Teething Information | Mount Sinai

Eruption of primary teeth; Well child care – teething

Teething is the growth of teeth through the gums in the mouth of infants and young children.

The structure of the tooth includes dentin, pulp and other tissues, blood vessels and nerves imbedded in the bony jaw. Above the gum line, the tooth is protected by the hard enamel covering.

Both baby teeth (deciduous or milk teeth) and permanent teeth have fairly well-defined times of eruption. The ages listed are the normal ages that a baby tooth emerges. Upper central incisors and upper lateral incisors erupt by 8 to 10 months. Upper canines (cuspids) erupt by 16 to 20 months. Upper first molars erupt by 15 to 21 months. Upper second molars erupt by 20 to 24 months. Lower central incisors erupt by 6 to 9 months. Lower lateral incisors erupt by 15 to 21 months. Lower canines (cuspids) erupt by 15 to 21 months. Lower first molars erupt by 15 to 21 months. Lower second molars erupt by 20 to 24 months.

Children typically begin to erupt a tooth between the 6th and 8th month of life. Signs of teething are drooling, irritability, gum swelling and sensitivity, sleeping problems, refusing food, the urge to bite on hard objects and possibly a low grade fever. The discomfort that results from teething is due to the pressure exerted on the tissue in the mouth, called the periodontal membrane, as the teeth erupt.

Information

Teething generally begins when a child is between 6 and 8 months old. All 20 baby teeth should be in place by the time a child is 30 months old. Some children do not show any teeth until much later than 8 months, but this is usually normal for the child and not due to a disease.

• The two bottom front teeth (lower incisors) often come in first.
• Next to grow in are usually the two top front teeth (upper incisors).
• Then the other incisors, lower and upper molars, canines, and finally the upper and lower lateral molars come in.

The signs of teething are:

• Acting cranky or irritable
• Biting or chewing on hard objects
• Drooling, which may often begin before teething starts
• Gum swelling and tenderness
• Refusing food
• Sleeping problems

Teething does not cause fever or diarrhea. If your child develops a fever or diarrhea and you are worried about it, talk to your health care provider.

Tips to ease your child’s teething discomfort:

• Wipe your child’s face with a cloth to remove the drool and prevent a rash.
• Give your child a cool object to chew on, such as a firm rubber teething ring or a cold apple. Avoid liquid-filled teething rings, or any plastic objects that might break.
• Gently rub the gums with a cool, wet washcloth, or (until the teeth are right near the surface) a clean finger. You may place the wet washcloth in the freezer first, but wash it before using it again.
• Feed your child cool, soft foods such as applesauce or yogurt (if your child is eating solids).
• Use a bottle, if it seems to help, but only fill it with water. Formula, milk, or juice can all cause tooth decay.

You can buy the following medicines and remedies at the drug store:

• Acetaminophen (Tylenol and others) or ibuprofen can help when your child is very cranky or uncomfortable.
• If your child is 2 years or older, teething gels and preparations rubbed on the gums may help the pain for a short while. Be careful not to use too much. Do not use these remedies if your child is younger than 2 years old.

Be sure to read and follow package instructions before using any medicine or remedy. If you are not sure how to use it, call your child’s provider.

What not to do:

• Do not tie a teething ring or any other object around your child’s neck.
• Do not place anything frozen against your child’s gums.
• Never cut the gums to help a tooth grow in, because this can lead to infection.
• Avoid teething powders.
• Never give your child aspirin or place it against the gums or teeth.
• Do not rub alcohol on your child’s gums.
• Do not use homeopathic remedies. They may contain ingredients that are not safe for infants. 

American Academy of Pediatrics website. Teething: 4 to 7 months. www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Teething-4-to-7-Months.aspx. Updated October 6, 2016. Accessed November 29, 2022.

American Academy of Pediatric Dentistry. Policy on oral health care programs for infants, children, adolescents, and individuals with special health care needs. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2020:39-42. www.aapd.org/globalassets/media/policies_guidelines/p_oralhealthcareprog.pdf. Updated 2020. Accessed November 29, 2022.

Turner EG, Dean JA. Eruption of the teeth: local, systemic, and congenital factors that influence the process. In: Dean JA, ed. McDonald and Avery’s Dentistry for the Child and Adolescent. 11th ed. St Louis, MO: Elsevier; 2022:chap 20.

Last reviewed on: 10/31/2022

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Your baby and teething – HSE.ie

Teeth do not usually appear until your baby is 6 months old or later. They may show signs of teething from about 13 weeks.

