Signs and Symptoms
One night last fall, as I tried every trick in my repertoire to get my cranky, drooling 1-year-old daughter to go to sleep, I realized something: Teething is nature's idea of a practical joke. Think about it. A baby's first tooth usually comes in somewhere between 4 and 8 months, just after you've finally gotten her to sleep through the night. In my case, we had a few months of peaceful slumber before Molly began cutting her first tooth. When she started working on her molars, I was back to pacing the floors, bouncing her around, and frantically searching for the Tylenol -- for both of us.
Of course, I have friends who swear that their babies barely made a peep while teething. "Jake just woke up one morning smiling with two new teeth," says my pal Randi. But a baby's reaction to teething depends upon many factors, including his tolerance for pain, his personality, and how dense his gums are, says Michael Hanna, DDS, a spokesman for the American Academy of Pediatric Dentistry.
Teething Signs and Symptoms
In a study published in Pediatrics, researchers at the Cleveland Clinic Foundation followed 125 children from their 3-month checkup through their first birthday. They found that during teething, there was a notable increase in:
- gum rubbing
- ear rubbing
- facial rash
- decreased appetite
- mild temperature
No one knows why teething babies produce all that saliva, says Dr. Hanna, but the theory is that the increase of muscle movement in the mouth during this teething period simulates chewing, which activates the salivary glands. (The excess drooling can in turn cause a rash around the mouth.) Biting and gum rubbing are the baby's efforts to relieve pressure in his gums.
First Cutting Teeth
While all these symptoms tend to crop up in the few days before and after a tooth's emergence from the gums, the process of developing teeth starts much earlier.
In-utero roots: Around the second trimester of pregnancy, tooth buds begin to form under the gums in your baby's mouth. Eventually, the roots begin to grow, forcing the crown up. "The tooth puts pressure on the tissues above it, and they slowly begin to break down," says Dr. Hanna. "The tissue gets thinner and thinner until it breaks and the tooth pops through."
Top and bottom debut: The first teeth to pop up are usually the two bottom front teeth (central incisors), followed by the four upper teeth (central and lateral incisors). Because these are thinner with a knifelike edge, they often slide through fairly easily.
Molar mayhem: But that's just the calm before the storm: Around baby's first birthday, the first molars will start to arrive in the back of the mouth; then come the canines (the pointed teeth between the molars and incisors); and then around age 2, the second molars, behind the first set.
"The molars are often much more painful because they are a big, fat, broad-surfaced tooth," says Dr. Hanna. "Those are the ones where you tend to see bulging gums." In some cases, fluid can build up, creating a bluish cyst over the unerupted molar. When the tooth breaks through and pops the cyst, your baby may wind up with a mouthful of blood, but it looks a lot worse than it is, says Dr. Hanna. "Once the sac erupts and the fluid comes out, it's over. The situation has corrected itself."
Keeping New Teeth Healthy
Between ages 1 and 3, your child will grow his full set of 20 teeth. Here, tips on how to keep them healthy and strong, from Cynthia Sherwood, DDS, a spokeswoman for the Academy of General Dentistry.
- Take your baby to his first dental exam by age 1, suggests the American Academy of Pediatric Dentistry and the American Academy of Pediatrics. The dentist will go over feeding and cleaning habits, plus check for early signs of tooth decay.
- Brush your infant's teeth with tap water. It contains fluoride (bottled water doesn't), which is needed for developing teeth and bones. Since too much fluoride can cause brown or white spots on incoming teeth, wait until age 2 to use pea-size amounts of fluoride toothpaste.
- Don't let kids fall asleep with a bottle or sippy cup; milk or juice that sits in the back of the top two front teeth can cause cavities.
Is It Teething or Something Else?
Until fairly recently, experts widely thought that teething was responsible for practically every cough, sneeze, and cry in a baby's first years. But experts now say that if your baby has a fever, appears ill, or suffers from any symptoms more severe than crankiness, drooling, and biting, it's best to have the pediatrician examine him to rule out something more serious, like an ear infection.
The Pediatrics study found that there was no correlation between teething and congestion, sleep disturbance, coughs, vomiting, or fevers over 102F. (Yet, despite this, subsequent studies have shown that some medical professionals -- nurses, pharmacists, and a few pediatricians -- still believe teething is responsible for many physical woes.)
