Teething in Babies: Symptoms and Remedies

Written by WebMD Editorial Contributors

In this Article

• What Is Teething?
• When Do Babies Start Teething?
• Signs and Symptoms of Teething
• Order of Tooth Eruption
• Soothe a Teething Baby
• Treatments to Avoid
• Teething Necklaces
• Teething Medicine
• How to Care for Baby’s New Teeth

Teething is when your baby’s teeth start to come through their gum line. Another word for it is odontiasis.

Most babies begin to teethe between 4 and 7 months old, but some start much later. There’s no need to worry if your baby’s teeth come in on another timetable — it can be different for every baby.

The symptoms aren’t the same for every baby, but they may include:

• Swollen, tender gums
• Fussiness and crying
• A slightly raised temperature (less than 101 F)
• Gnawing or wanting to chew on hard things
• Lots of drool, which can cause a rash on their face
• Coughing
• Rubbing their cheek or pulling their ear
• Bringing their hands to their mouth
• Changes in eating or sleeping patterns

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.

You also should call the pediatrician if your baby’s gums are bleeding or you see any pus or swelling of their face.

When and how teeth come in can be different for every baby and may be based on family history. But most of the time, the lower front two teeth come in first between 6 and 10 months, followed by the opposite top two teeth and the two on either side of those between 8 and 13 months. Next come the two on either side of the bottom front teeth, then the first molars appear between 10 and 16 months. The teeth in front of the first molars are next, and the back molars are the last ones to come in.

In all, 20 “baby teeth” will eventually be in place, usually by age 3.

What works to soothe a friend’s baby might not work for yours. You may need to try different things to help your little one feel better:

• Something cold in your 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 the baby uses them.
• Try offering a hard, unsweetened teething cracker.
• 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.

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
• 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.

Child health experts don’t recommend teething necklaces. They’re dangerous: They can strangle the baby. They also can choke if the necklace breaks and they swallow the beads.

If you do choose to use one, make sure to:

• Put it on a wrist or ankle, not around the baby’s neck.
• Always watch your baby when they wear it.
• Take it away when you aren’t watching your baby, even for a very short time.

You may have heard that amber teething necklaces release a pain reliever when heated. That’s not proven, and doctors say using one is not a good idea.

Medicine that you rub on your baby’s gums to stop the pain of teething may not help. It quickly washes away in the mouth and may numb the back of their throat and make it hard for them to swallow.

Stay away from over-the-counter teething gels and liquids that have the ingredient benzocaine. The FDA says this ingredient shouldn’t be given to children under 2. It can cause rare but serious side effects.

A small dose of a children’s pain reliever, such as acetaminophen, may help your baby. Don’t use ibuprofen for an infant under 6 months old, and ask your doctor before giving your baby any medication. Use it exactly as the doctor says.

Teething can be rough for you and your baby at first. But it’ll get easier as you both learn how to soothe each new tooth that pops out.

Good oral hygiene is important, even before your baby has teeth:

• Until teeth start to come in, clean your baby’s gums with a wet washcloth or piece of gauze at least once a day.
• Once they have teeth, clean your baby’s mouth the same way at least twice a day. After feedings is a good time for this.
• After their first birthday, you can start to use a soft-bristled baby toothbrush with water and a small amount of toothpaste that doesn’t have fluoride in it. You can also start flossing between their teeth.

Your child should see a pediatric dentist when the first tooth appears, or no later than their first birthday.

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At what age do babies start teething?

There are a lot of exciting milestones in your baby’s growth and development. There’s when they roll over for the first time. Then crawling, their first step, their first word, and on and on. And one of the biggest events is when your baby’s smile starts to turn into a toothy grin.

But when do babies get their first tooth? Do teeth come in a certain order? How do you soothe a baby’s sore gums?

Below, we answer these questions, explain other teething symptoms and answer common questions about cleaning baby teeth.

At what age do babies start teething?

The average age for a baby’s first tooth to come in is around 6 months old, but every child is different. Girls’ teeth usually come in a little earlier than boys’ do. But by the time a baby is 12 months old, they typically have 2-4 teeth. And by 3 years old, most kids have all of their primary or “baby” teeth.

How many baby teeth do kids have?

Children have a total of 20 primary teeth.

What order do baby teeth come in?

Baby teeth don’t always come in the same order for each kiddo. There are typical ranges for when certain teeth come in or “erupt,” but those ranges overlap. For example, many babies get their bottom central incisors sometime between 6 months old and 10 months old, and their top central incisors between 8 months old and 12 months old. But it’s also possible that a baby can start teething as early as 2 months old.

