The eruption of primary teeth in children can be distressing for the child and the child’s parents. Teething is the process by which an infant’s teeth sequentially appear by breaking through the gums. Teething was known as “dentitio difficilis,”
The eruption of primary teeth usually begins around 4-8 months of age with the eruption of the lower incisors, and is complete at around 30- 36 months of age when second primary molars erupt. The signs and symptoms associated with teething may be local or systemic. Local teething symptoms are; gingival swelling, irritation, redness of the gum, thumb sucking and gum rubbing. The systemic disturbances that are associated with teething include; loss of appetite, crying, increased salivation, drooling, diarrhea, boils, general irritability and fever, runny nose, conjunctivitis, and some day-time restlessness. Moreover, increased biting, wakefulness, ear rubbing and facial rashes have also been reported to be associated with teething. The teething period has been described as an 8-day window, including the 4 days before tooth eruption and the 3 days following.
The symptoms of teething vary from baby to baby. Teething may cause the following symptoms:
- Increased drooling
- Restless or decreased sleeping due to gum discomfort
- Refusal of food due to soreness of the gum region
- Fussiness that comes and goes
- Bringing hands to the mouth
- Mild rash around the mouth due to skin irritation secondary to excessive drooling
- Rubbing the cheek or ear region as a consequence of referred pain during the eruption of the molars
Importantly, teething is not associated with the following symptoms:
- Fever (especially over 101 F)
- Diarrhea, runny nose, and cough
- Prolonged fussiness
- Rashes over the body
Sequence of appearance
Stages of tooth emergence, at 0 months, 6 months, 9 months, 12 months, 2 years, 3 years, 4 years and 5years.
The infant teeth tend to emerge in pairs – first one lower incisor emerges then the other lower incisor emerges before the next set begin to emerge. The general pattern of emergence is:
- Lower central incisors (2) at approximately 6 months
- Upper central incisors (2) at approximately 8 months
- Upper lateral incisors (2) at approximately 10 months
- Lower lateral incisors (2) at approximately 10 months
- First premolars (4) at approximately 14 months
- Canines (4) at approximately 18 months
- Second premolars (4) at approximately 2–3 years
Pharmacological strategies for teething generally aim to achieve analgesia, anesthesia, sedation or a combination of these. The conservative use of acetaminophen and ibuprofen can aid in the discomfort caused by teething.
Cuddle Therapy: A little extra tender loving care goes a long way when infant is having a hard time teething. If infant gets distressed, hugs and cuddles will help comfort and reassures if he or she is distressed. Distract your child from the pain with activities such as reading, singing or playing.
Rubbing Gums: Lightly massaging baby’s gum with a clean finger for one to two minutes can aids in alleviating the discomfort. Keep infant’s mouth and gums clean even if does not have any teeth.
Teething Rings: Teething babies love to chew and bite on anything. Teething rings are made of different types of plastic. Approved teething rings do not cause cavities or choking.
Food for Chewing: If infant is over six months old, try offering them a sugar free teething biscuit or unsweetened rusk. It is also preferable to avoid foods that are too hard as these could bruise the gums and cause further pain.
Teething Gels: Teething gels massaged into the gums with a clean finger can provide relief.
Soothing Sore Chins: Excessive dribbling caused by teething can irritate babies’ chin, neck and chest which may become dry, chapped and sore. Applying a simple barrier cream can also help keep their skin soft and smooth and may ease any chapped skin.
How do I care for my baby’s new teeth?
Oral hygiene may be started even before eruption of the first tooth. Twice-a-day cleaning of the gums using the washrag used for cleaning the face and hands after eating is effective and simple. Fluoride has been shown to be extremely effective in reducing the development and severity of cavities. The American Dental Association and the American Academy of Paediatrics recommend the first dental visit be at 1 year of age. If a delayed schedule is chosen, the latest time for a first dental visit is 3 years of age.
Cognitive management of teething should be considered. Behavioral therapies such as sleep management can be used to combat sleep disturbances, wakefulness and irritation. Young children are exposed to a wide variety of situations, environments, illnesses and are guaranteed to have multiple episodes of fever, congestion, and diarrhea. The inclusion of teething and its management as a topic in antenatal classes, in professional health programs and in continuing professional education for health professionals and childcare workers should be considered.