Teething

Teething can cause significant pain in babies.

Teething is the process by which an infant's teeth erupt, or breakthrough, the gums. Teething is also referred to as "cutting" of the teeth and is medically termed odontiasis.

The onset of teething symptoms typically precedes the eruption of a tooth by several days. While a baby's first tooth can appear between 4 and 10 months of age, the first tooth usually erupts at approximately 6 months of age. Some dentists have noted a family pattern of "early," "average," or "late" teethers.

A relatively rare condition, "natal" teeth, describes the presence of a tooth on the day of birth. The incidence of such an event is one per 2,000-3,000 live births. Usually, this single and often somewhat malformed tooth is a unique event in an otherwise normal child. Rarely, the presence of a natal tooth is just one of several unusual physical findings which make up a syndrome.

If the possibility of a syndrome exists, consultation with a pediatric dentist and/or geneticist can be helpful. The natal tooth is often loose and is commonly removed before the newborn's hospital discharge to eliminate the risk of aspiration into the lungs.

Teething is generally associated with gum and jaw discomfort as the infant's tooth prepares to erupt through the gum surface. As the tooth moves beneath the surface of the gum tissue, the area may appear slightly red or swollen. Sometimes a fluid-filled area similar to a "blood blister" may be seen over the erupting tooth. Some teeth may be more sensitive than others when they erupt.

The larger molars may cause more discomfort due to their larger surface area that can't "slice" through the gum tissue as an erupting incisor is capable of doing. Except for the eruption of the third molars (wisdom teeth), the eruption of permanent teeth rarely causes the discomfort associated with the eruption of "baby" (primary or deciduous) teeth.

Teething may cause the following symptoms:

• Increased drooling
• Restless or decreased sleeping due to gum discomfort
• Refusal of food due to the soreness of the gum region
• Fussiness that comes and goes
• Bringing hands to the mouth
• Mild rash around the mouth due to skin irritation secondary to excessive drooling
• Rubbing the cheek or ear region as a consequence of referred pain during the eruption of the molars

Teething is not associated with the following symptoms:

• Fever (especially over 101 F)
• Diarrhea, runny nose, and cough
• Prolonged fussiness
• Rashes over the body

The following is the general order of eruption of primary teeth:

Between 6 to 12 years of age, the roots of these 20 "baby" teeth degenerate, allowing their replacement with 32 permanent "adult" teeth. The third molars ("wisdom teeth") have no preceding "baby" version and generally erupt in mid to late adolescence. Because they tend to promote crowding and crooked orientation, they are often removed.

The process of teething is not causally related to vomiting. As several pediatric dentists have noted, "Teething does not cause fever, runny nose, cough, or diarrhea. Teething causes teeth."

Even though grandmothers may debate the findings, research has not shown a causal relationship between teething and the development of a fever. Viral infections, which commonly occur independently and simultaneously with dental eruptions, may produce a fever. However, there is no teething virus.

Children will commonly have variable discomfort during the few days before tooth eruption through the gum line. Some babies are bothered more than others during the migration through the tissues deep to the gum line. Because of their shape, molars are more likely to be associated with teething discomfort.

Because teething is so common and other symptoms such as fever, fussiness, and diarrhea are also common, both conditions may often occur at the same time. Other illnesses or disorders (such as viral infections) are much more likely to be causing fever, fussiness, and/or nasal congestion with cough and diarrhea. It is important to contact a doctor if these or other symptoms seem concerning. Do not assume that they are just teething.

Some controversy surrounds the use of pain medicines.

Medicines that can be placed on the gums

While some parents endorse topical medicines, studies haven't consistently shown their benefits. The FDA issued a warning in May 2011 urging avoidance of oral medications containing the topical anesthetic benzocaine (such as Orajel).

Benzocaine is the main ingredient of many over-the-counter teething sprays, lozenges, and gels. The FDA warning points out an association with methemoglobinemia, a rare but severe complication. This side effect substantially limits the ability of red blood cells to transport oxygen throughout the body. This development may produce serious to lethal consequences. Individuals who develop methemoglobinemia will become pale, lightheaded, confused, and short of breath. A rapid heart rate is also common.

Such an adverse reaction may develop upon first exposure or after several exposures to benzocaine. Any individual with such symptoms after benzocaine exposure should seek immediate medical attention at the closest emergency room. Medication can be used to reverse these side effects.

Alcohol should never be used to numb the gums.

Medicines that are taken by mouth to help reduce the pain

Ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) can help with the pain. Ibuprofen shouldn't be given to infants younger than 6 months of age. Medications should be used only a few times when other home-care methods do not help. Caution should be taken not to overmedicate for teething. The medicine may mask significant symptoms that could be important to know about.

Do not give children products containing aspirin. No prescription drugs are routinely given for teething.

Teething infants often feel better when gentle pressure is placed on their gums. For this reason, many doctors recommend gently rubbing the gums with a clean finger or having the child bite down on a clean washcloth. If the pain seems to be causing feeding problems, sometimes a different-shaped nipple or cup use may reduce discomfort and improve feeding.

Cold objects may help reduce inflammation as well. Veteran parents have discovered the usefulness of frozen washcloths and ice cubes. Be careful to avoid having prolonged contact with icy objects on the gums. Never put anything in a child's mouth (including teething biscuits) that might make the child choke.

Homeopathic preparations for teething should be viewed with caution since the purity and concentration of ingredients are not guaranteed. Such products are not subject to FDA (Food and Drug Administration) review.

Oral hygiene may be started even before the eruption of the first tooth. Twice-a-day cleaning of the gums using the washrag used for cleaning the face and hands after eating is effective and straightforward.

Fluoride is highly effective in reducing the development and severity of cavities. Since fluoride amounts vary by water source, check with the child's pediatrician or dentist regarding any supplementation that may be necessary. Fluoride recommendations will be based on fluoride concentration in water consumed and the age of the child. An excess of fluoride may cause fluorosis -- permanent staining of the teeth. Children's teeth seem most vulnerable during the first three years of life. For this reason, fluoridated toothpaste is rarely necessary for children under 3 years of age.

Maternal fluoride supplementation during pregnancy has not been shown to benefit fetal dental integrity or protect the child's baby or permanent teeth from cavity formation.

Infants and children should never take a bottle to their crib or bed. Formula, breast milk, cow's milk, soy milk, and juice all can be associated with cavity formation. Ingestion of sticky fruit (such as raisins) or other foods heavily laden with sugar (such as candy) is also associated with an increase in cavity formation.

The American Dental Association and the American Academy of Pediatrics recommend the first dental visit be at 1 year of age. If a delayed schedule is chosen, the latest time for a first dental visit is 3 years of age. Trauma, oral malformations, staining of the teeth, dental pain, and unusual changes of the teeth or gums would warrant a dental visit when first noted by the parent.