Teething, honestly

Teething is one of the most over-diagnosed conditions in infancy, which matters mainly because attributing an illness to teeth delays finding the actual cause.

What the evidence shows

Prospective studies following infants daily through tooth eruption have found a consistent picture.

Symptoms cluster tightly around the day of eruption and the few days either side, rather than lasting weeks.

Associated symptoms include increased biting, drooling, gum irritation, irritability, sucking, disturbed sleep and reduced appetite for solids.

A mild rise in temperature has been observed in some studies, and fever above thirty-eight degrees has not been consistently associated with teething.

Which is the practically important finding: a baby with a genuine fever is ill, not teething.

What teething does not cause

Based on the same research.

High fever.

Diarrhoea.

Vomiting.

Cough or runny nose.

Rash other than mild dribble rash on the face.

Prolonged sleep disruption over weeks or months.

Or a baby who is generally unwell.

Each of these has other causes that should be considered, and the historical attribution of serious illness to teething caused genuine harm.

The timeline

Highly variable.

First teeth commonly appear between around six and ten months, with a normal range from around three months to well past a year.

Some babies are born with a tooth.

The usual order is lower central incisors, then upper central incisors, then lateral incisors, first molars, canines and second molars, with the full set of twenty primary teeth typically complete between two and three years.

Molars are generally reported as more uncomfortable.

A late first tooth is usually familial and warrants a dental review if there are no teeth by around eighteen months.

What helps

Simple measures with reasonable support.

Something cold to chew: a chilled — not frozen — teething ring, a cold flannel, or cold food for babies eating solids.

Frozen items can damage gums and should be avoided.

Gentle gum pressure with a clean finger.

Extra comfort and holding.

Wiping drool to prevent facial rash, and a barrier emollient on the chin.

And paracetamol or ibuprofen at the correct dose for a baby who is genuinely distressed, used for a short period.

What to avoid

Several products carry genuine risks.

Teething gels containing benzocaine or lidocaine, which several regulators advise against in infants because of rare but serious effects.

Homeopathic teething tablets, some of which have been recalled after contamination with belladonna.

Amber teething necklaces, which have no evidence of benefit and carry strangulation and choking risks — several safety agencies have issued warnings and deaths have occurred.

Rubbing alcohol or spirits on gums.

Sugary drinks or dipping dummies in anything sweet.

And frozen hard objects.

Caring for the teeth that arrive

Starting immediately.

Brush twice daily as soon as the first tooth appears, with a small soft brush and a smear of fluoride toothpaste at the concentration recommended for the age.

Brush last thing at night and at one other time.

Spit out and do not rinse, which keeps fluoride in contact with the teeth.

Adults should brush or supervise brushing until around seven years, since young children cannot do it effectively.

Avoid sugary drinks and free sugars, and never put a baby to bed with a bottle of anything other than water, since prolonged contact causes severe early decay.

Move from bottles to a free-flow cup from around six months and aim to stop bottles by around a year.

And take the child to a dentist from the eruption of the first tooth or by their first birthday, which is recommended in most countries and rarely done.

Dental problems in infancy

Worth recognising.

Early childhood caries, appearing as white or brown marks on the upper front teeth, which is common, preventable and requires treatment.

Tooth discolouration, which has several causes including trauma and iron supplements.

Tongue tie, which is a feeding issue rather than a dental one.

Eruption cysts, which are bluish swellings over an emerging tooth and are harmless.

And any injury to a tooth, which should be assessed, particularly if the tooth is displaced or the child was unwell afterwards.

General information only, not medical or dental advice. A fever, diarrhoea or an unwell baby is not teething — seek medical advice. Consult a dentist about your child's teeth.