An Introduction to Teething

See also: Teething Remedies | Best Teethers

The Latin name for teething sounds like it came straight out of Harry Potter’s Book of Spells: dentitio difficilis. It means “difficult dentition.” Academics today describe teething quite dramatically. Teeth “erupt.” They “break through” the gums. Babies “cut teeth.”

Sounds pretty dramatic.

But it might not actually be all that bad (for the baby, that is – for parents, it’s another story). While teething symptoms are different for each baby, medical professionals say that “teething is almost certainly a little uncomfortable for the child.”[1] Well that’s helpful; I never would have guessed that!

More on specific teething symptoms in a bit. First, let’s dive into teething 101.

An Introduction to Teething

Baby Teeth Order

The onset of teething varies greatly, but it typically starts somewhere between 4- and 10-months-old, with some late bloomers getting their first tooth closer to the one-year mark. As with most milestones, girls tend to get their first tooth before boys and preemies tend to start teething a little later.

During the process, the baby teeth (primary teeth, formally called “deciduous” teeth) move from below the gumline into their position in the mouth. You can get a feel for which teeth come in and when (below), but typically speaking, the bottom center teeth emerge first (usually in pairs), followed by the two center top teeth.

Most kids (read: parents) are done with teething by the time they are about 30 months old (about 2.5 years), at which point they will have the full complement of 20 primary teeth. The later ones (molars) tend to be the worst — we think.

Researchers typically define a “teething period” as an eight-day window surrounding the emergence of a tooth, spanning from four days prior, to three days after the “eruption day” on day five.[2] This sounds confusing, but it basically means that the breakthrough of any given tooth might start to bother a child a few days before it comes in, and keep bugging a child for a few days afterward.

Teething Symptomology: It’s Elusive

It’s not just you: the two-year-long teething process has been the bane of parents everywhere throughout time. Unfortunately, there isn’t a ton of research on teething symptoms or treatment. Part of the reason for this is that teething is caught in limbo somewhere between the worlds of pediatrics, dentistry, and cultural folklore. Teething happens before many parents take their kids to a pediatric dentist, and most pediatricians aren’t trained teething experts.

The result is that there aren’t a ton of specialists spending their days scrutinizing teething.

Making things tougher is that babies and toddlers can’t tell us how they feel. Most of the studies that do exist rely on parents’ reports of their children’s symptoms, and as well-meaning as they might be, the fact is that parents of wee ones tend to blame every symptom under the sun on teething. I know I do.

In one well-regarded project (albeit with a very small sample size of just 21 babies), parents “unanimously” said their babies suffered all kinds of teething symptoms, while child-care providers and professional dental examiners alike confirmed a complete lack of teething symptoms in the same children.[3] There goes that excuse for unexplained fussiness!

Here’s another thing: teething takes years. It mercilessly stretches out through infancy and toddlerhood, and the experience could be totally different for any given baby at seven months vs. two years. Furthermore, throughout all this time, kids are continually experiencing a variety of developmental changes, physical growth, milestones, and illnesses.

Because it coincides with so much – so many various literal and metaphorical growing pains – teething always seems to conveniently answer the question: “what’s wrong with baby??” It could explain a whole host of cranky behaviors: The baby is fussy? Teething. The baby isn’t sleeping? Teething. The baby won’t eat? Probably teething.

As one group of researchers put it, it “seems likely that teething is the scapegoat for many other events.”[4] And this is no knock on parents – it’s only natural. Who doesn’t want to explain their kids’ irritability? The mere explanation itself – “oh, she’s teething” – makes us feel better.

And that’s fine.

So What Do We Know About Teething Symptoms?

Death from Teething?

For one thing, teething is not a legitimate cause of death. Before you laugh this off, consider the following: historically, teething was thought to be a deathly problem.

• From the 1500s through the 1800s in France, about half of infant deaths were documented as due to teething.[5]
• In a single year in the late 1830s, more than 5000 deaths in England and Wales were recorded as teething deaths.
• In the 1840s, the English Registrar-General estimated that 12% of deaths of children under the age of four were the direct result of teething.[6]
• According to Utah pioneer records, between 1847 and 1881, 521 deaths were attributed to teething.[7]
• Even as late as the 1910s, infant and childhood deaths were still ascribed to teething.[8]

Thanks to modern medical knowledge, now we know this was all just coincidence. These “teething deaths” were probably caused by things like cholera, dehydration, and a myriad of other common early-childhood illnesses that are no longer threats. Needless to say, teething was a terrifying time for parents – literally a period to be survived.

Once a child had all his teeth, his parents could finally breathe a sigh of relief. Phew! Made it!![9]

Teething Symptoms

Studies suggest that some babies experience many symptoms, while others only experience one or two; but those same studies also noted that the same symptoms were also (less-highly) associated with non-teething babies. Thus, no symptom or set of symptoms reliably predicts teething.[11]

Great.

Of the studies that recorded teething symptoms, the most common ones were:

• Biting/sucking/chewing on fingers
• Drooling
• Gum rubbing
• Facial rash
• Inflammation
• Irritability
• Nighttime crying/disturbed sleep
• Poor appetite for solid foods
• Ear rubbing (especially on the side of the tooth emergence)
• Sometimes: a mild temperature elevation or possibly even a low-grade fever (less than 102°F)[12]

Interestingly, many of these symptoms align with veterinary reports of animal teething behaviors.[13]

Even when they reported different findings, authors all agree on one point: teething is not associated with any severe, health-threatening symptoms.[14] Whether or not you ascribe to the belief that teething causes unpleasant symptoms, it does not cause serious illness.

