Chapter

Does Teething Cause Fever, Rash, and Other Signs of Illness?

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

The pain of teething in infants has been recognized for 5000 years. Primary (“baby”) teeth eruption begins around 6 months and extends to 24–30 months, an age when infections and other causes of distress are very common. Sore gums, drooling, and biting behavior are well-established local (oral) signs and symptoms of teething. Many parents, and even health care providers, also believe that systemic symptoms like fever and diarrhea are caused by teething. The best-designed observational studies have involved longitudinal follow-up of infants with frequent, intensive measurement of new tooth eruption and of new signs and symptoms, but blinding of observers is difficult. The most rigorous of these observational studies show increased irritability and disturbed sleep associated with teething, but not diarrhea or true fever, although some have shown higher average temperatures within the normal range.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Aim To perform a systematic review and meta-analysis to establish if fever is associated with primary tooth eruption. Materials and methods Literature searches involved Pubmed, MEDLINE, Web of Science, Scopus and Cochrane. The potentially relevant studies had the full text analyzed. Only studies concerning fever during eruption period of primary tooth in humans were included. Papers in non-English language, and papers that included syndromic patients or patients with any disease were excluded. The meta-analyses were performed with Review Manager (version 5.3). Only studies that reported the results as dichotomous data were analyzed with Cochran-Mantel-Haenszel test in meta-analysis function of Review Manager 5.3. The fixed-effects model was used to evaluate the association between tooth eruption and fever. Results Search identified 83 potential studies. After exclusion of the duplicated studies, or were not related to the criteria of inclusion only 6 studies were selected for the systematic review. In the overall meta-analysis, no association was found [OR = 1.32 (0.88-1.96)] between fever and primary tooth eruption. However, in the subgroup analysis, when the method used to measure fever was the rectal temperature there was an association [OR = 2.82 (1.55-5.14)] between fever and primary tooth eruption. Conclusion There are few suitable studies in the literature regarding the association between primary tooth eruption and fever. However, our study found an association between fever and primary tooth eruption only when rectal temperature was performed How to cite this article Nemezio MA, De Oliveira KMH, Romualdo PC, Queiroz AM, Paula-e-Silva FWG, Silva RAB, Kuchler EC. Association between Fever and Primary Tooth Eruption: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2017;10(3):293-298.
Article
Full-text available
Context: Symptoms associated with the primary tooth eruption have been extensively studied but it is still controversial. Objective: To assess the occurrence of local and systemic signs and symptoms during primary tooth eruption. Data sources: Latin American and Caribbean Health Sciences, PubMed, ProQuest, Scopus, and Web of Science were searched. A partial gray literature search was taken by using Google Scholar and the reference lists of the included studies were scanned. Study selection: Observational studies assessing the association of eruption of primary teeth with local and systemic signs and symptoms in children aged 0 to 36 months were included. Data extraction: Two authors independently collected the information from the selected articles. Information was crosschecked and confirmed for its accuracy. Results: A total of 1179 articles were identified, and after a 2-phase selection, 16 studies were included. Overall prevalence of signs and symptoms occurring during primary tooth eruption in children between 0 and 36 months was 70.5% (total sample = 3506). Gingival irritation (86.81%), irritability (68.19%), and drooling (55.72%) were the most frequent ones. Limitations: Different general symptoms were considered among studies. Some studies presented lack of confounding factors, no clear definition of the diagnostics methods, use of subjective measures and long intervals between examinations. Conclusions: There is evidence of the occurrence of signs and symptoms during primary tooth eruption. For body temperature analyses, eruption could lead to a rise in temperature, but it was not characterized as fever.
