Drool, Drool Everywhere: Advice on Teething

By Michelle Place, CRNP-P
In the first few weeks of life we like to blame any irritability or general fussiness on gas (see blog post “It’s the Gas, Gas, Gas” posted March 29, 2017). As our babies get a little bit older and have a couple of months under their belt we start to blame any disruption in sleep patterns, unexplained crying, fever, diarrhea, runny nose, etc., etc. on teething. Knowing what to expect when your child’s first teeth are erupting through their gums will help you understand what is going on and how best to make your baby feel better.

When do babies start teething?

Around 2-3 months of age babies’ juices really start flowing. They start crying tears when they never had any before and the amount of saliva they produce increases to such a degree that they are unable to control it and it dribbles continuously from their mouths. Things are really damp and your mother-in-law (and everyone else you encounter on the street) declares that your baby is teething. Not yet.
The earliest the first tooth generally makes an appearance is around 4 months of age. Most commonly, the first teeth come in around six months of age, but babies can start teething anywhere from six to 13 months. There is great variability in the timing of teething. If your child does not show any teeth until later in their first year, don’t worry. The timing is determined by heredity, and it does not mean that anything is wrong.

In what order do baby teeth come in?

Your baby was born with all 20 primary teeth in place below the gumline. The first teeth to appear usually are the two bottom front teeth, also known as the central incisors. They are usually followed 4 to 8 weeks later by the four front upper teeth (central and lateral incisors). About a month later, the lower lateral incisors (the two teeth flanking the bottom front teeth) will appear.
Next to break through are the first molars (the back teeth used for grinding food), usually around your baby’s first birthday, then finally the eyeteeth (the pointy teeth in the upper jaw). Most children have all 20 of their primary teeth by their third birthday, so teething goes on for a long time!

How do I know if my baby is teething?

In many babies, you will not know until you look one day and spot that cute little tooth sticking out. For a lot of babies teething is a painless process.
There are a lot of symptoms that are blamed on teething including fever, runny nose, and diarrhea to name a few. In reality teething only causes two symptoms, drooling and irritability, that is it!
The reason parents think that teething causes fever, diarrhea and other symptoms is because in the second six months of life babies start attending daycare, mommy and me classes, and playdates. At the same time they also become more mobile and start putting everything into their mouths. As a result, babies develop a lot of viral illnesses at the same time that their teeth start coming. The timing is a coincidence. A fever greater than 100.4F is never caused by teething.
To reiterate, there are only two signs of teething:

  1. Fussiness: Just like any other time of fussiness, rocking, shushing and going for car rides can help soothe your baby.
  2. Drooling: You have been warned: lots of drooling is in store when your baby is teething. That is because teething stimulates saliva, so be prepared.

What are the best teething remedies?

  • Keep baby’s face as dry as possible: Gently wipe your baby’s face often with a cloth to remove the drool and prevent rashes from developing.
  • Massage: A light, gentle rub or massage might give your little one a lot of relief. Remember to wash your hands, then massage the sore areas in your baby’s mouth with your finger or knuckle.
  • Give your baby something cold to chew on.
    • Make sure it’s big enough that it can’t be swallowed or choked on and that it can’t break into small pieces.
    • A wet washcloth placed in the freezer for 15-30 minutes makes a handy teething aid (tie one end in a knot for better gnawing). Be sure to take it out of the freezer before it becomes rock hard — you don’t want to bruise those already swollen gums — and be sure to wash it after each use.
    • Rubber teething rings are also good, but avoid ones with liquid inside because they may break or leak. If you use a teething ring, chill it in the refrigerator, NOT the freezer.
    • Pay attention to what teething toys are made of and how easy they are to wash: Your baby will be putting this toy in her mouth, so you want to be sure that it is made of safe materials and easy to clean to prevent mold from growing inside. Also, never boil to sterilize it — extreme changes in temperature can cause plastic to get damaged and leak chemicals.
  • Teething biscuits and frozen or cold food are only OK for children who already eat solid foods. Do not use them if your child has not yet started solids. Make sure to watch your baby to ensure that no pieces break off or pose a choking hazard.
  • Medication at bedtime: If your baby seems irritable, give a weight-based dose of acetaminophen or ibuprofen (for babies older than 6 months) at bedtime to ease discomfort. Trying some of these other methods should ease your baby’s discomfort enough that giving medication around the clock is not necessary but a dose at bedtime for a couple of nights to help everyone sleep is reasonable.
  • Keep your usual bedtime routine: If your teething baby is irritable, try to make him comfortable, but keep to your usual bedtime routine. Changing the routine, even for a few nights, may lead to sleep troubles.

