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Teething (cont.)

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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.

Medically Reviewed by a Doctor on 9/19/2014

Patient Comments

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Teething - Baby's First Tooth Question: How old was your baby or child when her/his first tooth appeared?
Teething - Signs and Symptoms Question: What were your baby's teething signs and symptoms?
Teething - Order of Tooth Eruption Question: Did your child's primary teeth appear in "order"?
Teething - Medications Question: Did you treat your baby with topical pain medications while he/she was teething?
Teething - Home Remedies Question: What home remedies soothed your child's teething pain?
Teething - Seeing a Dentist Question: At what age did your child first see a dentist?
Source: MedicineNet.com
http://www.medicinenet.com/teething/article.htm

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