Teething is a painful process for parents and their baby. Learn more about the timeline for growing teeth and how to recognize the telltale symptoms.

By Marisa Cohen
Updated October 01, 2020
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A baby’s first teeth usually appear around 4 to 6 months—and these chompers help your child talk and eat solid foods, says Tanny Josen, D.D.S., a pediatric dentist at Kid Island Dental in Long Island, New York. But although teething is an important developmental milestone, it can be painful for babies (and their parents). Here, experts break down the teething process, and they share how to recognize the signs of getting those pearly whites.

Your Baby's Teething Timeline

Your child will grow a full set of 20 teeth between ages 1 and 3—but the process of developing them starts much earlier. Are you wondering how long teething lasts? Check out this baby teething timeline from the womb to toddlerhood.

Tooth 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 Michael Hanna, DDS, a spokesman for the American Academy of Pediatric Dentistry. "The tissue gets thinner and thinner until it breaks and the tooth pops through."

Top and Bottom Teeth: The first teeth to come in 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. 

Molars: Around your 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. "Teething 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."

Teething Symptoms in Babies and Toddlers

Baby teething pain is usually most severe in the days before a tooth cuts through the gums. A child’s reaction to teething depends upon many factors, including their tolerance for pain, their personality, and the density of their gum, says Dr. Hanna. That said, most children experience the following signs and symptoms of teething.

Swollen gums. If your child’s gums are swollen and you can feel at least one tooth-sized lump, that means teething is in progress.

Chewing, biting, and sucking. Because your child's gums are irritated, you might see them gnawing on just about anything—toys, crib rails, even their clothes and fists. 

Rubbing their gums, ears, and cheeks. Your baby might rub their gums to relieve pressure. They might also pull their ears and fidget with their cheeks—especially when their molars appear. (Note that yanking on ears can also signal an ear infection, so it's important to bring up this symptom with your pediatrician.)

Drooling. No one knows why teething babies produce so much 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. Excess drool can also cause occasional gagging or coughing.

Mouth rash. The continual wetness from excess drooling can cause a rash around the mouth, chin, or neck.

Irritability and nighttime fussiness. Not surprisingly, teething makes many babies crankier and fussier than usual. "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 Ari Brown, M.D., a pediatrician and coauthor of Baby 411: Clear Answers and Smart Advice for Your Baby's First Year. Note, however, that if your baby is grumpy all day long and appears uninterested in other activities, they might have an ear infection, so it’s best to contact your pediatrician.

Decreased appetite. Some kids lose their appetite and refuse to eat or drink. This teething symptom should be short-lived, though.

Low-grade fever. This is characterized by a fever of less than 101 degrees Fahrenheit, taken rectally, and can be caused by gum inflammation. If low-grade fever is accompanied by a runny nose, a bout of diarrhea, or other strange symptoms, call your pediatrician. Jill Lasky, D.D.S., a pediatric dentist at Lasky Pediatric Dental Group in Los Angeles, says teething doesn't cause these symptoms.

Loose stools. Babies may have loose stools from swallowing extra saliva or from changes in diet (teething babies are typically trying various solid foods for the first time). But Dr. Brown says to call the doctor “if the stools are explosive, numerous, or accompanied by blood or mucus.”

When to Visit the Pediatrician

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 worrisome symptoms, it's best to have their pediatrician examine them to rule out something more serious. That’s because “the tiny open wounds in the gums that result from the teeth erupting makes it more likely for the baby to catch a little bug," explains Dr. Lasky. 

Contact your pediatrician if any of the following symptoms are present:

  • High fever, diarrhea, or vomiting
  • The gums are red or blue instead of pink (this usually indicates an eruption cyst, a swelling of the gums above an erupting tooth; although most cysts are benign, it's best to have them checked)
  • The gums have lesions or bumps
  • Refusal to eat and drink for more than a couple of hours
  • Rashes on the body
  • Your child appears ill 

Comments (2)

Anonymous
January 4, 2020
Thanks. So helpful
Anonymous
January 29, 2019
Question my 7 month old baby has his two bottom teeth and keeps rubbing his tongue on it to the point he is getting little sours on it is this normal