As pediatric dentists, one of the many discussions we have with parents is how to deal with the teething process. Although every child grows up with different dental experiences, every child must go through the teething process, whereby many parents find themselves sharing the same stories and similar frustrations.
Historically, teething has been blamed for a variety of ailments, including runny nose, earache, diarrhea, fever, and other conditions. Contrary to popular belief, however, several studies have shown that teething does not cause any of these conditions. A study published in Pediatrics in 2000 asked parents to report on the daily occurrence of 18 symptoms over an 8-month period while their children were teething. Researchers found that although diarrhea, cough, vomiting, sleep disturbance, rashes or temperatures higher than 38.9 C were reported occasionally, they were not reported in enough children during the time teeth were erupting to be significantly associated with teething. A second study in Pediatrics found a similar result, namely that reported symptoms did not correlate with teeth coming into the mouth. No statistical association was found between fever, mood disturbance, rashes and tooth eruption. Further, a study published in The Journal of Family Practice in 2001 found no difference in a child’s reported temperature on days that teeth were erupting compared to days that teeth were not erupting in children between 6 months and 2 years old.
Many parents may ask why teething can be such a miserable experience for their child. It is important to remember that teething takes place over a period of 2 and a half years, so it is not surprising that coincidental symptoms occur. Children are often becoming more social during this time period, and may be entering daycare or preschool for the first time. They are around other children who may be sick, and are putting more items into their mouths. Many times, if we were to examine closely, we would see that other mild infections may be present during this time. One study reviewed 50 children who were admitted to the hospital with the chief complaint of teething. It was found that 48 of these children had other medical conditions that their symptoms could be attributed to. If you notice that your child has a high temperature, it is important to visit your child’s pediatrician, as it is likely that another infection is present.
There are some symptoms that are correctly associated with teething, including daytime restlessness, thumb-sucking, gum-rubbing, drooling, hand or object-biting, and potentially a loss of appetite. Slight temperature elevation may occasionally be seen. Drooling, object-biting and hand-rubbing have been shown to occur in children who teethe earlier, which may indicate that these behaviors are developmental rather than specific to teething.
Some simple techniques can be used to help alleviate the true symptoms of teething. If you notice excessive drooling, try to keep your child’s mouth and chin clean and dry to prevent skin irritation. Sore gums are common, and can be rubbed with a chilled teething ring, damp gauze, clean finger, or cold wet washcloth. We do not recommend using common over-the-counter numbing gels, as they have recently been linked to serious health risks in some children. These gels may contain benzocaine, a local anesthetic which has been linked with a serious blood disorder that reduces oxygen in the bloodstream. Commonly used gels include Anbesol, Orajel, Baby Orajel, Orabase, and some store brands. Over-the-counter ibuprofen or acetaminophen may be used at the recommended dosage for your child’s weight, although children should not be given aspirin. Aspirin can cause a potentially fatal disease called Reyes Syndrome which affects the brain and liver.
Some children may develop a harmless cyst above a developing tooth. The cyst may look like a blue/red/purple bubble on the gums. It is painless, and will disappear when the tooth erupts through. As soon as you see teeth in your child’s mouth, we recommend using a soft toothbrush to gently brush the teeth and massage the gums. We encourage parents to visit their child’s dentist with any concerns during the teething process, but to visit the pediatrician for vomiting, diarrhea or fever.