Teething is the process by which an infant's teeth sequentially appear by breaking through the gums. Teething may start as early as three months or as late, in some cases, as twelve months. The typical time frame for new teeth to appear is somewhere between six and nine months. It can take up to several years for all 20 deciduous (aka "baby" or "milk") teeth to emerge. The process of teething is sometimes referred to as "cutting teeth".
Sequence of appearance
The infant teeth tend to emerge in pairs – first one lower incisor emerges then the other lower incisor emerges before the next set begin to emerge. The general pattern of emergence is:
- Lower central incisors (2)
- Upper central incisors (2)
- Upper lateral incisors (2),
- Lower lateral incisors (2)
- First molars (4)
- Canines (4)
- Second molars (4)
Milk teeth tend to emerge sooner in females than in males. The exact pattern and initial starting times of teething appear to be hereditary. When and how teeth appear in an infant has no bearing on the health of the child.
The level of pain that a baby can handle will be different for each child. Some may be a lot fussier than others while they are teething. The soreness and swelling of the gums before a tooth comes through is the cause for the pain and fussiness a baby experiences during this change. These symptoms usually begin about three to five days before the tooth shows, and they disappear as soon as the tooth breaks the skin. Some babies are not even bothered by teething.
Common symptoms include drooling or dribbling, mood changes and feelings of irritability or crankiness and swollen gums. Crying, sleeplessness, restless sleep at night, and mild fever are also associated with teething. Teething can begin as early as 3 months and continue until a child's third birthday. In rare cases, an area can be filled with fluid and appears over where a tooth is erupting and cause the gums to be even more sensitive. Pain is often associated more with large molars since they cannot penetrate through the gums as easily as the other teeth.
Some of the signs or symptoms that a baby has entered the teething stage will be actions that are noticeable. They may chew on their fingers or toys to help relieve pressure on their gums. Babies might refuse to eat or drink due to the pain. Symptoms will generally fade on their own, but a doctor should be notified if they worsen or are persistent. Teething may cause signs and symptoms in the mouth and gums, but it doesn't cause problems elsewhere in the body.
Pulling on the ears is another sign of pain; the pain in the mouth throbs throughout the baby's head so they pull their ears believing that it will provide relief. Mild rash can develop around the mouth due to skin irritation that is caused because of excessive drooling or dribbling.
Teething has not been shown to cause fever or diarrhea. A slight rise of temperature may occur when the teeth come through the gum, but this does not make a baby ill.
Before treating a baby for teething, it is important to know what it is causing the baby to be upset. Rubbing a finger gently along the gums in search for swollen ridges or the feel of a tooth below the gums is the best way to be certain. If unsure, it is recommended that the child be seen by a pediatrician before treatment is administered.
Infants chew on objects to aid in the teething process. This can be dangerous if the baby is allowed to chew on objects which are small enough to be swallowed or which could break while being chewed and cause choking. Teething rings and other toys, called teethers, are often designed with textures that will appeal to an infant during teething.
In cases where the infant is in obvious pain, some doctors recommend the use of anti-inflammatories or child-safe pain-relief treatments containing benzocaine. Some infants gain relief from chewing on cold objects.
Dentists recommend brushing infants' teeth as soon as they appear. It is not advisable to wait for the teething process to be complete. Dentists may recommend against the use of fluoride toothpaste during teething.
Not all parents are excited about the idea of using medications to treat a baby's pain and suffering. Medicines are often applied to the babies gums to relive swelling and pain. These gels are similar to the toothache gel that is used by adults for sore gums and toothaches, but is administered in much smaller doses. It works as a numbing agent to dull the nerves in the gums so that pain is less noticeable. It is important to follow the directions on the package to ensure that the correct amount of medication is administered and proper techniques are used to reduce the risk for infection. It is important not to let the medicine numb the throat because that may interfere with the normal gag reflex and may make it possible for food to enter the lungs.
Acetaminophen and ibuprofen are also recommended to treat the pain and swelling that babies experience, but should not be administered to babies under six months of age. It should only be used a few times a day so that it does not mask symptoms that are being experienced due to other medical conditions and not because of teething. Products that contain aspirin should not be given to a child unless directed by a pediatrician. A teething ring is generally a soft plastic device that can be chewed on and allows the baby to break down some of the gum tissue and promote the growth of the teeth out of the gum. Some teething rings can easily be broken or damaged, so other types of teething devices can be made from household items. Placing a wet washcloth in the freezer for a few minutes is effective but be careful not to expose a baby's gums to coldness for too long.