Teething

Teething crib

Last Updated December 20th, 2021

Overview of teething

There are several milestones in the growing years of a child. These include- crawling, walking, the growth of teeth and the development of speech. Among all these milestones, teething seems to be the most unpleasant and painful experience for a child. It is an indicator of the development of a child’s first set of teeth. Medically, teething is not a disease. But there are numerous complications related to this condition that a child has to cope with. It usually starts at the age of 4 months and can extend up to 8 months. Teething marks a very important stage in the dental development of a child. Parents should take care so that no oral or dental disease develops during this period.

 

What is teething?

Teething cribTeething or “difficult dentition” or “dentition difficilis” is the natural phenomenon of the eruption of the first few teeth in the earliest stage of a child’s development. It starts with the appearance of upper and lower incisors. Normally, the process starts at the age of 4 months and is almost complete at the age of 8 months. The process is fully complete within the age of 30-36 months, with the eruption of the second primary molars. Usually, the two front teeth present in the bottom are the first ones to erupt. Around 4-8 weeks later, the four front teeth present in the upper gum appear. Within 3 years of age, almost all children have their 20 primary teeth formed. 

 

How does teething occur?

The phenomenon of teething involves two main processes- bone formation and bone resorption. An eruption pathway is generated on opposite sides of the dental follicle. The common tooth germs from within the dental follicle at this stage. A reduced enamel epithelium forms over the dental follicles. The enamel epithelium and the oral epithelium merge at the cusp of the erupting tooth. In the next stage, the upper layer (of fused epithelium) degrades. The development of the periodontal ligament, pulp, and roots of the teeth occurs in the next stage. Finally, the tooth crown emerges and the process of growth of teeth is complete.

 

What are the factors regulating teething?

There are numerous factors that regulate the mechanism of teeth development. Some of these factors may accelerate the process, while some may delay it. The commonly studied factors are listed below-

  • Genes: A particular variety of gene called C-FOS is responsible for “protein-coding” in the early years of a child’s development. Mutations or abnormal activities of this gene can adversely impact the process of teeth development.
  • Hormones: Some important hormones that are regulators of the teething mechanism are- Thyroid hormones, Parathyroid hormones and Pituitary Growth Hormones. These hormones also regulate the functioning of the salivary glands which become overactive during teeth development.
  • Growth factors: Certain growth factors such as Transforming Growth Factors β1 (TGF- β1), Colony Stimulating Factor-1 (CSF-1), Epidermal Growth Factor (EGF) are directly related to “teething”. Infants feeding on breast milk for a long period of time usually have a healthy and timely teething. On the other hand, malnourished children usually exhibit an extremely delayed teething with numerous complications.
  • Cytokines: A few harmful chemicals are released into the child’s body during the “teething period” that lead to the complications associated with teething. These chemicals are called cytokines. A few examples of these types of chemicals are- Interleukin 1α (IL-1α), Interleukin 1β (IL-1β), Tumour Necrotising Factor α (TNF- α) and Interleukin 10.
  • Proteins: A few proteins are closely related to “teething”. These are- Immunoglobulin-A (IgA), Parathyroid Hormone related Peptide (PTHrP) and Monocyte Chemotactic Protein-1 (MCP-1). Defects in protein-coding can lead to complications in the teething period. 

 

What are the common signs and symptoms?

Teething painTeething is accompanied by two main types of symptoms- localized and systemic. The localized symptoms include- irritation and swelling of gums, rubbing of gums and constant thumb-sucking. The systemic manifestations include- excessive drooling, poor appetite, restlessness, constant crying, fever, and irritability. The symptoms are discussed in details below-

  • Drooling: In a few infants, excessive drooling occurs within the age of 3-4 months. This occurs due to the generation of excess saliva in the mouth.
  • Biting: A baby in its teething period tends to bite and nibble at every solid object around it. This helps relieve the pressure of emerging teeth under the gums.
  • Rubbing: A teething baby is often found to rub its cheeks and pull its ears frequently. This happens due to pain in the gums radiating to the cheeks and ears. This symptom is more prominent when the back molars start erupting.
  • Coughing: A baby is found to cough constantly during the teething period. This occurs due to the accumulation of excess saliva in the mouth.
  • Irritation: Irritation and inflammation of gums occur during the teething process. This is also accompanied by soreness and redness of gums when the molars erupt.
  • Rashes: Red patches and tiny reddish dots may appear on the chin and around the mouth. This is often a result of excessive salivation and constant drooling that irritates the sensitive skin of the child.
  • Flu-like symptomsA child may be found to have a low-grade fever and an extremely runny nose, with constant itching during the teething period. A proper diagnosis should be carried out to check whether the symptoms are associated with teething or any other infection.
  • Disturbed sleep: Interrupted sleep occurs especially at night, due to increasing pain caused by the developing molars.
  • Bowel incontinence: Some children show Diarrhoea-like symptoms during teething. This is caused by the swallowing of excess saliva that increases the liquidity of the stool.
  • General malaise: The child may exhibit restlessness, irritability and constant crying. 

