John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Teething facts
- What is teething?
- When do babies start teething?
- What are the signs and symptoms of teething?
- What is the order of tooth eruption in infants?
- How long does teething last?
- When should I call the pediatrician?
- What medications are used to treat teething pain?
- What home remedies provide relief for teething pain?
- How do I care for my baby's new teeth?
- When should my child see the dentist?
What is the order of tooth eruption in infants?
The following is the general order of eruption of primary teeth:
- Central incisors: 6-12 months of age
- Lateral incisors: 9-16 months of age
- Canine teeth: 16-23 months of age
- First molars: 13-19 months of age
- Second molars: 22-24 months of age
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 of their tendency to promote crowding and crooked orientation, they are often removed.
How long does teething last?
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.
When should I call the pediatrician?
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 from teething.
What medications are used to treat teething pain?
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 benefit. The FDA issued a warning in May 2011 urging avoidance of oral medications containing the topical anesthetic benzocaine. 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 extremely serious 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 who has such symptoms after exposure to benzocaine should seek immediate medical attention at the closest emergency room. A 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 pain. Ibuprofen shouldn't be given to infants younger than 6 months of age. Medications should be used only for the 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 a child products containing aspirin. No prescription drugs are routinely given for teething.
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