What teething remedies are unsafe for babies?

  • Teething gels with benzocaine: The Food and Drug Administration (FDA) recommends that parents and caregivers not use benzocaine products for children younger than 2. Benzocaine is an over-the-counter anesthetic, which is found in products like: Anbesol, Hurricaine, Orajel, Baby Orajel and Orabase. These products can cause serious risks and provide little to no benefits for treating oral pain, including sore gums in infants due to teething. Benzocaine has, also, been associated with a rare but serious—and sometimes fatal—condition called methemoglobinemia, a disorder in which the amount of oxygen carried through the bloodstream is greatly reduced.
  • Homeopathic Teething Tablets: The FDA also urges parents not to use  homeopathic teething tablets after lab testing found they contained belladonna, a toxic substance, sometimes far exceeding the amount stated on the label. Homeopathic teething products have not been evaluated or approved by the FDA for safety or effectiveness, and the agency says it is unaware of any proven health benefit of the products. In late 2016, the FDA advised parents to stop using homeopathic teething tablets and gels after there were multiple incidents of babies and toddlers having seizures after taking them
  • Amber necklaces: There is a substance found in amber that when warmed by placing it next to the baby’s skin is supposed to pass through the skin to create a pain-relieving effect, however, there is no scientific research or evidence to back up these claims. The necklaces are a choking and strangling hazard. The FDA released an official warning in December 2018 after receiving reports of children choking on beads that break off and an 18-month-old being strangled to death by an amber necklace during a nap.
  • Never place an aspirin against the tooth, and don’t rub alcohol on your baby’s gums.

Now that they are here, how should I care for my baby’s teeth?

  • The care and cleaning of your baby’s teeth is important for long-term dental health. Even though the first set of teeth will fall out, tooth decay makes them fall out more quickly, leaving gaps before the permanent teeth are ready to come in. The remaining primary teeth may then crowd together to attempt to fill in the gaps, which may cause the permanent teeth to come in crooked and out of place.
  • Daily dental care should begin even before your baby’s first tooth comes in. Wipe your baby’s gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!).
  • Once your child has a tooth, you should begin brushing them twice a day with a smear of fluoride toothpaste the size of a grain of rice, especially after the last drink or food of the day. Remember not to put your baby to bed with a bottle because the milk or juice can pool in your baby’s mouth and cause tooth decay and plaque.
  • Once your child turns 3, the American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) recommend that a pea-sized amount of fluoride toothpaste be used when brushing. When your child is able, teach him or her to spit out the excess toothpaste.
  • It is best if you put the toothpaste on the toothbrush until your child is about age 6. Parents should monitor and assist their child while brushing until he or she is around 7 or 8 years old. When your child can write his or her name well, he or she also has the ability to brush well.
  • The American Dental Association (ADA) recommends that children see a dentist by age 1, or within 6 months after the first tooth appears, to spot any potential problems and give advice about preventive care.
  • Your baby’s teeth and gums will also be examined, and fluoride varnish applied, at well-baby checkups at Potomac Pediatrics. Remember, regular childhood dental care helps set the stage for a lifetime of healthy teeth and gums.