I get questions all the time about teething, and we had a reader suggest an article to answer some common questions I get about teething. Let’s dive into tooth development and find more about those chompers 🦷 

“When does teething start?”

Teething typically starts between 6-10 months, though it can start earlier or later. The first teeth to erupt are usually the bottom central teeth (i.e. mandibular central incisors). Within a month or two, the upper central teeth (maxillary central incisors) erupt closely followed by the upper side (or lateral) incisors within the next few weeks. The lower side lateral incisors come in about a month or two later. 

Following these teeth the first molars come in, typically around 15 months. The canines come in around 18-20 months, and the second molars between 2-2.5 years. Given this is so spread out it’s not unusual for symptoms to come and go. Teeth development is different for everyone and we never expect every baby’s teeth to come in following this pattern. What most parents can expect, though, is symptoms of teething!

“What are the symptoms of teething?”

The symptoms of teething are broad and can mimic an illness in kids. That’s why it is really important for you to get your child checked out if they’re having any of these symptoms to make sure it’s nothing else. 

Symptoms include low grade fevers (not typically above 100.4 F or 38 C), fussiness, excessive drooling, and sometimes diarrhea. A lot of parent wonder why they get these symptoms. The actual process of teeth cutting through the gum tissue is very “inflammatory” to the body. Thus, you get symptoms of inflammation and pain. The pain can be severe- more severe than you think!

A final word on teething symptoms is the ear tugging that I see a lot. The nerves that innervate the back teeth are related to the nerves of the ear and as such, tugging on the ear can be a sign of teething. If you notice fever, fussiness, and ear tugging, however, you should have your child checked for an ear infection to be safe. 

“It all makes sense now!” 

“What can I do to help my baby be more comfortable?”

The most common things I see parents do are teething necklaces (or rings), orajel or other numbing agents, or medications that help with pain such as Tylenol or Motrin. 1 of these is okay, 2 are not. Can you guess which ones? 

Teething rings (either necklaces, bracelets, or anklets) that are made of beads should be avoided. They can break and cause choking but also can cause strangulation. They can also cause injuries to the mouth and infections. These are made up risks, they’re real! It’s also important to note that some teething rings are reported to release natural anti-inflammatory compounds that help with pain. Though this has not been proven, I have parents swear to me that they help. As such, if you do decide to use one of these on your child they should always be supervised. If you aren’t going to be able to supervise them, you should take it off to be safe. Something bad can happen quickly, so don’t take chances. 

Orajel (or other off brand numbing agents) are dangerous in kids under 2 years of age. The active ingredient in these  (lidocaine, benzocaine) can cause heart issues in kids even in small doses. Over the counter remedies can contain small amounts of deadly nightshade (or belladonna) that can cause breathing problems, lethargy, sleepiness, and agitation. And you thought you could trust them!

The best thing for teething is supportive care. Chewing on wet cooled rags, teething toys (such as this adorable giraffe or this scarf designed for chewing), and even your finger (as long as it’s the first tooth and it hasn’t erupted!) are appropriate and can help. Since kids have preferences so you should try different materials (i.e. silicone vs wood). Massaging the gums can help as well. Occasional use of Tylenol or Motrin (as long as it is cleared by your child’s doctor) can be okay too. Time is your friend- it will get better.

“When should I see a dentist?”

The American Academy of Pediatrics and the American Dental Association recommend seeing a dentist no later than age 1. I’ll be honest though, I don’t know many parents who do! Though it’s still they’re recommendation, I’m a realist and I tell my patient’s parents to make sure they have seen a dentist no later than age 2, ideally sooner. This visit is important in educating you on proper dental hygiene and making sure teeth are healthy and stay healthy. I’ve known and seen very young children with tooth decay, so please don’t ignore dental health even if they’re just baby teeth! 

Cleaning the teeth as soon as they start breaking through is also important as decay can start happening immediately. Use regular toothpaste (yes, regular) either on your finger or a brush. Use no more than the size of a grain of rice. Rinse the area with your finger afterwards. 

“When should I worry?”

Delayed tooth eruption is defined as teeth that haven’t erupted more than 6 months beyond the normal range for a particular tooth (I.e. if the lower central teeth haven’t erupted by 16 months). This also includes asymmetric tooth eruption (e.g. the left lower central tooth comes in but 6 months has passed and you don’t see the other side). This can be due to a genetic problem or a host of other medical conditions. 

Fast tooth eruption can be seen in preterm birth and a variety of syndromes but in and of itself isn’t a problem. You have to make sure you are taking proper care of the teeth, however! 

Finally, if your child has a high fever and is teething it’s important to consider other things that cause fever such as illness. Just because it sounds like a horse doesn’t mean it couldn’t be a zebra! 

Summary

Teething is the ire of many parents. It’s tough for kids to deal with and the fussiness can drive you mad. Stay cool and patient and help support your little nugget through it with some of the tips I had above. Avoid numbing agents in the mouth and be careful when considering the use of beaded necklaces or bracelets. Try different materials and textures, and get them checked if they have high fevers or seem more fussy than usual. 

No one ever said getting those 20 teeth were easy 😵

What has worked for you and your child with teething? Let other parents know below 👇