 

What are the necessary diagnostic tests?

Dental caries may develop at an advanced stage when the child has already grown a few teeth. Dental probe and dental radiograph are recommended by the dentists in such cases.

 

Treatment and management

Teething infantThere are no treatments for teething. However, the sore gums of the baby can be managed by the following methods:

  • Hard foods– Giving the baby chilled solid foodstuffs to bite on (such as a peeled cucumber or carrot) can ease the irritation.
  • Teething toys– Hygienic and cold teething toys can be given to the baby to ease the sore gums. A cold washcloth, a cold spoon etc. can also help to relieve the discomfort. Use of fluid-filled teething rings should be avoided. The teething toy should be safe for the baby.
  • Gum massage– Massaging with a mild pressure can help in relieving the discomfort. A clean finger or a moistened gauze pad can be used to massage the baby’s gums.
  • Over-the-counter remedy- In cases where the baby becomes cranky and irritable, over-the-counter medications such as ibuprofen or acetaminophen can be given.

As teething is a natural phenomenon occurring while the teeth erupt in the mouth, there are no methods to prevent it.

Facts

  • Numbing gels and medications with benzocaine can sometimes prove lethal if used for babies less than 2 years of age. They might lead to a fatal condition known as methemoglobinemia.
  • Homeopathic teething products have not been approved by the US FDA (United States Food and Drug Administration) for safety or effectiveness.

Facts

  • First teeth of the baby to erupt are the lower central incisors. These erupt around 6 months of age.
  • Babies have a total of 20 teeth which shed before the eruption of their permanent counterpart.

Facts

  • The baby teeth need to be cleaned by means of a soft baby brush as soon as they erupt in the oral cavity.
  • According to the American Dental Association (ADA), the baby should be taken to a registered dentist for a dental checkup soon after the eruption of the first tooth.

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Dos and Don'ts

Dos
  • Massage your baby’s gums. Massaging with a mild pressure can help in relieving the discomfort. A clean finger or a moistened gauze pad can be used to massage the baby’s gums.
  • Give chilled solid foodstuffs such as a peeled cucumber or carrot to ease the irritation.
  • Take your baby for a regular dental checkup as soon as the first tooth erupts in the baby’s oral cavity.
Don'ts
  • Leave the baby unattended after giving hard foods such as carrots or cucumbers. A broken piece might cause choking.
  • Use homeopathic teething medications and medications which have benzocaine or lidocaine. They might be harmful to the baby and even prove fatal in some cases.
  • Ignore symptoms such as a high fever, diarrhea, rash etc. Consult a pediatric dentist.

 

 

 

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Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
amylase test
Amylase Test Amylase test is done by checking the level of this protein in the blood sample and also in…
chloride test
Chloride Test A chloride test of the blood checks the level of chloride in body, an important factor governing the…
complement c4 test
Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
Optavia diet
The features of an Optavia diet The Optavia diet endorses pre-packaged meals and snacks called "fuelings" that are tasty, low in calorie, and incorporates…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
Jackfruit: Slice your way into higher immunity, better digestion, & more… Native to the South East Asia, the jackfruit is a fruit brimming with thousands of health benefits. Discover…
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
Epley maneuver: Why is this the best protection from the symptoms of vertigo? Epley maneuver is an exercise that can treat the symptoms of benign paroxysmal positional vertigo (BPPV).  It was…
The Cabbage Soup Diet: The healthiest way to instant weight loss Cabbage soup diet rapid weight loss diet for those who want to shed those extra pounds in less…
Atkins diet weight loss
Atkins Diet: The right steps to carb control that can help you lose those pounds fast The Atkins diet is a high fat, low-carb diet with proven weight loss benefits that is flexible enough…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
phenytoin test
Phenytoin test Phenytoin is a drug that is administered mainly to epilepsy patients. The phenytoin blood test measures the level…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
ANTIPHOSPHOLIPIDANTIBODY(APL)_IgG
Antiphospholipid (APL) antibody-IgG The Antiphospholipid Antibody testing is a blood test used to determine an autoimmune disorder called Antiphospholipid syndrome linked…
valproic acid test
Valproic Acid Test Valproic acid test is performed to generally check for psychiatric and even neurological conditions such as bipolar disease…
Rubella IgM test
Rubella IgM Test The Rubella IgM test is a blood test that is performed to diagnose the presence of the rubella…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
sodium blood test
Blood Sodium Test A blood sodium test measures the amount of sodium (an important electrolyte) in your body. It is also…
Okra: How can this nutrient-dense vegetable help you fight diabetes? Okra is a food which is rich in nutrients and minerals which are extremely essential for a healthy…
hidden benefits walking
9 benefits of walking we bet you didn’t know! Did you know walking can be the miracle pill for eternal youth? Everyone knows walking is good for…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
acne removal tips
Anatomy of acne: 7 instant steps to kiss those zits goodbye Blackheads, whiteheads, or pimples-call them what you may. Acne is never good news.Did you know some of the…