Teething symptoms and how to care for your baby's first teeth

Most babies get their first tooth between 6 and 10 months, though some start earlier or later.¹ Teething can make a baby drooly, cranky and keen to chew, but it does not cause a real fever or diarrhoea.¹ Brushing should start with the very first tooth, using a rice-grain smear of fluoride toothpaste.²

When do babies start teething?

The first tooth usually comes through between 6 and 10 months of age. Some babies feel gum discomfort weeks or months before that, even from about 3 months.¹

Timing runs in families. A few babies are born with a tooth, and some healthy babies have none at their first birthday. A late first tooth on its own is rarely a worry if your baby is otherwise growing and developing well. If there is still no tooth well into the second year, mention it at a check-up.

Which teeth come first, and when will all the baby teeth be in?

The two lower front teeth usually come first, and most children have all 20 baby teeth by about 3 years of age.¹

After the lower front teeth, the upper front teeth usually follow, then the teeth on either side. The big back teeth (molars) and the pointed canine teeth come in the second year. Molars are often the most uncomfortable, so a toddler of 18 months may be more upset by teething than a baby of 7 months.

What are the signs of teething?

The most common signs are sore, swollen gums, irritability and drooling.³

A review that pooled 16 studies found that about 7 in 10 children had some sign or symptom around the time a tooth came through. Gum irritation was seen in about 87 percent, irritability in about 68 percent, and drooling in about 56 percent.³ Other common signs:

• Chewing on fists, toys and anything within reach.
• Rubbing the ear or cheek on the same side.
• Waking more at night, or fussing during feeds.
• A red cheek or a mild rash on the chin from drool.

Symptoms usually last a few days around each tooth, not for weeks.

Does teething cause fever?

No. Teething may raise the temperature very slightly, but not to the level of a true fever.³

The same review found that temperature could rise a little around tooth eruption, but it was not a fever.³ The American Academy of Pediatrics (AAP) also calls fever a false symptom of teething.¹ So if your baby has a temperature of 38 degrees C or more, look for another cause, such as a viral infection, ear infection or urine infection. Grandparents often say "it's just teeth"; please do not let that delay a check-up for a febrile baby, especially one under 3 months.

Does teething cause diarrhoea or loose motions?

No. Teething does not change how your baby's gut works, so loose motions have another cause.¹

Babies who are teething chew everything, and that is the age when they also start crawling and exploring the floor. Germs from hands and toys are a more likely reason for loose stools. In Kolkata's monsoon, stomach infections are common. Keep offering feeds as usual. Call your doctor if diarrhoea lasts more than a day.¹ Watch for signs of dehydration: fewer wet nappies, a dry mouth, or unusual sleepiness.

What helps teething pain?

Something firm and cool to chew on, and gentle gum rubbing with a clean finger, help most babies.⁴

• A solid teething ring made of firm rubber.⁴
• A clean, damp, chilled washcloth to gnaw on.¹
• Gum massage with your clean finger for a minute or two.⁴
• Extra cuddles and patience at bedtime.

Cold helps, but do not let your baby chew on anything frozen solid.¹ Avoid teethers filled with liquid, which can split.¹ Always stay with your baby while she uses a teether, in case of choking.⁴ Hard biscuits marketed as "teething rusks" often contain sugar and can break into chunks, so Dr Dutta prefers a teething ring.

Can I give paracetamol for teething pain?

Occasionally, yes, for a baby who is very uncomfortable, but ask your paediatrician about the dose first.¹

The dose depends on your baby's weight, not just her age. Use the syringe that comes with the medicine, never a kitchen spoon. Paracetamol is for a bad night, not for every day of every tooth. If your baby needs pain relief for several days in a row, she should be examined, because something other than teething may be going on.

Are teething gels safe for babies?