Article
Full-text available
To assess the association between primary tooth eruption and the manifestation of signs and symptoms of teething in infants. An 8-month, longitudinal study was conducted with 47 noninstitutionalized infants (ie, receiving care at home) between 5 and 15 months of age in the city of Diamantina, Brazil. The nonrandomized convenience sample was based on the registry of infants in this age range provided by the Diamantina Secretary of Health. Eligible participants were infants with up to 7 erupted incisors and no history of chronic disease or disorders that could cause an increase in the signs and symptoms assessed in the study. Tympanic and axillary temperature readings and clinical oral examinations were performed daily. A daily interview with the mothers was conducted to investigate the occurrence of 13 signs and symptoms associated with teething presented by the infants in the previous 24 hours. Teething was associated with a rise in tympanic temperature on the day of the eruption (P = .004) and with the occurrence of other signs and symptoms. Readings of maximal tympanic and axillary temperatures were 36.8°C and 36.6°C, respectively. The most frequent signs and symptoms associated with teething were irritability (median: 0.60; P < .001), increased salivation (median: 0.50; P < .001), runny nose (median: 0.50; P < .001), and loss of appetite (median: 0.50; P < .001). Irritability, increased salivation, runny nose, loss of appetite, diarrhea, rash, and sleep disturbance were associated with primary tooth eruption. Results of this study support the concept that the occurrence of severe signs and symptoms, such as fever, could not be attributed to teething.
Article
Full-text available
A relationship between teething and fever was sought by examining mothers' reports of the 20 days before the eruption of the first tooth in 46 healthy infants. Twenty infants had a fever of greater than 37.5 degrees C on day 0 compared with seven infants (or fewer) from day 19 to day 4. The danger of attributing fever to teething is emphasised.
Article
Full-text available
“There can be no excuse for ascribing fever, fits, diarrhoea, bronchitis, or rashes to teething,” wrote the BMJ in 1975.1 The intervening quarter century has seen the growth of evidence based medicine, yet it has also illustrated how great may be the distance between research evidence and professional practice and how slowly that gap may close. Good evidence now exists from careful prospective studies that teething is associated with, at most, minor and relatively infrequent symptoms.2–3 How do the views of professionals now align with the evidence? This study aimed to determine current beliefs about teething and related practices of child health professionals in Victoria, Australia. We surveyed representative samples of the five groups of professionals most closely concerned with the health of children in Victoria (population 4.6 …
Article
Full-text available
An 8-month-old girl has been referred to the emergency department by her general practitioner with a 24-h history of drooling, intermittent screaming and low-grade fever (maximum 38.2°C). She is refusing solids and her fluid intake has decreased. Her parents report that her nappies are drier than normal but her stools are looser. She has had some relief from oral paracetamol syrup. Her parents suspect teething. On examination she is found to be miserable. She is not clinically dehydrated and has a diffusely hyperaemic right cheek. On examination of her mouth you notice a raw area on her upper gums where two teeth are erupting. No other abnormal clinical signs are noted. You agree that the infant may be teething, but wonder if there are any symptoms that would distinguish between teething and an alternative diagnosis. In an infant with suspected teething (patient), are there any symptoms or signs pathognomonic of teething (assessment) that would allow for the reassurance of parents without further management (outcome)? Secondary sources: none. Medline (1966–September 2006) using the Ovid interface was analysed for articles containing the keywords “(teething or tooth) and symptom$ and (infant or baby)”. Limits included human and English language only. In total, 78 articles were identified, of which teething was the main focus in 21 articles. There were three prospective studies1–3 and two retrospective studies45 examining the …
Article
Background: Parents believe that teething is associated with signs and symptoms, which may induce them to give medications that could harm their children. Some children may require alleviation of symptoms and overall attention. Aim: To assess parents' beliefs and attitudes towards teething. Design: Through electronic databases and grey literature, this systematic review identified cross-sectional studies reporting parents' beliefs, knowledge and attitudes about the signs and symptoms of primary tooth eruption in children aged between 0 and 36 months. Three reviewers independently selected the studies, collected the information, assessed methodological quality, and checked for accuracy with disagreements solved by a fourth reviewer. The Agency of Research and Quality in Health questionnaire for cross-sectional studies was used for the quality assessment. Descriptive analysis with median and interquartile ranges were adopted. Results: Twenty-nine studies comprising 10,524 participants from all geographic regions were included. The methodological quality of the studies was moderate. Most parents have beliefs in signs and symptoms during dentition, the most reported symptom being the desire to bite. Oral rehydration was the most exposed attitude in the studies included. Only a small proportions of parents reported no attitude. Conclusions: The majority of parents believed in at least one sign or symptom associated with teething, and only few of them would do nothing or just wait for the signs or symptoms to pass, with no difference among countries. Protocol doi: 10.17605/OSF.IO/S2KZ3.
