The Teething Struggle: Tips to Identify and Soothe

“Teething” is often blamed for babies’ broken sleep, crying, fever and diarrhea. But is it the really the cause? Learn what to expect when a baby is teething, the order of tooth presentation, how to relieve any discomfort, and how to care for your baby’s teeth.

What is teething?

Teething refers to time the tooth is breaking through the skin. During this time your baby's gums may become red, shiny and swollen. If you touch your baby's gums with your finger you can feel the hard point of the tooth underneath.

When do teeth appear?

Your child's 'baby teeth' (also known as 'milk teeth') have already formed in his gums by the time of his birth. On average, the first tooth generally appears around the age of 6 months; however, this can vary. Apart from the unusual occurrence where a baby can be born with teeth, the first tooth rarely emerges before the age of 3.5 months and for some babies a tooth may not appear until 15 months.

By 12 months babies usually have 4 to 8 teeth. By 18 months 12 teeth and by 3 years all 20 baby teeth will generally be in place. Baby teeth will be lost between the ages of 6 and 12 years to make way for permanent teeth (also called adult teeth).

Order of appearance

Teeth generally appear in a certain order. They also tend to make their appearance in pairs (usually one soon after the other), with the lower pair generally arriving before the upper pair.

The order of appearance generally follows this pattern...

4 central incisors - arrive around 6 - 8 months
4 lateral incisors - arrive around 7 - 10 months
4 first molars - arrive around 12 - 16 months
4 cuspids (eye teeth) - arrive around 15 to 20 months
4 two-year molars - arrive somewhere between 2 to 3 years

All 20 teeth will be in place between 2 and 3 years of age.

Signs of teething

Some babies show no signs of discomfort while teething and others may appear to be bothered by each one of their 20 baby teeth as they come through. Apart from being able to see or feel the tooth, it's possible that all other symptoms commonly thought to be signs of teething could be due to other reasons.

Red swollen sore gums or a visible bump in the gums (are the only reliable signs).
Pain or discomfort in the mouth.
Irritable or clingy behavior.
Pulling ears.
Wakefulness.
Slightly raised temperature (a fever is not a sign of teething).
Flushed cheeks.
Drooling/dribbling.
Chewing or biting.
Coughing due to excessive saliva.
Chin or facial rashes.
Loss of appetite.
Feeding difficulties.

How long does teething last?

Symptoms are generally minor and relatively infrequent; discomfort due to the tooth breaking through the skin will usually last for less than a couple of days (occasionally a little longer if multiple teeth are breaking through at the same time).

If symptoms continue past 3 days without a tooth in sight, there is likely to be other reasons for your baby's discomfort or distress.

When it's NOT teething

Epstein Pearls

Whitish pearly-appearing bumps (technically cysts) will appear in the roof of the mouth and gums of 80% of babies during the early months of life. They sometimes resemble emerging teeth. They are quite harmless and will disappear

Normal developmental changes

Like many other parents, you may become concerned about teething when your baby is around 3 months old. This is the age when a baby's salivary glands are increasing production. However at 3 months your baby is not mature enough to move the saliva to the back of his mouth and swallow it (which occurs around 15 months), hence the saliva simply flows out of his mouth.

Babies are in an oral stage of development and find it comforting to suck or chew on any object they can get into their mouth. By around the age 3 months your baby has developed enough control over his arm movements to be able to place his fingers and hand in his mouth at will (or guide objects to his mouth). Prior to gaining this control, sucking on his hands in the past has been a 'hit or miss' process. What can appear like more 'chewing' at this time is a normal developmental response appropriate for this age.

Illness

Many people believe teething can cause fever and diarrhea; however, this has not been proven. Many symptoms thought to be caused by teething may actually be caused by illness. The important thing is not to use teething to explain away what might be signs of illness.

Teething - myth or fact?

1. Drooling and chewing on things are sure signs of teething.

FALSE: Although drooling and chewing on hands or objects may be more obvious when your baby is teething, these signs can also be due to normal developmental changes (see above). The only sure sign of teething is when you can see or feel the emerging teeth.

2. Teeth can move up and down in the gums.

FALSE: Your baby's permanent teeth are forming below his baby teeth, as they develop they slowly push the baby teeth to the surface. There's no room for his baby teeth to move back down again. However, once a tooth has broken through to the surface it's possible for the skin to cover the tooth again temporarily, which may make it appear like the tooth has moved backwards.

3. Extended periods of discomfort are due to the teeth moving in the gums towards the surface.

FALSE: Even before birth, all baby teeth are formed in your baby's gums and are already slowly progressing toward the surface. If the movement of teeth as they gradually progress to the surface was painful, then the pain would be constant because all teeth (baby and permanent) are forming and/or gradually progressing towards the surface at the same time (some simply arrive sooner).

