Teething Troubles

How to Help Keep Your Baby Comfortable

Dear Doctor,
My baby is six months old and she seems to be teething. What can we expect and how can I keep her comfortable?

Dear Carla,
Teething is definitely a notable milestone in an infant's life — and your baby will quite frequently let you know it. A hot topic among many new parents, teething is the process by which an infant's teeth sequentially appear in the mouth. More specifically, it describes the tooth eruption process through which primary (baby) teeth emerge through the gums and into the mouth. The typical time frame for teething to begin is usually between six and nine months although it may start as early as three months or as late as twelve months in some cases.

Most children have all 20 of their primary teeth by the age of three. Typically, although not invariably, the two lower front teeth tend to erupt first, followed by the two upper front teeth. The first molars come in next, followed by the canines (eyeteeth).

What You Can Expect

Although teething is different for each baby, and both symptoms and length of time it takes for a tooth to make its appearance vary, many parents recognize the following signs:

• Irritability
• Biting and gnawing
• Gum swelling
• Chin (facial) rash
• Disrupted sleeping patterns
• Ear rubbing
• Drooling
• Decreased appetite

Teething is different for each baby, and both symptoms and length of time it takes for a tooth to make its appearance vary.

Although most infants make it through the teething process without much discomfort, occasionally it can be considerable. Even if there is no discomfort you can expect a child to exhibit some of the classic signs and symptoms associated with teething. For example, don't be surprised if your baby's gums become swollen or if she begins to drool more than usual as tooth eruption triggers excess saliva production. Biting or chewing on anything she can get her hands on to alleviate or stimulate the process is quite common. Excessive salivation can lead to chin reddening and chafing. She may also start to wake up frequently during the night.

These symptoms are usually most prevalent during the week that the tooth or teeth actually begin to break through the gums, starting about four days before the event and lasting about three days after a tooth finally appears.

Gum swelling may occasionally be associated with eruption cysts (fluid-filled sacs), which appear as small, bluish, almost see-through, bubble-shaped swellings overlying an erupting tooth. Occasionally blood mixes with the fluid, when they are referred to as eruption hematomas (“hemat” – blood; “oma” – swelling or tumor). Generally, no treatment is needed because the tooth erupts through the cyst, popping it, which causes it to disappear spontaneously.

While there is some controversy, most sources agree that diarrhea, rashes and fever are not normal for a teething baby. If your infant has a fever or diarrhea while teething or continues to be cranky and uncomfortable, call your pediatric dentist or pediatrician. Evaluation is necessary to rule out a systemic (general body) cause for the illness.

How You Can Help Keep Her Comfortable

Here are some other remedies that may help reduce the irritation your baby is experiencing in her mouth:

• Teething rings — The American Academy of Pediatric Dentistry (AAPD) recommends parents use a clean, chilled, rubber teething ring, or cold wet washcloth for teething babies.
• Chilled pacifiers — These are also helpful. Be careful not to freeze teething rings or pacifiers, as ice can burn if left in place too long.
• Gum massage — Massaging inflamed gums with your clean finger may be helpful to counteract the pressure from an erupting tooth.
• Cold foods — When your youngster is old enough, cold foods like popsicles may soothe sore gums, but confine them to mealtimes because sugars can cause decay.
• Over-the-counter medicine — If teething pain persists, you can give your baby acetaminophen or ibuprofen, but check with a pharmacist for the correct dosage. The medicine should be swallowed and not massaged into the sore areas, as this, too, can burn. Despite the old practice of rubbing alcohol on the gums of a teething baby, no amount of alcohol should be used or given. Products containing Benzocaine*, a numbing agent should not be used for children less than two years of age, except under the advice and supervision of a healthcare professional.

See Your Dentist Or Pediatric Dentist

Lastly, and most importantly, if you are not sure what to look for, or are concerned about your baby's continuing discomfort, see your dentist or pediatric dentist — a specialist in the growth and development of children's teeth and jaws. Pediatric dentistry includes the management, treatment and prevention of dental problems such as teething. It's also important to make sure your child is just teething and that nothing serious is causing her symptoms. Remember, the right time to see and establish a relationship with a dentist or pediatric dentist is in the first year of your child's life.