Teething is normal and happens when the baby’s teeth push through the gums and begin to grow out. This process usually happens at 6-9 months. Your baby may be more fussy than usual, may start dribbling more, or want to chew on something, have a fever, or cry more often than usual.
Although the milk teeth develop when the baby is growing in the womb, the teeth only start to grow through the gums when the baby is 6-9 months old. When the teeth grow, special chemicals are released by the body, which causes part of the gums to separate and allows the teeth to grow through.
Signs and symptoms of teething
For many babies, teething leads to mild symptoms that just last a few days. However, for others, teething is painful and can last much longer. Symptoms of teething often occur a few days (or even weeks) before the tooth comes through the gum. Common symptoms and signs include:
red and swollen gums;
red flushed cheek or face;
rubbing their ears on the same side as the tooth;
dribbling more than usual;
waking more at night and generally being more unsettled;
inconsistent feeding; and
rubbing of gums, biting, chewing or sucking more.
Teething can be painful, but it doesn’t usually make babies sick. Call your doctor if your baby has diarrhea, vomiting, rashes on the body, a higher fever, or cough and congestion. These aren’t normal signs of teething and you must consult with a doctor to check for another cause of these symptoms (for example, an ear infection, chest infection or urinary infection).
Order of tooth eruption
The teeth grow through the gums in stages. Usually, the lower front teeth come through first, followed by the top middle teeth. Other teeth follow over the following months. A child is usually aged around 2½ or 3 years when they have their full set of first teeth. Generally, 20 baby teeth/milk teeth will eventually be in place by age 3.
While a baby's first tooth can appear between 6 and 9 months of age, some dentists have noted a family pattern of "early," "average," or "late" teethers, therefore children may not get teeth at the same time or in the same order as outlined above and that is perfectly normal.
The following is the general order of eruption of primary teeth:
Central incisors: 6-12 months of age
Lateral incisors: 9-16 months of age
Canine teeth: 16-23 months of age
First molars: 13-19 months of age
Second molars: 22-24 months of age
Between 6 to 12 years of age, the roots of these 20 "baby" teeth degenerate, allowing their replacement with 32 permanent "adult" teeth. The third molars ("wisdom teeth") have no preceding "baby" version and generally erupt in mid to late adolescence.
A relatively rare condition, "natal" teeth, describes the presence of a tooth on the day of birth. The incidence of such an event is one per 2,000-3,000 live births. Usually, this single and often somewhat malformed tooth is a unique event in an otherwise normal child. The natal tooth is often loose and is commonly removed prior to the newborn's hospital discharge to eliminate the risk of aspiration into the lungs.
How to manage a teething child
If your child is in pain with their teething, then giving paracetamol or ibuprofen may help. These should be given at the recommended doses for their age.
You may need to try different things to help your child feel better:
Something cold in the baby’s mouth, like a cold pacifier, spoon, clean wet washcloth, or a solid (not liquid) refrigerated teething toy or ring. Some experts say frozen teething toys are too cold and may hurt your baby’s mouth. Make sure to clean teething toys, washcloths, and other items after each use.
Try offering a hard, unsweetened teething cracker. Chewing on chilled fruit or vegetables may also help.
If your baby is older than 6-9 months, you can offer cool water from a sippy cup, too.
Massage the gums by gently rubbing them with your clean finger. If the teeth haven’t come in yet, you can let your baby gnaw on your finger. If you’re nursing your baby, try dipping your fingers in cool water and massaging their gums before each feeding. That may keep them from biting your nipple while nursing.
Importantly, never put anything in your baby’s mouth that isn’t specifically approved to help soothe teething. Even some products described as teethers or teething aids aren’t safe choices, including ones:
filled with liquid that can tear and spill;
made of breakable material, like plastic, that can possibly lead to choking; and
that are frozen solid --these can be too hard on a baby’s mouth.
Another reason to be aware of the material used to make the teethers:
Some can be made from harmful substances, like lead. Look for ones made of rubber.
Take Home Message
Teething is a normal developmental milestone in children. It can happen between 6-9 months.
This article is written by Dr. Itumeleng Buti (MBChB)
References
1. Massignan C, Cardoso M, Porporatti AL, et al; Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis. Pediatrics. 2016 Mar137(3):1-19. doi: 10.1542/peds.2015-3501. Epub 2016 Feb 18.
2. Kakatkar G, Nagarajappa R, Bhat N, et al; Parental beliefs about children's teething in Udaipur, India: a preliminary study. Braz Oral Res. 2012 Mar-Apr26(2):151-7.
3. Plutzer K, Spencer AJ, Keirse MJ; How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial. Child Care Health Dev. 2012 Mar38(2):292-9. doi: 10.1111/j.1365-2214.2011.01215.x. Epub 2011 Mar 6.
4. Colin Tidy. Children’s Health: Teething.[Internet] Patient. [updated 2021 January 25 Cited 2022 April 17] Available from: https://patient.info/childrens-health/teething.
5. John Mersch. When Do Babies Start Teething? [Internet] MedicineNet: [ Cited 2022 April 17] Available from: https://www.medicinenet.com/teething/article.htm
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