Baby teeth chart

Again, the exact timing and order that babies’ teeth come in can vary. But here’s when they generally tend to come in:

• Bottom central incisors: 6-10 months
• Top central incisors: 8-12 months
• Bottom lateral incisors: 10-16 months
• Top lateral incisors: 9-13 months
• Bottom canines: 17-23 months
• Top canines: 16-22 months
• Bottom first molars: 14-18 months
• Top first molars: 13-19 months
• Bottom second molars: 23-31 months
• Top second molars: 25-33 months

How do I know if my baby is teething? Watch for these baby teething symptoms

Not all babies show signs of teething. But common teething symptoms can include:

• Increased fussiness
• Increased drooling, which can cause coughing and lead to a rash on baby’s face, chin or chest
• Chewing on their hands or gnawing on objects
• Rubbing their cheek or ear
• Red or swollen gums that appear to be bulging
• A low-grade fever (less than 101 degrees Fahrenheit)

Usually, signs of teething will start a few days before a new tooth comes in, and go away once it has.

Is teething painful for babies?

Some babies will experience discomfort or pain while teething, which helps explain some of the teething symptoms you’ll notice. Gum soreness and swelling can lead to fussiness, or cause your little one to rub their cheeks or chew on anything they can get their hands on. The good news is that most discomfort will pass quickly.

Which are the most painful teeth for babies as they come in?

Typically, the first teeth to come in are the most uncomfortable for babies, as the feeling of a tooth coming in is new and unfamiliar. The molars can also be painful because they’re larger than other teeth.

How long does teething fussiness last?

If your baby is fussy during teething, you can expect it to last for a couple days to a week before the tooth erupts through the gums. If it lasts longer than this, check in with your child’s doctor.

When to talk to a doctor about teething concerns

Again, teething symptoms are usually mild and improve in a couple of days. But talk to your child’s doctor if:

• Symptoms are prolonged or get more severe (such as constant irritability or especially aggressive chewing)
• Your child has a fever higher than 101 degrees Fahrenheit
• Your child gets diarrhea alongside teething symptoms

How to soothe baby’s gums during teething

If your baby is showing signs of discomfort when they’ve got a tooth coming in, there are a few different things you can do to make them more comfortable.

• Wipe away drool from their chin regularly – This can help prevent skin irritation and rashes.
• Massage your baby’s gums – You can simply use a clean finger or chilled teething ring.
• Give your baby a cold washcloth or chilled teething toy to chew on – If your baby has already been introduced to solid foods that can be chilled, you can also use those. Only use a fridge to chill things (rather than the freezer), and don’t use toys that have liquid in them.
• Talk with your child’s doctor about over-the-counter pain relievers – Medications like acetaminophen or ibuprofen can help relieve pain and inflammation. Just make sure you’re using one that is meant for babies, and you follow all the instructions on the label.

Don’t try to relieve your baby’s symptoms with teething gels or teething tablets, as they may contain harmful ingredients. If you have questions about a method or teething product that isn’t listed above, talk to your child’s doctor.

Baby oral care: Answers to frequently asked questions

With the arrival of teeth comes the need to keep them clean. Here’s what to know to get your baby’s dental health off to a good start.

When should I start brushing my child’s teeth?

Start brushing as soon as the first tooth has come in.

How do I brush my baby’s teeth?

Use a small, soft toothbrush or washcloth twice a day. Start with water or a fluoride-free training toothpaste. Once your child is around 3 years old, you can start using small amounts of fluoride toothpaste.

Flossing should start when your child has teeth that have come in next to each other. If regular floss is too tricky, try using a floss pick.

Why do I need to brush my baby’s teeth?

Even though baby teeth will fall out, they’re still important. Healthy baby teeth support the health, spacing and alignment of the permanent teeth that come in after them. And getting your child used to regular brushing early on will help them form good oral hygiene habits.

Plus, tooth decay can start at a very young age. Children with tooth decay are more likely to have ear and sinus infections, and develop conditions like obesity, diabetes and heart disease. Healthy teeth help children speak quickly and clearly, too, which can give them more confidence as they grow up.

What else can I do to keep my baby’s teeth healthy?

If your child is still nursing or drinking a bottle at bedtime or overnight, talk with their doctor about when it makes sense to wean them from these feedings. This is because the sugars in your own milk or formula can sit on your baby’s teeth for prolonged periods of time overnight.

Most babies are able to sleep through the night without needing to eat sometime between 4 and 6 months old. And once they’re around 12 months old, nighttime bottles before bed can usually be stopped as well.

