Teething Overview
Teething refers to the process of new teeth rising or erupting through the gums.
Teething can begin in infants as young as 2 months of age, even though the first tooth usually does not appear until about age 6 months of age. Some dentists have noted a family pattern of "early," "average," or "late" teethers. Usually, the first tooth to erupt is one of the lower, central incisors. Some children will have a pattern of serial eruption of their teeth. Others will have multiple dental eruptions at the same time. As the tooth penetrates the gums, the area may appear slightly red or swollen over the tooth. Sometimes a fluid-filled area similar to a "blood blister" may be seen over the erupting tooth.

Some teeth may be more sensitive than others when they erupt. The first tooth to erupt may be the most sensitive. Sometimes, the larger molars cause more discomfort due to their larger surface area that can't "slice" through the gum tissue as an erupting incisor is capable of doing.

Teething Symptoms
Many children have little or no problem with teething, while others may have significant discomfort. Usually, the pain with teething comes and goes and may seem to ease after several minutes.

Teething may cause the following symptoms:
increased drooling;
restless or decreased sleeping due to gum discomfort;
refusal of food due to soreness of the gum region;
fussiness that comes and goes;
bringing the hands to the mouth;
mild rash around the mouth due to skin irritation secondary to excessive drooling; and
rubbing the cheek or ear region as a consequence of referred pain during eruption of the molars.

Teething has not been shown to cause the following:
fever (especially over 101 degrees);
diarrhea, runny nose and cough;
prolonged fussiness; and
rashes on the body.

When to Seek Medical Care
Because teething is so common and other symptoms such as fever, fussiness, colds, and diarrhea are also common, both conditions may often occur at the same time. Teething may not be causing these symptoms. Other illnesses or disorders (for example, viral infections) are much more likely to be causing fever, fussiness, nasal congestion with cough, and diarrhea. It is important to contact your doctor if these or other symptoms seem concerning to you. Do not assume that they are just from the teething.

Teething should not require emergency care. If there is concern that something other than teething may be causing symptoms, contact your health-care provider.

Exams and Tests
The diagnosis of teething is made based on the presence of the signs and symptoms.

Teething Treatment
Self-Care at Home
Often, the infant's gums feel better when gentle pressure is placed on the gums. For this reason, many doctors recommend gently rubbing the gums with a clean finger or having the child bite down on a clean washcloth.

If the pain seems to be causing feeding problems, sometimes a different-shaped nipple or use of a cup may reduce discomfort and improve feeding.

Cold objects may help reduce the inflammation as well. Veteran parents have discovered the usefulness of frozen washcloths and ice cubes for this purpose. Be careful to avoid having prolonged contact of very cold objects on the gums. Also, never put anything into a child's mouth that might cause the child to choke.

Use of pain medications: Some controversy surrounds the use of pain medicines for teething.

Medicines that can be placed on the gums: Certain over-the-counter medicines can be placed directly on the gums to help relieve pain. They contain medicines that temporarily numb the gum. They may help for brief periods of time, but they have a taste and sensation that many children do not like. It is important not to let the medicine numb the throat because this may interfere with the normal gag reflex and may make it possible for food to be aspirated and get into the lungs. For this reason, many doctors do not recommend the use of these medicines. While some parents endorse topical medications, studies have not consistently shown their benefit.

Medicines that are taken by mouth to help reduce the pain: Acetaminophen (Children's Tylenol) or ibuprofen (Children's Advil or Motrin) may also help with pain. Ibuprofen should not be administered to infants younger than 6 months of age. Medications should be used only for the few times when the other home-care methods do not help. Caution should be taken not to overmedicate for teething. The medicine may mask significant symptoms that could be important to know about. Do not give children products containing aspirin.
 

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