Your child should have most of their 20 baby teeth by the time they’re 2 and a half years old.

Signs your baby is teething

If your baby is teething they might:

• have red, flushed cheeks
• dribble – you should wipe this away from the skin folds on their neck because it can cause soreness
• chew on their fists or on their toys more than usual
• have sore and tender gums and cry more
• have a nappy rash

Non-urgent advice: Contact your public health nurse or GP if your child:

• has a high temperature (more than 38 degrees Celsius)
• has diarrhoea
• generally seems unwell

This is not caused by teething.

How to help your teething baby

It’s upsetting to see your baby in discomfort from teething. Comforting and playing with them will help distract them.

Tips for helping a teething baby

• Try giving your baby something to chew on, such as a cool teething ring.
• Massage your baby’s sore gums with a sugar-free teething gel.
• Use mild sugar-free pain relief if your baby wakes at night and is irritable.
• Give them cold water to drink – this helps to keep babies hydrated and may also soothe their gums.
• Give them healthy foods to chew on, such as pieces of carrot or apple, or breadsticks – only do this if they’re 6 months or older.
• Stay close to your baby when they’re eating in case they choke.

Teething rings

Chewing on a teething ring can help soothe a baby’s gums as well as distract them from the pain.

Use teething rings that are big enough so your child will not choke on them. Keep a spare clean teething ring in the fridge.

Never tie a teething ring around a baby’s neck. This could strangle them.

Check the product instructions on teething ring hygiene and how long to cool the ring for.

Never put the ring in the freezer as the temperature could damage your baby’s gums.

You can also use a cold wet facecloth for a baby to chew on. Make sure the facecloth is clean.

Teething gels and pain relief

Sugar-free teething gels are available over the counter from the pharmacy. They contain a mild local anaesthetic which helps numb any pain. These are for babies older than 4 months.

If your baby is still in discomfort after using teething gels, consider giving them sugar-free paracetamol or ibuprofen medicine for babies. Do not use ibuprofen medicines if your baby is under the age of 3 months.

Contact your GP or pharmacist for information on the safe use of gels and pain relief.

Always follow the instructions on the leaflet and the packaging. Make sure you use the right amount and only as recommended. If you’re unsure, ask your GP or pharmacist.

Never use products on your baby that are meant for adults or for older children. These products are not suitable for relieving the symptoms of teething in babies.

Amber teething jewellery

We do not recommend using amber teething jewellery for your baby. These can be necklaces, anklets, or bracelets.

Amber teething jewellery can choke your baby.

Important

Never put jewellery, cords or string around your baby’s neck

Homeopathic teething products

There are some unlicensed homeopathic products and remedies sold online. These are not safe for young infants and babies.

Research into these products shows that they may cause serious side effects.

These include:

• difficulty breathing
• seizures
• agitation
• excessive sleepiness
• constipation and difficulty peeing

This warning does not apply to Nelson’s homeopathic teething products, sold in Ireland with the brand name of ‘Teetha’.

Nappy rash and teething

Babies who are teething may get nappy rash and sore bottoms. Check your baby’s bottom and change their nappies often.

Using a barrier nappy cream may help. Leaving the baby’s nappy off for a period of time, although messy, is soothing for babies.

Nappy rash

Teething and crying

Anything that causes your baby to cry more is difficult for you too. If you’re tired and stressed, try asking for help from friends or family.

Why your baby is crying

Thumb-sucking and soothers

Some small children suck their thumb because they find it soothing. They may develop this habit at around 18 months.

Thumb-sucking and soothers

Breastfeeding

Research has shown that breastfeeding up to 12 months of age can help reduce tooth decay.

Get advice from your public health nurse or GP if you plan to continue breastfeeding after your baby is 12 months old.

When to start brushing your baby’s teeth

Before teeth appear, clean your baby’s gums twice a day with a clean soft wash cloth or gauze.

When your baby’s first tooth appears you can introduce gentle toothbrushing twice a day. This is normally at around 6 months of age.

Use water and a small, soft toothbrush. Do not use toothpaste at this age.

Brushing your baby’s teeth will get them used to teeth brushing as part of their daily routine.

You can set a good example by letting them watch as you brush your teeth.

Looking after your child’s teeth

First dentist appointment

Take your baby to the dentist when their first teeth start to appear at around 6 months of age.

Your dentist will check that their teeth are developing correctly. They will show you how to care for your baby’s teeth.

