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ISSN 097 5-843 7 IN TERNA TIONA L JOURN AL OF DE NTAL CLINICS 2011 :3(2): 75-77
©INTERNA TIONAL JOUR NAL OF D ENTAL CL INICS VOLU ME 3 ISS UE 2 APRI L - JUNE 2011 75
Teething trouble and its management in children
Zakirulla Meer, Allahbaksh Meer
Abstract
Teething is the process by which an infant's teeth sequentially appear by breaking through the gums.
This article aims to describe the clinical s igns and symptoms, parent’s belief about teething and myths and
modern approaches to teething.
Key Words: Teething;Primary Teeth;Tooth Eruption;Pain;Infant
Received on: 13/08/2010 Accepted on: 13/11/2010
Teething was known as “dentition
difficilis,” Latin for pathologic dentition or difficult
dentition. Even though teething is a normal part of
infant development, surprisingly little is known
about the causes and management of teething signs
and symptoms.(1, 2) It is widely believed that pain
and other discomfort associate with tooth eruption
in infants should and can be managed by
pharmacological and non-pharmacological means.
Teething pain is the commonest symptom
associated with the eruption of the primary
dentition.(2)
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 timing of tooth eruption varies by as
much as six months.(3) Early intervention is to
help establish good dental hygiene and decrease the
risk of dental caries.(4)
The relationship between the eruption of
the deciduous teeth and the general health of
infants has been documented for over 5,000
years.(5) 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.(6-8)
The systemic disturbances that are associated with
teething include; loss of appetite, crying, increased
salivation, drooling, diarrhea, boils, general
irritability(9) 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.(10) Generally, the
eruption of deciduous teeth begins when other
changes in the infant’s immune s ystem, growth and
development are also occurring; that is, around six
months of age. This predisposes an infant to a
variety of infections like respiratory tract
infections, urinary tract infections, middle ear
infections, etc.(11)
The teething period has been described as
an 8-day window, including the 4 days before tooth
eruption and the 3 days following. The two most
recent prospective cohort studies found only a
weak, if any, association between teething and
many previously reported symptoms.(4)
Neaderland described three common perceptions of
teething: i) teething is pathological and has cause-
effect relationships with symptoms, ii) teething is
physiological, symptoms are merely co-incidental;
and iii) teething is predominantly physiological,
and discomfort is a normal consequence. For many
people, teething is perceived to cause significant
discomfort to infants and substantial distress to the
parents.(2, 4)
The symptoms of teething vary from baby
to baby. The list below describes symptoms that a
teething baby may experience. (4)
Irritability: As tooth rises closer to the
surface, gums may become increasingly sore and
painful. The pain and discomfort usually worsen
when the first teeth and molars come out. This is
due to the fact that molars are bigger in size.(12) In
most cases, the baby becomes accustomed to the
teething sensation and over time to lerates the pain
better.(13)
Drooling: From three to four months of
age, drooling is increased than normal. Teething
stimulates drooling, and it can be worse for some
babies than others.(5)
Coughing: The extra saliva can cause
occasionally cough or gag. This is usually nothing
to worry about, as long as baby does not seem to be
in any discomfort, show signs of a cold or flu and
run a high fever.(5)
Chin rash: If infant drools a lot, the
constant contact with saliva can cause the skin
around the chin and mouth to become irritated. To
help prevent this, gently wipe your baby’s mouth
and chin periodically throughout the day.(5)
Biting and gnawing: A teething baby will
gnaw on anything he or she can get their mouth
around. The counter pressure from biting or
gnawing on an object helps to relieve the pressure
from under the gums.(13)
REVIEW ARTICLE
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©INTERNA TIONAL JOUR NAL OF D ENTAL CL INICS VOLU ME 3 ISS UE 2 APRI L - JUNE 2011 76
Cheek rubbing and ear pulling: Pain in
the gums may travel to the ears and cheeks,
particularly when the back molars begin coming
out. It is for this reason that you may see your baby
rubbing his or her cheeks or pulling at the ears.
