Teething is the process by which an infant’s first teeth (the deciduous teeth, often called “baby teeth” or “milk teeth”) sequentially appear by emerging through the gums. Teething may start as early as three months or as late as twelve months. The first teeth typically appear between six and nine months. It can take several years for all 20 teeth to complete the tooth eruption; they typically arrive in pairs. Though the process of teething is sometimes referred to as “cutting teeth”, when teeth emerge through the gums they do not cut through the flesh. Instead, special chemicals are released within the body that cause some cells in the gums to die and separate, allowing the teeth to come through.
Teething used to be considered (wrongly) a cause of death, as many children died in the first years of life, at the same time as teething occurs. “The tendency in the past to attribute serious disease to teething was so prevalent that in 1842 teething was the registered cause of death in 4.8% of all infants who died under the age of 1 year and 7.3% of those between the ages of 1 to 3 years according to the Registrar General’s report.”
Ironically, while teething is a natural process which creates little more than discomfort, some methods for relieving teething pain have caused serious harm and even death. Old remedies for teething include “blistering, bleeding, placing leeches on the gums, and applying cautery to the back of the head”. In the sixteenth century the French surgeon Ambroise Paré introduced the lancing of gums using a lancet, in the belief that teeth were failing to emerge from the gums due to lack of a pathway, and that this failure was a cause of death. This belief and practice persisted for centuries, with some exceptions, until towards the end of the nineteenth century lancing became increasingly controversial and was then abandoned, although as late as 1938 an Anglo-American dental textbook advised in favour of lancing, and described the procedure. In the first half of the twentieth century, teething powders in the English-speaking world often contained calomel, a form of mercury. It was removed from most powders in 1954 when it was shown to cause “pink disease” (acrodynia), a form of mercury poisoning.
Teething toys have a long history. In England in the 17th–19th centuries, a coral meant a teething toy made of coral, ivory or bone, often mounted in silver as the handle of a rattle.
The level of pain that a baby can handle will be different for each child. Some may be a lot fussier than others while they are teething. The soreness and swelling of the gums before a tooth comes through is the cause for the pain and fussiness a baby experiences during this change. These symptoms usually begin about three to five days before the tooth shows, and they disappear as soon as the tooth breaks the skin. Some babies are not even bothered by teething.
Common symptoms include drooling or dribbling, mood changes, irritability or crankiness, and swollen gums. Crying, sleeplessness, restless sleep at night, and mild fever are also associated with teething. Teething can begin as early as 3 months and continue until a child’s third birthday. In rare cases, an area can be filled with fluid and appears over where a tooth is erupting and cause the gums to be even more sensitive. Pain is often associated more with large molars since they cannot penetrate through the gums as easily as the other teeth.
Some noticeable symptoms that a baby has entered the teething stage include chewing on their fingers or toys to help relieve pressure on their gums. Babies might also refuse to eat or drink due to the pain. Symptoms will generally fade on their own, but a doctor should be notified if they worsen or are persistent. Teething may cause signs and symptoms in the mouth and gums, but it doesn’t cause problems elsewhere in the body.
Pulling on the ears is another sign of pain; the pain in the mouth throbs throughout the baby’s head so they pull their ears believing that it will provide relief. Mild rash can develop around the mouth due to skin irritation that is caused by excessive drooling or dribbling.
Milk teeth tend to emerge sooner in females than in males. The exact pattern and initial starting times of teething appear to be hereditary. When and how teeth appear in an infant has no bearing on the health of the child.
Before treating a baby for teething, it is important to know what is causing the baby to be upset. Rubbing a finger gently along the gums in search for swollen ridges or the feel of a tooth below the gums is one way to be certain. If unsure, it is recommended that the child be seen by a pediatrician before treatment is administered.
A teething ring is generally a soft plastic device that can be chewed on and allows the baby to break down some of the gum tissue which promotes the growth of the teeth out of the gum. Some teething rings can easily be broken or damaged, so other types of teething devices can be made from household items. Placing a wet washcloth in the freezer for a few minutes and then applying it gently to the gums can be effective, but care must be taken not to expose a baby’s gums to coldness for too long.
Infants chew on objects to aid in the teething process. This can be dangerous if the baby is allowed to chew on objects which are small enough to be swallowed or which could break while being chewed and cause choking. Teething rings and other toys, called teethers, are often designed with textures that will appeal to an infant during teething. Drawing water into a pacifier and freezing it as another way to offer a teething child relief. The cold pressure on the gums gives relief without making the child’s fingers cold.
Some infants gain relief from chewing on cold objects. Some children respond well to chilled foods. Suggestions for chilled foods that might appeal to a baby include applesauce, yogurt, and pureed fruits.
Dentists recommend brushing infants’ teeth as soon as they appear. It is not advisable to wait for the teething process to be complete. Dentists may recommend against the use of fluoride toothpaste during teething.