They can also give advice on how to help with problems such as teething.

Dental treatment for your baby

Babies with tongue tie

Some babies are not able to move and stretch their tongues freely because they have a short, tight or thick frenulum (the skin attaching the tongue to the base of the mouth). This is known as ‘tongue tie’.

It’s hard for children with a tongue tie to remove food debris from around their teeth because of their limited tongue movement. This can lead to tooth decay.

Some babies may need a frenectomy (frenotomy). This is where the frenulum causing the tongue tie is released in a minor operation.

Tongue tie

When to get medical advice

Urgent advice: Contact your GP urgently if your baby:

• has a temperature of more than 38 degrees Celsius
• is lethargic and drowsy

These symptoms are not caused by teething.

Teething may cause a mild rash on a baby’s chin or neck, but it does not cause a widespread rash.

Babies who are not drinking and not having plenty of wet nappies per day might be dehydrated.

Important

Contact your GP for advice if you’re worried about any symptoms in your baby

You can get more advice on caring for your baby’s teeth from your dentist or public health nurse.

Can teeth be cut at 3 months

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Teething at three months of age: normal or pathological

When the baby is completely small, his anxiety, fever and the appearance of other undesirable symptoms are more often associated by parents with the disease, but not with the appearance of the first teeth. After all, the average eruption time is within 6-8 months. But pediatric dentistry knows many cases where the process begins earlier than these time frames. Therefore, parents need to prepare to help the child at any time.

Teething at 3 months: what parents need to know

Noticing changes in the behavior and deterioration of the baby’s well-being, parents wonder if teeth can erupt at 3 months. Although such timing is not typical, it is worth knowing that the appearance of incisors at this age is possible. By the way, there are rare cases when a child is already born with erupted teeth.

Deviations in both directions from the average time frames are considered normal. Each child’s body is individual. In addition, the timing of eruption is influenced by various factors:

• the course of pregnancy – milk bite is laid in the womb at 7-8 weeks;
• mother’s diet – contribute to the rapid eruption of the use of pregnant dairy products in large quantities;
• additional intake of mineral complexes – in particular vitamin D and C;
• genetic predisposition to early eruption;
• climatic conditions – the process of teething begins earlier among the inhabitants of the south.

In some cases, early tooth growth may indicate pathology, in particular endocrine disorders. But it is believed that it is not the timing that speaks about the healthy development of the baby. What matters is what teeth climb. It is important that the order in which they appear is observed. The central teeth grow first from below, followed by their antagonists from above. Then the lateral incisors appear, after them the fangs (first the upper ones, then the lower ones). The molars on the lower and upper jaws are cut last.

Symptoms of teething

How not to confuse the process of the appearance of the first teeth with a certain disease? The following symptoms may indicate teething:

1. Swelling of the gums, friability, redness. Sometimes the tooth is visible through the tissues. In some cases, hematomas form.
2. Irritability. The baby may be disturbed by pain, itching, so he becomes restless, tearful. The child’s sleep is disturbed due to discomfort.
3. Active sucking. When the baby actively sucks on the breast or nipple, in this way he tries to relieve the discomfort from the pressure of the tooth on the gum from the inside. In some cases, the baby, on the contrary, loses its appetite.
4. Increased body temperature (often up to 37.5°). In most cases, this is a short-term symptom. A higher temperature indicates the addition of a bacterial infection.
5. Increased salivation. Such a symptom can not only indicate teething. At 3 months, this is a physiological process. Therefore, it is worth taking into account other signs. When the first teeth appear, salivation may cause a rash around the mouth. Since at the age of three months the baby is often in a supine position, saliva flows down the walls of the throat. It enters the nasal passages, which provokes rhinitis. When mucus gets into the throat, a cough also occurs, which often manifests itself in a dream.

These symptoms do not occur all at once, but they still cause concern for parents. They worry about whether teeth can be cut at such an early age, and here they still have to deal with the deterioration of the baby’s well-being.

Since many of the symptoms are associated with infectious diseases, it is best to take the child to the doctor. You should not hesitate to visit a specialist if the baby is lethargic, has a high temperature that does not fall, rashes appear on the oral mucosa, and vomiting occurs. The last symptom does not always indicate a complication. It can also occur due to mucus getting into the stomach.

When an infection is added, the child develops diarrhea. This condition requires careful monitoring, since frequent and loose stools can provoke dehydration.