Most are not recommended. The US Food and Drug Administration (FDA) warns that benzocaine gels can cause a serious, sometimes fatal blood condition, and that these products offer little or no benefit.⁴

The condition is methaemoglobinaemia, where the blood cannot carry oxygen properly. The FDA also warns that viscous lidocaine (another numbing gel) can cause seizures in young children if too much is swallowed.⁴ Numbing gels wash away quickly with drool anyway.¹ Homeopathic teething tablets and gels, especially ones containing belladonna, should also be avoided.¹ Never rub alcohol, brandy or whisky on the gums.¹ And no honey for babies under 1 year, as it can carry the germ that causes infant botulism.⁵

Are amber teething necklaces and bracelets safe?

No. The FDA has received reports of deaths and serious injuries, including strangulation and choking, linked to teething necklaces such as amber beads.⁴

A necklace can tighten around the neck or catch on a cot. Beads can break off and block the airway. There is no good proof that amber releases anything that eases pain. The same goes for black threads, taabeez or chains around a baby's neck or wrist during sleep. Dr Dutta understands these often carry family meaning. If you want to keep one, put it on only while your baby is awake and being watched, and take it off at sleep time.

When should I start brushing my baby's teeth?

Start as soon as the first tooth appears, using a fluoride toothpaste.²

Before teeth come, you can wipe the gums with a clean, soft, damp cloth after feeds. It gets your baby used to having her mouth cleaned. Once a tooth is through, use a soft baby toothbrush with a small head. Brush in the morning and before bed. Lay her on your lap with her head towards you, or sit her on your lap facing away; both give you a good view.

How much fluoride toothpaste should a baby use?

Under 3 years, use only a thin smear of toothpaste, no bigger than a rice grain. From age 3, use a pea-sized amount.²

Fluoride makes tooth enamel stronger and is proven to prevent decay.⁶ The tiny amount keeps the benefit while limiting how much a child swallows, which lowers the risk of white marks on the teeth (fluorosis).⁶ Check the label and choose a regular fluoride toothpaste. Some toothpastes sold for babies contain no fluoride, so read the label. Do not rinse with lots of water after brushing; just let your child spit out what she can once she is old enough.

What is bottle tooth decay or early childhood caries?

Early childhood caries is tooth decay in children under 6. It often starts on the upper front teeth as white chalky lines that turn brown, and it is very common in India.

A review of 71 Indian studies found that nearly half of young children, about 47 percent, had early childhood caries.⁷ Decay in the youngest children has not fallen over the past decade, even where it has improved in older children.⁸

Decay happens when milk, juice or sweet food sits on the teeth for long periods. To prevent it:

• Avoid letting your baby fall asleep with a bottle of milk. If she needs one at bedtime, put only water in it.²
• Do not dip a pacifier in sugar, honey or jaggery.
• Avoid juice and sweet drinks in a bottle or sipper.
• Wipe or brush teeth after the last night feed when you can.

Can my baby's first teeth decay even with breastfeeding?

Yes, decay can happen in breastfed babies too, especially once sweet foods are started and teeth are not brushed.

Breastfeeding has many benefits and you do not need to stop. The bigger risks are sugary snacks, biscuits, sweets given by visitors, and no brushing. Clean the teeth twice a day with a smear of fluoride toothpaste, and keep sweet foods to mealtimes rather than all day.

When should my baby first see a dentist?

Take your child to a dentist by the first birthday, or within 6 months of the first tooth coming through.²

The first visit is short. The dentist checks the teeth and gums, looks for early decay and teaches you how to brush. The AAP advises fluoride varnish (a protective coating painted on the teeth) every 6 months until age 5, and more often for children at high risk.² Fluoride varnish is now regarded as standard care in children's primary health care.⁶ Your paediatrician can also check teeth at routine visits, as young children often see us more than they see a dentist.⁸

When should I see a doctor or dentist about teething?

See a doctor if your baby seems unwell, because teething alone should not make her ill.

• Fever of 38 degrees C or more, or any fever in a baby under 3 months.
• Diarrhoea lasting more than a day, or signs of dehydration.¹
• Refusing to feed, or far fewer wet nappies than usual.
• Swelling of the face or a gum swelling with pus.
• White, brown or black spots on the teeth.
• A tooth that is broken or loose after a fall.
• No teeth at all well into the second year.

Go to hospital straight away if your baby is very drowsy, breathing fast, has a fit, or has swallowed a bead or button battery.