Teething

Introduction

Teething is the process in which the deciduous teeth (sometimes known as milk teeth or baby teeth) emerge through the gum.

  • Most infants start teething around 6 months of age, but some can start as early as 3 months. Teething continues until the age of 2-3 years.
Order Appearance of Baby Teeth

NOTE: Primary tooth exfoliation occur as part of the process of permanent tooth eruption, which usually begins at approximately 6 years of age.



Symptoms

It is normal for infants whose primary teeth are erupting to be cranky, chew on objects, and have excessive drooling.

Parents frequently report that their infants who are teething have fever, diarrhoea, or other systemic symptoms.



Management

The appropriate management of teething is to relieve local discomfort.

  • Chewing on a chilled [not frozen] teething ring.
  • The use of analgesics (paracetamol suspension) for pain.
  • Topical teething gels*.

* UpToDate does not recommend OTC (including homeopathic remedies) or prescription-strength topical analgesics (e.g., lidocaine, benzocaine) for teething pain because the benefit in managing teething pain has not been demonstrated, yet may be harmful.

  • Laboratory analysis of some homeopathic remedies found greater amounts of Atropa belladonna (deadly nightshade, an anticholinergic agent) than claimed on the label. Symptoms of belladonna toxicity include seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, and agitation.
  • Viscous lidocaine has been associated with serious adverse reactions (including death) in young children being treated for mouth pain, including teething.
  • Methemoglobinemia has been reported in association with the use of oral benzocaine sprays; benzocaine-containing teething gels should not be used in teething infants or children <2 years old.
  • The Medicines and Healthcare Products Regulatory Agency (MHRA) issued the precautionary advice for topical oral pain relief gels containing salicylate salts, which include Bonjela and Bonjela Cool. These products should only be used in patients who are 16 years of age and over because of fears it could cause Reyes syndrome.

Parents should be encouraged to clean their baby teeth from their first appearance using a baby toothbrush.



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