However, keep in mind that pulling at an ear can
also be a sign of an ear infection. (5)
Diarrhea: Most parents usually notice
slightly looser bowel movements when a baby is
teething. It is believed that the most likely cause of
this is the extra saliva swallowed, which then
loosens the stool. (4)
Low-grade fever: A low-grade fever can
be defined as a temperature above 36.5 degrees and
fluctuating constantly but not exceeding 38.5
degrees. It is important to notify your doctor if a
fever lasts more than two days.(5)
Not sleeping well: With teething pain
occurring during the day and night, you may find
your child wakes more often at night when the pain
becomes too much. Most parents agree that the
child wakes more often at night during the first set
of teeth and when the molars come out.(13)
Cold-like symptoms: Runny noses,
coughing and general cold symptoms are believed
to be caused by the baby regularly having his or
her hands in their mouth. Play it safe and always
notify your doctor if these symptoms occur.(13)
Teething is associated with increased
drooling, sucking of digits and rubbing of gingiva.
Nevertheless, more recent prospective studies
reveal that most systemic teething signs and
symptoms (fever, vomiting, facial rashes, sleep
disturbances, stool looseness, decreased appetite
for liquids, and cough) are due to other causes.(5)
Many of the historical misconceptions about
teething and the related dangerous remedies
persist.(4)
The largest study by Macknin showed
significant associations with biting, drooling, gum
rubbing, irritability, sucking and temperature
37.5°C.(10) However, attributing these symptoms
to teething was not possible as no symptom
occurred in 35% of infants during each teething
period, and no symptom occurred 20% more often
in the teething period than in the non-teething
period. The results presented by Jaber et al
considered only temperature and only included
children before the emergence of their first
tooth.(14)
Survey was conducted among Finnish
mothers to know their belief bout teething, they
found that 90% of mothers believed teething causes
gum rubbing and finger sucking, 77% that it causes
drooling, and 50% that it leads to fever, sleep
disturbance and daytime restlessness. Recently
Coreil, citing 18 studies from the Americas, Asia,
Africa, and Australia, commented on the near-
universal belief across folk cultures worldwide that
teething is related to diarrhea. Many Australian
parents likewise believe that teething causes
numerous symptoms in young children even when
such symptoms may be indicative of other serious
conditions.(15)
The conclusions of all the prospective
studies are that no specific sympto ms or clusters of
symptoms can reliably predict the emergence of a
tooth. Furthermore, symptoms that might be
attributed to teething are not serious, and the
presence of fever (38.5°C) or other clinically
important symptoms are very unlikely to be caused
by teething. This is borne out by Swann, who
reviewed 50 children admitted to hospital with a
presenting complaint of teething.(16) In 48
children, a medical condition was diagnosed,
including one case of bacterial meningitis.
Although delayed teething may be associated with
several disease-related conditions such as
hypopituitarism, hypothyroidism, and rickets, and
syndromes like Down syndrome and cleidocranial
dysplasia, 1% of healthy children may not have had
their first tooth by 12 months of age.(17) Teething
is viewed by parents as a significant event in the
growth and development of a child, and they
usually get concerned when their infants don’t have
a tooth by 9–10 months.(11)
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.
Benzocaine at a concentration of 20% gives
temporary relief of pain on mucosal tissues. These
local anesthetics agents are found commonly in
teething preparations. Benzocaine should be used
with caution and generally is not recommended
because of the risk of methemoglobinemia and can
interfere with the gag reflex and cause your infant
to choke.(4)
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.(3)
Rubbing Gums: Lightly mass aging 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.(5)
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©INTERNA TIONAL JOUR NAL OF D ENTAL CL INICS VOLU ME 3 ISS UE 2 APRI L - JUNE 2011 77
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.(3)
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 prov ide
relief. (5)
Soothing Sore Chins: Excessive dribbling
caus ed 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.
Cognitive management of teething should
be considered. Behavioral therapies such as sleep
management can be used to combat sleep
disturbances, wakefulness and irritation.(11)
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.
Authors Affiliations: 1. Dr. Dr. Zakirulla Meer. M.D.S.,
M.B.A, Assistant Professor, Dept. of Pediatric
Dentistry, College of Dentistry, King Khalid University,
ABHA, Kingdom of Saudi Arabia, 2. Dr. Allahbaksh
Meer, (M.P.H), Post Graduate Student, Anglia Ruskin
University, United Kingdom.
References
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Address for Correspondence
Dr. Zakirulla Meer. M.D.S., (M.B.A)
Assistant Professor,
Dept. of Pediatric Dentistry,
College of Dentistry,
King Khalid University, ABHA,
Kingdom of Saudi Arabia.
E mail: drzak786@yahoo.co.in
Source of Support: Nil, Conflict of Interest: None Declared