You can also take steps to reduce or discourage pacifier use or thumb sucking. Pacifiers specifically can be helpful early in your child’s development. They can provide comfort and have even been shown to reduce the risk of SIDs. But as your child gets older, pacifiers – and aggressive thumb sucking – can cause issues with tooth alignment.

When does my baby need to visit the dentist?

Along with brushing and flossing, regular dental visits are key to your baby’s dental health. The American Academy of Pediatric Dentistry recommends that kids see a dentist by their first birthday, or within 6 months of their first tooth coming in.

During these visits, the dentist will examine your child’s soft tissues, gums and jaws. The earlier your child sees a dentist, the more likely they are to have good oral health in the future.

Teething in a child: timing, care, ways to relieve pain

Children will definitely appreciate the parental contribution to maintaining dental health when they grow up. In order to help the baby from the very beginning, it is necessary to know the structural features, the stages of formation and the correct order of teething.

Teeth development before eruption

The health of your baby’s teeth should be taken care of long before they erupt. It is useful for expectant mothers to know that the rudiments of milk teeth are formed already at the 7-8th week of intrauterine development, and permanent ones at the end of 4 months. Not just teething timing, but even level enamel mineralization both milk and molars depends on how the pregnancy proceeds. Therefore, it is so critical that a woman receives all the vitamins, microelements and is as healthy as possible.

But not only food is important. The results of the research showed that in the presence of industrial harmful substances in the environment of the expectant mother during pregnancy and numerous stressful situations, the formation of all dental tissues is disrupted in the child and the timing of the appearance of milk teeth is shifted. Among children born to women with high blood pressure, late eruption of temporary teeth was noted in 56.7%. Approximately one third of the examined children born to mothers with heart defects revealed late eruption of temporary teeth, as well as deviations in the pairing and sequence of their eruption. The duration of pregnancy also plays a role. There is a pronounced dependence of the timing of the eruption of the first teeth on the degree of prematurity: the earlier the baby was born, the later the first teeth erupt ^{[1, 2]} .

Why baby teeth are needed

Nature has conceived the correct order and timing of teething in children. Evolutionarily, this is due to the need to form the bite and jaw bones for chewing and speech. Over the years, the bones grow, and the milk teeth, which at the beginning of their appearance fit snugly against each other, diverge by the age of 6-7, forming wide, natural interdental spaces for this period – tremas and diastemas.

There are only 20 teeth in the milk bite. This is due to the fact that they must be correctly placed in the small children’s jaw of the first years of a baby’s life, and excludes crowding of teeth that provokes dental diseases. The last of the milk teeth are replaced at the age of 10-12 years. However, they are very important for the physiological formation of the jawbones and permanent occlusion.

Proper growth and health of milk teeth help:

• rebuild the body from lactophoric to a mixed type of nutrition;

• reserve space for the normal positioning of future molars;

• form a mixed bite.

There is an erroneous opinion that milk teeth in case of infection with caries can not be treated, but immediately removed. But modern dentists are against such tactics. Early removal is fraught with displacement of neighboring milk teeth and the appearance of problems already with an adult bite. Therefore, it is so important to maintain the presence and health of all milk teeth until the moment when permanent teeth erupt on their own ^[3] .

The structure of milk teeth

Temporary teeth have thinner enamel, and their internal pulp cavity is larger compared to permanent ones. All this makes the tooth lighter, which helps with the eruption of permanent teeth, but at the same time accelerates the development of caries and pulpitis. However, there are bonuses: by the time the molars begin to erupt, which will remain with the child until the end of life, the roots of milk teeth even dissolve to ensure their rapid and relatively painless loss.

Terms of eruption of milk teeth

Teething is a genetically programmed event that occurs at a certain period. Physiological teething is characterized by three main features: certain timing, pairing and sequence of teething. Galaktionova M. Yu.

Children’s milk teething rates differ depending on their ethnicity. But as studies show, in general, the world is experiencing a reduction in the time from birth to the moment when the first tooth appears. This is due, according to most researchers, to the global acceleration of human development ^[1] . How and when milk teeth erupt is one of the indicators of a child’s physical development.

Causes of violation of the order and timing of teething in children can be:

• heredity;

• climatic conditions;

• nature of feeding;

• certain diseases, such as rickets.

The eruption rates for milk teeth according to the American Dental Association are presented in the table.

The specified periods are average indicators, varying depending on individual and family characteristics ^[4,5] . But the sequence of appearance of teeth is essential, and it is better to track and record it. From a physiological point of view, the correct order of eruption of milk teeth in children is important for bite formation .

