The “Tooth” about Teething

If you look on google, it seems like everything can be a symptom of teething - which makes things super confusing for a parent who is dealing with sleep changes or new fussiness. The truth is that teething gets unfairly blamed for many routine infant behaviors.

Here’s an overview of what to expect, when to expect it, and what you can do about it (and perhaps just as importantly… what you should avoid).

PC: Colin Maynard (Unsplash.com)

Signs of teething

There are really only two definite signs of teething:

• a raised bump under the gums (which can be swollen/red)

• seeing actual teeth!

But, of course, there are many minor signs that your baby might experience. These should only last 2-3 days, as the tooth comes through, and can include:

• Mild fussiness

• Suddenly increased drooling

• Gnawing or biting

• Temporary changes in appetite or sleep (Teething gets unfairly blamed for normal fluctuations in eating & sleep patterns. While the discomfort can cause a change in these functions it should not continue longer than 2-3 days.)

• Pulling on ears, cheek rubbing, or head tilt/shake (These can be normal signals of tiredness or of ear infections too but you might see them during teething. If baby is persistently uncomfortable, though, they may need to see the doc)

• Sometimes: looser stools (due to swallowed saliva), tooth grinding, or slight elevations in temperature, but never more than 100.4F.

When does teething start?

Babies are usually born without teeth, although very rarely one can see something called a “natal tooth”. In most cases, the process of “teething” or odontiasis begins around the 6 month mark and the last teeth can come in as late as 3 years. BUT some children don’t get their first tooth until they are a year, and that’s okay. 

There are 20 primary teeth that we expect, and they are already present below the gum line at birth. These are made up of 8 incisors, 4 canines, and 8 molars. The first teeth to come in are usually the middle lower teeth, and the last are the molars. Most baby teeth fall out by 12-13 years.

Although there is a typical order in which teeth come in, this won’t be true of every child. Remember: your baby hasn’t read the manual.

What can I do for my teething baby?

Teething can cause some discomfort in the days surrounding when the tooth comes in, but this should not really last longer than 2-3 days. Symptoms that last longer than that are likely due to something other than teething and may need an evaluation from your pediatrician.

Most babies do not need medications to get through teething, and we don’t recommend teething tablets, gels, or amber necklaces, because all have risks. But there are some things you can try if you find your little one is fussy.

• Silicone teethers (Pick teethers that are easy to grip and not filled with gel, in case they break. They can be chilled in the fridge but should not be frozen. Always supervise your child closely if they have a teething toy, and be sure to clean and sanitize them as needed).

• Breastmilk/formula/puree popsicles

• Cold washcloth (Tie a knot in a washcloth and then dip the end in breastmilk/formula/water. Place in a ziploc in the freezer for 15-30 minutes. These are particularly soothing because they are easier to gnaw on and for baby to manipulate into all areas of the gums).

• Gum massage (You can do this with a clean finger or a silicone brush).

• A cold spoon (Chill a spoon in the fridge and hold against the gum).

• A pacifier (My kids always liked this: dip a pacifier in water, breastmilk or formula and chill for 15-30 minutes).

• Snuggles (Skin-to-skin is known to be soothing even beyond the newborn stage. Cuddles and nursing can be very helpful to get your baby-and you-through this phase).

• Ibuprofen and/or Tylenol (These medications can be used as needed for 2-3 days if none of the other measures seem to be working. Ibuprofen should never be used under 6 months of age. Always be sure to follow the directions on the medication bottle and check in with your pediatrician as needed).

Things to avoid

Just because there are products on the market does not mean that those products are safe or recommended (or effective).

Many teething tablets and gels have been recalled by the FDA and are generally unregulated, so they have variable amounts of listed ingredients. Some of those ingredients can be risky for infants (such as belladonna or benzocaine).

There is no scientific evidence that supports the use of amber teething necklaces, and they are a significant strangulation risk.

FAQs and TPM tips

How quickly do teeth come in?

This can vary a lot from baby to baby. Some babies will have teeth come in slowly over weeks, whereas others will get several within a few weeks.

But my 3 month old is drooling and putting their hands in their mouth! Could this be teething?

This is developmentally normal. The salivary glands begin to function around 3-4 months of age, so most babies start to produce more drool at that point - and it is noticeable because most infants do not have great oro-motor muscle control at that age. It is also normal for babies to start bringing their hands to their mouth more frequently beginning around this age, so these two symptoms together can look a lot like teething. 

My baby has a rash around their mouth because of teething! What can I do?

The saliva and hands rubbing on the face can lead to some irritation of the skin around the mouth. Using a barrier ointment (such as Vaseline) and keeping the area clean and dry can be helpful.

When should I call the doctor?

Teething will not cause fevers > 100.4, watery/frequent/ongoing diarrhea, vomiting, cough and congestion, dehydration, extreme or persistent fussiness, or an ongoing loss of appetite. These are all reasons to call the doctor.