Tummy troubles? Another misconception is that teething causes diarrhea, says Ari Brown, MD, a pediatrician and coauthor of Baby 411: Clear Answers and Smart Advice for Your Baby's First Year (Windsor Peak Press). "Babies may have loose stools from swallowing extra saliva," Dr. Brown says, "but if the stools are explosive, numerous, or accompanied by blood or mucus, she needs to be evaluated for something else."
Grumpy baby? And while most teething babies will be fussy, not all fussy babies are teething. "Teething babies may be edgy or hard to settle at naptime and bedtime because of throbbing gums, but it's a dull pain, so you can usually distract them during the day," says Dr. Brown. "But the pain from an ear infection is intense, so the baby is more likely to be grumpy all day and will not be interested in engaging in other activities."
Food factors? Another factor affecting your little one's mood and health is his diet, explains Dr. Hanna. Because this is a stage when your baby may be trying a different new food every few days, allergies or gas could be the cause of his Oscar-worthy grouchiness. Bottom line? "Look at the big picture," he says. "There are a lot of things other than teething going on at this time in a baby's life."
Mommy Can Make It Better
Thankfully, when your child is cutting a tooth and she looks at you with that "Fix it, Mama!" expression, there are several things you can do to ease the pain.
Before She Starts Teething
"Begin a regimen of massaging and cleaning the baby's gums as soon as he is born," Dr. Hanna suggests. Whether you breast- or bottlefeed, clean his mouth out after feedings whenever possible. "Using a clean piece of gauze or a washcloth, rub your finger along the gum pads, cleaning out any leftover milk," he says.
If you continue this through the teething stage, you'll accomplish two things: First of all, your baby will be used to having something stuck in his mouth after meals, which will make toothbrushing easier down the road. Second, the pressure from the massage will make teething just a little less painful.
"The pressure of the tooth coming in from below is countered by the pressure from the massaging on the top," says Dr. Hanna. "It feels good, and it helps break down the gum tissues slowly."
Teething Rings: Yes or No?
Some babies and toddlers instinctively soothe themselves by grabbing anything within reach and biting on it, but biting on hard toys can sometimes damage incoming teeth. As an alternative, offer your baby a chilled (not frozen) plastic teething ring and check it every day to make sure she hasn't bitten through.
Also, as I learned the hard way, if your child is attached to her pacifier, don't take it away now. She finds comfort from the pacifier, and she can use it to massage her gums. If she relieves pressure by chewing on you, pull her off you. Sternly say, "No biting!" and offer something else to chew on, recommends Dr. Brown. "It is perfectly acceptable to discipline for biting, even when no malice is intended," she adds.
Both of my daughters seemed to find some solace from sucking on a wet, cold washcloth. Other parents I know swear by frozen, slushy applesauce, chilled plums or apricots, teething biscuits, and mini-bagels.
"We've found that Popsicles really do the trick," says Teresa Sellinger, a mother of two in Sparta, New Jersey. "We bought an inexpensive plastic Popsicle tray and freeze fruit juice in it so there's always something healthy in the freezer for the kids to suck on."
For kids who eat solid foods, Dr. Hanna recommends freezing a banana, cutting off a small slice, and wrapping it in a washcloth. "The cold helps numb the gums and ease the pain, and the hardness helps break down the gum tissue," he explains. Just make sure the banana doesn't get loose from the washcloth. On its own, the fruit is a choking hazard.
At nighttime, when teething babies tend to be crankiest, Dr. Hanna says, "Don't be afraid to give them infant Tylenol to help them sleep through the night." Topical treatments can be helpful also, but be careful to put only the tiniest dab right on the site of the pain, he says. "If you use too much, a child can swallow it and numb his throat." And despite what your grandmother or babysitter may tell you, never dab whiskey on a baby's gums. Even a small amount can sedate the child, which could be dangerous.
You may suffer a lot of sleepless nights while your baby works on producing those choppers, but when she smiles that huge ear-to-ear grin and says "cheese!" it will all be worthwhile.
Marisa Cohen, a mother of two, is a writer in New York City.
Originally published in American Baby magazine, May 2005.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.