Symptoms NOT attributed to teething:

• Diarrhea
• Coughing
• Temperature above 102°F
• Vomiting
• Body rashes

Even though the research is technically inconclusive, a few reasonable conclusions about the features of teething can be drawn:

• We don’t know how much teething hurts, but it probably doesn’t feel great.
• Teething affects babies differently, and can also affect the same child differently over time.
• Teething symptoms, if any, are probably “minor and self-limiting.”[15]

In the end, the few medical and dental authorities who’ve devoted their time to teething often come back to what the famed English pediatrician Ronald S. Illingworth famously wrote in his book The Normal Child in 1975:

“Teething produces nothing but teeth.”[16]

The Takeaway

Parents everywhere can breathe a sigh of relief — perhaps teething isn’t as awful for our babies as we’ve been taught.

Teething may not be as painful as we assume (and it certainly doesn’t cause death, illness, or GI problems), but it is the source of major anxiety for parents across the board.

Don’t worry: there are definitely some things we can do to ease the discomfort of teething.

In the meantime, don’t stress!

Keep Reading…

Part 2: Teething Remedies (general)

Part 3: Best Teethers

Citations

[1] M. P. Ashley, “Personal View: It’s Only Teething… A Report of the Myths and Modern Approaches to Teething,” British Dental Journal 191, no. 1 (July 14, 2001): 7, doi:10.1038/sj.bdj.4801078.

[2] M. L. Macknin et al., “Symptoms Associated With Infant Teething: A Prospective Study,” PEDIATRICS 105, no. 4 (April 1, 2000): 747, doi:10.1542/peds.105.4.747.

[3] Melissa Wake, Kylie Hesketh, and James Lucas, “Teething and Tooth Eruption in Infants: A Cohort Study,” Pediatrics 106, no. 6 (December 1, 2000): 1376, doi:10.1542/peds.106.6.1374; J Frank and J Drezner, “Is Teething in Infants Associated with Fever or Other Symptoms?,” The Journal Of Family Practice 50, no. 3 (March 2001): 257–257.

[4] Wake, Hesketh, and Lucas, “Teething and Tooth Eruption in Infants,” 1378.

[5] G. T. McIntyre and G. M. McIntyre, “Teething Troubles?,” British Dental Journal 192, no. 5 (March 9, 2002): 251, doi:10.1038/sj.bdj.4801349; Markman, “Teething,” e61.

[6] Ashley, “Personal View,” 5.

[7] H. L. Gibbons and C. K. Hebdon, “Teething as a Cause of Death. A Historical Review.,” Western Journal of Medicine 155, no. 6 (December 1991): 659.

[8] Ashley, “Personal View,” 6.

[9] James Wynbrandt, The Excruciating History of Dentistry: Toothsome Tales & Oral Oddities from Babylon to Braces (Macmillan, 2000), 174.

[10] Macknin et al., “Symptoms Associated With Infant Teething”; Wake, Hesketh, and Lucas, “Teething and Tooth Eruption in Infants.”

[11] Zakirulla Meer and Allahbaksh Meer, “Teething Trouble and Its Management in Children,” International Journal of Dental Clinics 3, no. 2 (2011): 76; Melinda Wenner Moyer, “Parents Can’t Handle the Tooth,” Slate, May 4, 2015.

[12] Macknin et al., “Symptoms Associated With Infant Teething,” 751, 752; McIntyre and McIntyre, “Teething Troubles?,” 251; Linda S. Nield, James P. Stenger, and Deepak Kamat, “Common Pediatric Dental Dilemmas,” Clinical Pediatrics 47, no. 2 (March 1, 2008): 100, doi:10.1177/0009922807305810; A I Owais, F Zawaideh, and O Bataineh, “Challenging Parents’ Myths Regarding Their Children’s Teething,” International Journal Of Dental Hygiene 8, no. 1 (February 2010): 33, doi:10.1111/j.1601-5037.2009.00412.x; Joana Ramos-Jorge et al., “Prospective Longitudinal Study of Signs and Symptoms Associated With Primary Tooth Eruption,” Pediatrics 128, no. 3 (September 1, 2011): 471, 475–76, doi:10.1542/peds.2010-2697; K. Plutzer, A. J. Spencer, and M. J. N. C. Keirse, “How First-Time Mothers Perceive and Deal with Teething Symptoms: A Randomized Controlled Trial,” Child: Care, Health and Development 38, no. 2 (March 1, 2012): 294, doi:10.1111/j.1365-2214.2011.01215.x; “Breaking through to a New Smile,” The Journal of the American Dental Association 145, no. 11 (November 1, 2014): 1192, doi:10.1016/S0002-8177(14)60254-3.

[13] Ashley, “Personal View,” 7.

[14] Wake, Hesketh, and Lucas, “Teething and Tooth Eruption in Infants,” 752; ibid., 1374.

[15] Plutzer, Spencer, and Keirse, “How First-Time Mothers Perceive and Deal with Teething Symptoms,” 293.

[16] Moyer, “Parents Can’t Handle the Tooth.”

[17] Macknin et al., “Symptoms Associated With Infant Teething,” 747.