Article
To investigate current beliefs and treatment recommendations for teething symptoms among health professionals in New Zealand. Cross-sectional survey of seven groups of health professionals. A written questionnaire was mailed in March 2011 to 336 health professionals practising in Wellington City, Hutt Valley and Kapiti Coast, in New Zealand. The self-administered questionnaire sought information on how many children are perceived to experience teething symptoms, what symptoms are attributed to teething, suggested treatments for teething symptoms, and how distressing teething is to children and parents. The response rate to the single-wave survey was 41%. Although the beliefs varied widely across the groups, almost half (48%) of health professionals believed that some children have teething-associated problems, and 32% believed that most children do. Just over one-third of participants incorrectly attributed fever to teething. Health professionals also incorrectly chose nappy rash (31%), loose stools (27%), runny nose (19%) and mouth ulcers (15%) as teething signs or symptoms. Most participants (65%) suggested paracetamol as a treatment for teething; 60% chose teething gels and 48% suggested teething toys or rings. Most respondents believed that teething is moderately distressing to both the child and parent. The findings show that misconceptions about the symptoms of teething are held by some health professionals. Many believe that teething causes a variety of serious and systemic symptoms. The study has also shown that teething beliefs vary greatly across the different health professions.
Article
According to current medical opinion, teething diarrhea (TD) is a myth; yet cross-cultural data document a worldwide distribution of popular belief in the association of frequent, loose stools with tooth eruption. A mail survey in 1990 of 215 pediatricians practicing in Florida investigated beliefs and practices related to TD. Thirty-five percent of respondents believed there is a real association between diarrhea and tooth eruption. When compared with pediatricians who do not believe in TD, these respondents were more likely to be more recent graduates of medical school, to be in general pediatric practice, to be female, to see more patients per week, and to practice in metropolitan areas. The most common explanations for the link between dentition and diarrhea were changes in eating habits, increased salivation, and stress. Respondents reported that both they and the parents of their patients tended to view TD as less serious than other types of diarrhea, and both managed it accordingly. When compared with earlier studies, our findings indicate that belief in TD among pediatricians may have increased since the 1970s. The results suggest a need for more empirical research on the effects of tooth eruption on bowel function.
Article
Studies of infant teething have been retrospective, small, or conducted on institutionalized infants. To conduct a large, prospective study of healthy infants to determine which symptoms may be attributed to teething and to attempt to predict tooth emergence from an infant's symptoms. Prospective cohort. Setting. Clinic-based pediatric group practice. One hundred twenty-five consecutive well children of consenting Cleveland Clinic employees. Parents daily recorded 2 tympanic temperatures, presence or absence of 18 symptoms, and all tooth eruptions in their infants, from the 4-month well-child visit until the child turned 1 year old. Daily symptom data were available for 19 422 child-days and 475 tooth eruptions. Symptoms were only significantly more frequent in the 4 days before a tooth emergence, the day of the emergence, and 3 days after it, so this 8-day window was defined as the teething period. Increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething. Congestion, sleep disturbance, stool looseness, increased stool number, decreased appetite for liquids, cough, rashes other than facial rashes, fever over 102 degrees F, and vomiting were not significantly associated with tooth emergence. Although many symptoms were associated with teething, no symptom occurred in >35% of teething infants, and no symptom occurred >20% more often in teething than in nonteething infants. No teething child had a fever of 104 degrees F and none had a life-threatening illness. Many mild symptoms previously thought to be associated with teething were found in this study to be temporally associated with teething. However, no symptom cluster could reliably predict the imminent emergence of a tooth. Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething, other possible causes must be ruled out.teething, tooth eruption, teeth, deciduous dentition.