Teething aid

The appearance of milk teeth is not an easy process not only for the children themselves, but also for their parents. The most common teething symptoms:

• swelling and redness of the gums;

• excessive salivation;

• itching and urge to keep hands, toys in mouth;

• capriciousness of a child;

• sleep disorder;

• refusal to breast, bottle or complementary foods;

• temperature increase;

• stool disorders;

• runny nose.

The following will help you get through this period as comfortably as possible:

• special teething rings that relieve itching, especially with a cooling effect;

• local anesthetic dental gels;

• antipyretic and analgesic preparations;

Gentle silicone fingertip massage to soothe and relieve your baby ^[6]

Baby Teeth Care

Once the first tooth has erupted, don’t put off going to the dentist. Schedule a visit (at least once every 3-4 months). And after the first birthday, it is also desirable to be observed by an orthodontist. If there are no problems, visits to him should be repeated once a year ^[7,8]

Proper care at home is important.

• Milk teeth are suitable for an ultra-soft toothbrush with a small head.

• Children’s mouth rinses are used from about 4 years old or from the time the child can spit.

• Parents should supervise the brushing of preschool children’s teeth and, if necessary, help and clean missed areas.

• Adults should teach their children to rinse their mouth after meals from a very young age.

• Until the child has learned to spit on his own, toothpaste should not contain fluorides.

• A bathroom timer or a favorite song helps you stick to the 2-minute brushing time.

• Solid food should be included in the diet daily in sufficient quantities to properly form the bite and stimulate the gums.

These simple tips help keep baby teeth healthy from the very beginning until they are naturally replaced by permanent teeth.

List of sources

1. Izmestieva OV, Galaktionova M. Yu., Manashev GG Characteristics of exogenous and endogenous factors affecting the eruption of temporary teeth in children. 2012 // https://cyberleninka.ru/article/n/harakteristika-ekzogennyh-i-endogennyh-faktorov-vliyayuschih-na-prorezyvanie-vremennyh-zubov-u-detey (date of access: 21.02.2020)

2. Galaktionova M. Yu., Izmest’eva OV Timing of eruption of temporary teeth and the nature of feeding children in the first year of life. 2012 // https://cyberleninka.ru/article/n/sroki-prorezyvaniya-vremennyh-zubov-i-harakter-vskarmlivaniya-detey-pervogo-goda-zhizni (date of access: 02/21/2020)

3. Iordanishvili AK, Korovin NV, Serikov AA Anatomical and topometric characteristics of the jaws during eruption and retention of wisdom teeth. 2017 //https://cyberleninka.ru/article/n/anatomo-topometricheskie-harakteristiki-chelyustey-pri-prorezyvanii-i-retentsii-zubov-mudrosti (Accessed: 02/21/2020)

4. Bimbas ES, Saipeeva MM, Shishmareva AS Timing of eruption of permanent teeth in children of primary school age. 2016 //https://cyberleninka.ru/article/n/sroki-prorezyvaniya-postoyannyh-zubov-u-detey-mladshego-shkolnogo-vozrasta (date of access: 02/21/2020)

5. Shilova N., Berzina S., Brinkmane A., Dulevska I., Umbraszko S., Briede I. Timing and sequence of eruption of primary teeth and factors influencing them. 2017 // https://cyberleninka.ru/article/n/sroki-i-posledovatelnost-prorezyvaniya-molochnyh-zubov-i-vliyayuschie-na-nih-faktory (date of access: 02/21/2020)

6. Bogdanova NA, Zueva TE How to help a child with teething? A new look at an old problem. 2019 // https://cyberleninka.ru/article/n/kak-pomoch-rebenku-pri-prorezyvanii-zubov-novyy-vzglyad-na-staruyu-problemu (date of access: 02/21/2020)

7. Ayupova FS Tactics of treatment of children with anomalies in the eruption of permanent posterior teeth. 2013 // https://cyberleninka.ru/article/n/taktika-lecheniya-detey-s-anomaliyami-prorezyvaniya-postoyannyh-bokovyh-zubov (date of access: 21.02.2020)

8. Gatalsky VV Control of the mesiodistal size of the dentition as one of the aspects of the prevention of dental anomalies. 2005 // https://cyberleninka.ru/article/n/kontrol-meziodistalnogo-razmera-zubnogo-ryada-kak-odin-iz-aspektov-profilaktiki-zubochelyustnyh-anomaliy (date of access: 21.02.2020)

Teething at 2 months: normal or abnormal

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Baby is naughty, his sleep is disturbed, takes the breast and immediately lets go? Perhaps the process of teething has begun. “Teeth cutting at 2 months?” – you ask. When your baby is very young, you can associate the baby’s anxiety with some kind of illness, but not with the process of the appearance of the first incisors. Let’s understand the possible timing of teething. We cannot regulate them, but we can alleviate the condition of children in the event of unpleasant symptoms.

