortable with the dentist, other staff, and the office environment.

Regular dental visits are important to teach your child good dental care and to help prevent cavities and other problems. The exam also helps to identify and treat problems early and prevent them from becoming more serious.

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Caring For Your Child

If your baby is uncomfortable while teething, you can try the following.

  • Rub the affected gum.

    Use a clean finger (or cold teething ring) to gently rub the area of tooth eruption for about 2 minutes at a time. Many babies find this soothing, although they may protest at first.

  • Provide safe objects for your baby to chew on, such as teething rings.

    Don't use fluid-filled teething rings. Babies who are teething like to gnaw on things to help relieve the pressure from an erupting tooth. Having safe objects to chew on can help prevent your baby from chewing on those that are dangerous, such as electrical cords or window sills that have lead paint.

  • Give your baby an over-the-counter pain reliever, if needed.

    Use a pain reliever that is labeled for his or her specific age. Read and follow all instructions.

    Do not give aspirin to anyone younger than 20, because it has been linked to Reye syndrome, a rare but serious disease.

Do not use teething gels for children younger than age 2. Ask your doctor before using mouth-numbing medicine for children older than age 2. The U.S. Food and Drug Administration (FDA) warns that some of these can be dangerous.

Do not use teething tablets. The FDA warns against using teething tablets. They may contain belladonna, a toxic substance that can harm your child.

Promoting healthy teeth

Follow these tips to give your child the best chance for healthy teeth and gums.

  • Take measures to help prevent tooth decay in your child's primary teeth.
    • As soon as your baby's teeth come in, start cleaning them with a soft cloth or gauze pad.
    • As more teeth erupt, clean teeth with a soft toothbrush, using only water for the first few months.
    • Help to prevent baby bottle tooth decay by always taking a bottle out of your baby's mouth as soon as he or she is finished.
    • Clean your baby's teeth after feeding, especially at night.
    • When your baby starts eating solids, offer healthy foods that are low in sugar, and keep milk feedings during the night to a minimum.
  • Schedule regular well-child visits with your child's doctor.

    During these exams, the doctor will check your child's dental health.

  • Take your child to the dentist for early and regular dental care.

    Take your child to the dentist within 6 months of when your child's first tooth comes in but no later than your child's first birthday.

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References

Citations

  1. American Academy of Pediatrics (2008). Preventive oral health intervention for pediatricians. Pediatrics, 122(6): 1387-1394. Available online: http://www.pediatrics.org/cgi/content/full/122/6/1387.

Credits

Current as of: September 20, 2021

Author: Healthwise Staff
Medical Review:
John Pope MD - Pediatrics
Kathleen Romito MD - Family Medicine
Thomas M. Bailey MD - Family Medicine