Article
Many symptoms are attributed to teething in infants. There is little evidence to support these beliefs, despite their implications for clinical management. We investigated relationships between tooth eruption, fever, and teething symptoms. Prospective cohort study. Twenty-one children 6 to 24 months old attending 3 suburban long-day care centers >/=3 days/week. Measures. 1) Daily temperature recording and examination of alveolar ridges for tooth eruption (dental therapist). 2) Daily questionnaires-symptoms over preceding 24 hours (staff and parents independently). 3) Final questionnaire-beliefs/experiences related to teething (parents). Definitions. Eruption day-the first day a tooth could be seen or felt. Non-toothdays-more than 28 days clear of any eruption day. Toothdays-the 5 days preceding eruption days. Data were collected for 236 toothdays and 895 non-toothdays pertaining to 90 teeth. Child temperatures were similar on toothdays and non-toothdays (36.21 vs 36.18, paired t test). Logistic regression adjusted for age did not show an association between toothdays and temperature (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 0.80, 2.27 for high fever; OR = 1.34, 95% CI = 0.48, 3.77 for low fever). Logistic regression models allowing for within-child cluster effects and age were fitted to daily staff and parent reports of mood, wellness/illness, drooling/dribbling, sleep, diarrhea, strong diapers, red cheeks, and rashes/flushing. Only parent-reported (but not staff-reported) loose stools were significantly associated with tooth eruption (OR = 1.86, 95% CI = 1. 26, 2.73). When the toothday definition was varied to 10 days preceding or 5 days surrounding tooth eruption, this single significant association was no longer apparent (OR = 1.42, 95% CI = 0.98, 2.05 and OR = 1.47, 95% CI = 0.97, 2.21, respectively). All parents retrospectively reported that their own children had suffered a range of teething symptoms. This study did not confirm the expected strong associations between tooth eruption and a range of teething symptoms in children 6 to 30 months old, although we cannot rule out the possibility that weak associations may exist (Type II error). These findings contrast with strong parent and professional beliefs to the contrary. Such beliefs may preclude optimal management of common patterns of illness and behavior in young children.teething, infants, symptoms, tooth eruption, illness.
Article
Paediatric dentistry is not my usual field of work. I am now based almost entirely in restorative dentistry and it is five years since I worked in the dental department of a children's hospital. An essay on teething would appear to be an unusual choice of topic. With the current professional climate of 'general professional education' and 'lifelong learning' I can easily justify my time and effort studying a subject somewhat removed from my regular work. However, to be completely honest, I have reached that age when many of my friends, relatives and colleagues are enjoying the sleepless nights that accompany expanding families. Add to this the fact that I have recently married into a family of midwives, health visitors, nurses and new mothers. I was not sure that I was giving the best, most up to date advice when asked about teething. So some reading around was required. If only it were that simple. I now feel equipped to give a little more help than simply saying, "It's only teething..."
Article
It is commonly believed that teething in infants can cause a variety of signs and symptoms. Previous studies have suggested an association between teething and fever, irritability, drooling, rashes, vomiting, diarrhea, night crying, and convulsions. The objective of this study was to evaluate differences in the beliefs of pediatricians, pediatric dentists and parents regarding symptoms caused by teething in infants. A survey consisting of demographic information and questions concerning commonly reported symptoms associated with teething was administered to 100 randomly selected Iowa pediatricians, all practicing pediatric dentists in Iowa (n = 33) and a convenience sample of 120 parents from the greater Iowa City area. Responses were analyzed using the Chi-square test. Response rates for each group were: pediatricians 45%; pediatric dentists 76%; and parents 50%. The majority of individuals in each group believed that teething in infants can cause swollen gums, drooling, irritability, inflamed gums, restlessness, sleeplessness, and fever. There were significant differences in the percent of agreement relating to drooling (p = 0.001), inflamed gums (p = 0.001), and sleeplessness (p = 0.027). A greater percentage of pediatric dentists and parents agreed that these symptoms were caused by teething than did pediatricians. The largest difference between groups was related to the association between teething and diarrhea. The majority of parents (56.7%) and pediatric dentists (52.0%) believed that diarrhea is associated with teething compared to just 9.1% of pediatricians. These results support the hypothesis that differences regarding beliefs about teething symptoms exist between parents, pediatricians, and pediatric dentists. There is more agreement between parents and pediatric dentists than between either of these groups and pediatricians.
Morphine? Wolf’s teeth? Hare brain? The endless quest to solve teething
  • N Day
  • GT McIntyre
Teething: facts and fiction
  • L Markham
Leeds: University of Leeds General Cemetery Collection
  • I Gerard
  • K Root
  • Teething