How to alleviate the child’s condition during teething

We have already dealt with the question of whether teeth can erupt at the age of three months. But when this process begins, parents face another dilemma – what to do to alleviate the child’s condition. In such a stressful situation, he needs bodily and psycho-emotional contact – carry the baby in your arms, rock him, gently talk to him. This will help relieve nervousness. To eliminate other unwanted symptoms, the following methods are used:

1. Gum massage. Do it with your fingertip, after washing your hands. In order not to injure the child, you must also cut your nails. There are also silicone fingertips with bristles or pimples on sale. To determine the intensity of massaging movements, you need to monitor the reaction of the baby.
2. Refrig. Since ordinary teethers are not suitable for a 3-month-old baby, other alternative methods are used – they cool the nipple or apply a gauze napkin soaked in cold boiled water.
3. Pharmaceutical products. If you notice that the baby’s incisors are starting to climb, you should consult with the pediatrician which gel or ointment to choose. Not all drugs are suitable for the smallest, but there is still a choice. For example, “Kamistad” or “Kalgel” are safe for three-month-old children.
4. Antipyretics. Help drugs based on paracetamol and ibuprofen. In addition to normalizing body temperature, they relieve pain. Babies are often given candles, for example, Efferalgan.

Care must be taken to notice which way is best for the baby. During the period when teeth erupt, he also needs careful care. In order not to infect the gums, you need to keep his nipple clean, monitor breast hygiene. Saliva should be wiped with clean napkins, without making an effort so as not to irritate delicate skin. After that, with light massaging movements, you can apply baby cream. It will be useful for the baby to walk in the fresh air in places where there are no large crowds of people.

Date: September 23, 2021

Tips on how to calm a crying baby

Crying is a way for a baby to communicate, but despite its naturalness, it is not out of place to try to calm a crying baby. It is logical that parents will have a question: “How to calm the child?” This may seem like a daunting task at times, but understanding the reasons will help you learn how to soothe a crying baby. Remember: you are doing great. We just want to give you some useful tips to help ease your worries.

If you have any questions or concerns about your baby’s crying, seek medical advice. Sometimes crying can be a sign of an existing medical condition, so it’s best to pay attention to any additional symptoms right away.

Why your baby is crying

Baby crying is not only natural but also expected, especially during the first three months of life. Babies usually cry for an hour every day for the first few weeks. At about six weeks old, your baby may cry for up to two hours a day, and from eight weeks on, again for about one hour a day. However, remember that all babies are different and cry differently! ¹

Crying is a way of saying something is wrong. When it comes to learning how to soothe a crying baby, it’s important to understand what exactly is causing her anxiety. Your baby may cry if: ¹

• he is hungry;
• baby has belching or bloating;
• need a diaper change;
• he wants to sleep;
• wants to be picked up or rocked;
• baby is hot or cold;
• baby has colic;
• feels uncomfortable: wants to roll over, presses on diaper or clothes, or tight swaddling interferes with baby;
• the baby is teething.

If your baby cries for more than three hours a day and more than three days a week, he may be suffering from colic. However, this is not a reason to panic, and there are several ways to soothe a child with colic. Find out here about colic, its symptoms, and how to soothe a baby with colic.

If you think reflux (regurgitation) may be the cause of your crying, you can learn more about the different types of reflux and how to manage it here.

Be sure to contact your child’s doctor if your baby seems ill or has the following symptoms in addition to excessive crying: ¹

• fever;
• shortness of breath or cough;
• vomiting;
• diarrhea;
• rash;
• crying worse when the child is picked up or moved;
• increased irritability or lethargy.

How to soothe a crying baby

Once you’ve ruled out some potential causes of crying, you’ll have a better idea of ​​how to soothe your baby. The most important thing to remember is not to get upset and stay as calm as possible.

Here are some tips and tricks on how to calm your baby: ²

1. Swaddle your baby.

One of the most useful techniques to soothe a crying baby is swaddling. When doing this, make sure that you do not cover the child’s head and do not overheat him. Don’t swaddle your baby too tight: swaddling too tightly can interfere with your baby’s natural body position, breathing, and blood circulation: your baby may not like it, causing him to cry. Don’t swaddle your baby when he starts to roll over, which usually happens around four months of age.

2. Take the child in your arms and comfort.

When your baby is crying, it’s natural for you to want to pick him up. And when your newborn cries for no reason, he probably wants to be picked up. If you’re trying to calm your baby at night, try keeping him upright or in a rocking chair until he falls asleep.