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    Teething

    Teething

    Topic Overview

    What is teething?

    Your baby is teething when his or her first set of teeth, called primary teeth , break through the gums.

    When does teething typically start?

    Teething usually begins around 6 months of age. But it is normal for teething to start at any time between 3 months and 12 months of age. By the time your child is about 3 years old, he or she will have all 20 primary teeth.

    The lower front teeth usually come in first. Upper front teeth usually come in 1 to 2 months after the lower front teeth. See a picture that shows when the primary teeth come in .

    What are the symptoms?

    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 the tooth shows, and they disappear as soon as the tooth breaks the skin. Many babies don't seem to be affected by teething.

    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.

    Mild symptoms that get better usually are nothing to worry about. Call your doctor if your baby's symptoms are severe or don't get better.

    How can you help your baby be more comfortable while teething?

    Here are some tips to help your baby feel better while teething:

    • Use a clean finger (or cold teething ring) to gently rub your baby's gum 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.
    • If needed, give your baby an over-the-counter 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.

    Many parents use other teething remedies, such as gels you put on a baby's gums. Many experts question if these work and are safe. If you want to try these products, talk to your doctor about which types are safe and how often to use them.

    Frequently Asked Questions

    Learning about teething:

    Knowing what to expect:

    Getting treatment:

    Ongoing concerns:

    What to Expect

    Tooth development

    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 his or her 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 of teething

    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. Some babies may show signs of discomfort from sore and sensitive gums, be cranky, drool, and have other mild symptoms. 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.

    Mild symptoms that gradually improve usually are nothing to worry about and may even be related to a viral infection or other condition. Severe or ongoing symptoms should be closely watched and discussed with your doctor.

    Common concerns

    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.

    Home Treatment

    Controlling symptoms safely

    If your baby has discomfort while teething, you can:

    • 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 babies to chew on, such as 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 relief medicine that is labeled for his or her specific age. For example, acetaminophen or ibuprofen may help relieve your baby's discomfort. Follow all instructions on the label . Do not give aspirin to anyone younger than 20, because it has been linked with Reye syndrome .

    Although some parents use topical gels and other teething remedies, there are questions about how effective and safe these products are. Talk to your doctor about which types of products are safe and how often they can be used.

    Promoting healthy teeth

    You can give your child the best chance for healthy teeth and gums.

    • Take measures to help prevent tooth decay in your child's primary teeth. For example, 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 within 6 months of when your child's first tooth comes in but no later than your child's first birthday. 1

    For more information on caring for your child's teeth, see the topic Basic Dental Care or Tooth Decay.

    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.

    Your doctor may refer your child to a dentist who specializes in children's teething problems, if this seems to be needed.

    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. 1

    Some parents dread 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 his or her dentist carefully. Talk to your child about what to expect. And 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. For more information on routine checkups and tooth care, see the topics Basic Dental Care and Tooth Decay.

    Other Places To Get Help

    Organizations

    American Academy of Family Physicians: FamilyDoctor.org
    P.O. Box 11210
    Shawnee Mission, KS66207-1210
    Phone: 1-800-274-2237
    Fax: (913) 906-6075
    Web Address: www.familydoctor.org

    The website FamilyDoctor.org is sponsored by the American Academy of Family Physicians. It offers information on adult and child health conditions and healthy living. There are topics on medicines, doctor visits, physical and mental health issues, parenting, and more.


    American Academy of Pediatrics
    141 Northwest Point Boulevard
    Elk Grove Village, IL60007-1098
    Phone: (847) 434-4000
    Fax: (847) 434-8000
    Web Address: www.aap.org

    The American Academy of Pediatrics (AAP) offers a variety of educational materials about parenting, general growth and development, immunizations, safety, disease prevention, and more. AAP guidelines for various conditions and links to other organizations are also available.


    American Dental Association
    211 East Chicago Avenue
    Chicago, IL60611-2678
    Phone: (312) 440-2500
    Web Address: www.ada.org

    The American Dental Association (ADA), the professional membership organization of practicing dentists, provides information about oral health care for children and adults. The ADA can also help you find a dentist in your area.


    KidsHealth for Parents, Children, and Teens
    Nemours Home Office
    10140 Centurion Parkway
    Jacksonville, FL 32256
    Phone: (904) 697-4100
    Web Address: www.kidshealth.org

    This website is sponsored by the Nemours Foundation. It has a wide range of information about children's health?from allergies and diseases to normal growth and development (birth to adolescence). This website offers separate areas for kids, teens, and parents, each providing age-appropriate information that the child or parent can understand. You can sign up to get weekly emails about your area of interest.


    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.

    Other Works Consulted

    • Fenick AM, Nelson LP (2011). Oral health supervision. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 47?52. New York: McGraw-Hill.
    • Karp JM (2011). Delayed tooth emergence. Pediatrics in Review, 37(1): e4?e17.
    • Klein U (2012). Oral medicine and dentistry. In WW Hay Jr et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 465?476. New York: McGraw-Hill.

    Credits

    By Healthwise Staff
    Primary Medical Reviewer John Pope, MD - Pediatrics
    Specialist Medical Reviewer Thomas M. Bailey, MD - Family Medicine
    Last Revised April 16, 2013

    Last Revised: April 16, 2013

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