Is it possible for a baby to cut teeth at such an early age? The two lower central incisors grow first and usually erupt one after the other. But you should understand that the time frame is not limited. Sometimes the process can take a while. There are times when the first incisors appear earlier. Therefore, when asked whether teeth can be cut at two months, experts give an affirmative answer. Deviation of the time frame for several months in both directions is considered the norm. Only in the event that a one-year-old child does not have a single tooth, you should consult a doctor.

Every body is different, so some babies have their first tooth at 2-3 months. The process is determined not only by genetics, but also by a number of other factors:

• climatic conditions;
• maternal nutrition;
• peculiarities of the course of pregnancy;
• disorders of the endocrine system – sometimes the early appearance of teeth may indicate its anomalies.

If a mother during pregnancy drank multivitamins or additional mineral complexes containing vitamins D and C, then teething may accelerate. Contributes to this and the use by a woman of fermented milk products in large quantities.

What are the symptoms of teething

Only some parents do not experience difficulties with teething in a child and notice the incisor by chance, not understanding when it appeared. In most cases, the process is accompanied by unpleasant symptoms:

1. Puffiness, “looseness” of the gums. Redness, bumps may form. Sometimes the teeth are visible through the gums. In some cases, there are bluish hematomas.
2. Increased salivation. Because of this, rashes around the mouth may appear. But salivation at 2 months of age does not always indicate teething. During this period, such a process is physiological. If the rash occurs elsewhere, it has nothing to do with teething.
3. Restless state. The child cries a lot, is naughty, the quality of his sleep worsens. Often the baby cannot be soothed. Conventional methods (swinging, nipples, etc.) do not help.
4. Increased body temperature. More often these are indicators up to 37.5 ˚C. This can happen due to local inflammation (gums). A higher temperature indicates the activity of viruses.
5. Loss of appetite. During the period of the appearance of teeth, children do not eat well or refuse to eat at all. Sometimes the baby cannot be attached to the breast. Some babies kick their feet while feeding.
6. Runny nose and cough. Due to increased salivation, mucus flows down the back of the throat. It enters the nasal passages, since the baby at the age of two months is more in a supine position. When mucus enters the throat, it provokes a cough. More often it occurs during sleep.

These symptoms do not occur all at once and can be combined in different ways. Often for parents, they become a serious cause for concern. Even the fact that a child is teething at such an early age is already shocking.

It is important not to confuse signs of infectious or neurological diseases that have similar symptoms with the process of teething. Therefore, it is better to show the baby to the doctor. The following symptoms also serve as a reason to seek help: the child is very lethargic, he has a high temperature (above +38 ˚С), vomiting or sores in the mouth have appeared. A child can also vomit due to excessive salivation when mucus enters the stomach. Liquid and frequent stools also indicate the attachment of an infection. Diarrhea can cause dehydration.

How to help a baby

If a baby starts teething at 2 months, besides fatigue due to sleepless nights, parents are worried about their baby. Since he is tormented by pain, discomfort, he eats little and sleeps poorly, it is necessary to help relieve unpleasant symptoms. To do this, use the following methods:

1. Massage the gums. Wash your hands thoroughly first. Massage is done with a fingertip. It is worth trimming your nails so as not to damage the gums. Massaging relieves pain. The degree of effectiveness of the method can be determined by the reaction of the child.
2. Apply cold. Ordinary teethers, which are sold in pharmacies and are offered to older children, a baby at the age of two months will not gnaw. In this case, he can cool the nipple or apply a gauze pad to the problem area. It is pre-moistened with cold water or chamomile infusion, which helps relieve inflammation.
3. Lubricate gums with anesthetic gels. For example, “Kamistad” or “Kalgel” are the means that can be used even at an early age.
4. Provide antipyretic and analgesic drugs based on ibuprofen and paracetamol. 2-month-old babies put candles. It can be, for example, “Efferalgan”.

During teething, it is important to ensure that your baby is properly cared for. It is necessary to monitor the cleanliness of the pacifier. Saliva needs to be wiped only with clean napkins. The skin around the mouth should be lubricated with a special baby cream.