4. Teething pain can last for weeks or months before a tooth finally appears.

FALSE: Teething only causes discomfort around the time your baby's tooth is ready to break through his gum. Teething discomfort generally lasts for only a couple of days. (Many babies experience no discomfort from teething). Long periods of irritability, which are commonly blamed on teething, are generally due to other reasons.

5. Teething causes fever.

FALSE: An elevated temperature is due to an infection somewhere in your baby's body. Although your baby's gum may become red and swollen when a tooth is ready to break through to the surface, this is due to pressure against his gum from the tooth as it's ready to emerge and not due to an infection.

6. Teething cause diarrhea.

FALSE: Many people claim diarrhea is a sign of teething, contributing this to swallowing excessive amounts of saliva. Because a child's stomach contains a mild hydrochloric acid, the amount of saliva swallowed is unlikely to make any great difference. However, loose bowel movements at the time of teething could be explained as a result of a tummy upset due to the fact that a teething child bites and chews on just about anything they can get into their mouth... clean or not so clean.

7. It's safe to use painkillers and teething gels.

TRUE & FALSE: It can be, but only under advice of a doctor. All medication (including natural therapies) can cause side effects, some of which may be potentially harmful. Prolonged use of pain relieving medications is no recommended except under the advice of a doctor.

8. Teething causes a child to wake at night.

TRUE: Although, it's true that teething discomfort may increase wakefulness, prolonged periods of wakefulness (more than a couple of nights) are often due to reasons other than teething.

Teething discomfort does not appear only at night. If your baby does not appear to be troubled by teething discomfort during the day, it's unlikely that night time wakefulness is due to teething.

9. A baby can be irritable for weeks because of teething.

FALSE: Teething is the most commonly blamed condition for unexplained irritability in babies over the age of 3 months (colic is blamed before that age). When a tooth is about to break through the surface of the gum this can cause your baby to feel uncomfortable. However, irritability lasting more than a few days without the emergence of a tooth is likely to be due to reasons other than teething.

What you can do to help

To help reduce the pain associated with teething the following measure may be helpful.

Gently, but firmly, massage or press on your baby's gum with a clean finger or soft cloth. If this obviously upsets your baby don't continue.
Give your baby something cold to suck or chew on. You can buy plastic teething toys/ rings which you can cool in the refrigerator. Some babies find it great to chew on a face washer that has be moistened and cooled in the freezer for a few hours.
Regularly clean teething rings, toys or anything else that your baby chews on, to prevent the growth of germs.
Prevent skin rashes on the face by washing away saliva with a warm, clean face washer and applying protective ointment.
A teething rusk is good to chew on, but be careful pieces don't break off becoming a choking hazard.

Teething aids such as teething gels or pain killers should only be used if advised by your doctor.

How to keep your baby's teeth healthy

DO

Start cleaning your baby's teeth twice a day, as soon as teeth appear. Use a clean cloth to wipe over your baby's teeth.
As more teeth develop you can use a soft toothbrush. (Until around the age of 8 years a child lacks the coordination to adequately clean their own teeth. Parents need to assist their child with brushing teeth until that time).
Begin using low-fluoride toothpaste (made for children) at around 2 years. Only a smear of toothpaste (as big as a pea or less) should be used. Encourage your child to not eat or swallow toothpaste after brushing, teach him how to spit it out.
Keep toothpaste tubes out or reach of children.
Take your child a pediatric dentist twice a year.

DON'T

Don't put your baby's pacifier in your own mouth then give it back to him, as you will transfer bacteria which cause dental decay from your mouth to his.
Don't dip a pacifier or teething rings in honey or other sweet foods, as this may lead to dental decay. (Honey is not recommended for babies under 12 months due to the risk of botulism, a serious gastro-intestinal infection).
Don't give your baby or young child a bottle of milk, formula or fruit juice to suck on after a feed, or to go to sleep with. The sugar in milk and fruit juice can lead to tooth decay if it remains in your baby's mouth for a long time.
Don't use lemon juice on his gums once teeth come into his mouth, because lemon juice has a lot of acid and can damage the tooth enamel.
Don't use toothpaste until 2 years of age (at an age where he can be taught to spit it out).

When to see a doctor

Teething may cause your baby to be mildly 'off-color' but it doesn't cause serious illness. Take your child to the doctor if teething troubles last longer than 3 days or sooner if your baby has...

A fever.
Diarrhea; or
Is not drinking enough fluids.

Written by Rowena Bennett.