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2022 Feb

The Trouble with Teething

Practical tips for your baby’s teething stage.

You notice that your baby is drooling, chewing everything in sight, and seems fussy. Is he or she teething? Teething begins between six and 12 months of age but may occur sooner or later. The two lower front teeth are the first to break through, followed by the two upper front teeth. Children have all of their 20 baby teeth by age three.

Signs of teething include swollen gums, fussiness, and chewing behavior. Some will keep their fingers in their mouth or pull on their ears. You may notice a change in sleep patterns. They may feel warm (less than 100.3°F), but do not get a true fever. Drooling increases between four to six months as they prepare to consume baby foods, but this may occur in excess while teething.

It is soothing for you to massage the gums with a clean finger. Use of a chilled solid teething ring may be helpful. A clean, wet cold (or lightly frozen) washcloth may be used to gnaw on while supervised. Check with your pediatric health care provider before giving your infant any medication, but if approved, infant acetaminophen (Tylenol) can provide relief from teething discomfort. Always dose infant acetaminophen by weight and not by age.

Knowing what to avoid is also important. Do not use infant ibuprofen (Motrin) in babies under six months of age. Do not use Orajel or medication that includes benzocaine as the Food and Drug Administration (FDA) has issued warnings that benzocaine and belladonna are not safe for infant use. Do not use teething necklaces. Research has not proven effectiveness, and they are a strangulation/choking hazard. Do not use teething aids filled with liquids. These can tear open exposing your infant to toxic substances. Do not given infants teething aids that are frozen solid, as they might bruise gums. Do not give your infant teething tablets or homeopathic teething gels or medications as these are not safe for infants.

The American Academy of Pediatric recommends that the first dental visit occur no later than one year of age or after the eruption of the first tooth. This visit will include an examination and the establishment of a dental home. Seek out a pediatric dentist as most family dentists will not see a child until they are three years old.

Until you see a pediatric dentist, your pediatric health care provider can apply fluoride to your child’s teeth during the well-baby visit. Fluoride helps to protect the teeth by making the tooth enamel more resistant to tooth decay. There is fluoride in most tap water, but not in bottled water. The use of tap water can help prevent dental cavities. If you have well water, consider testing it to check the fluoride content as your child may need additional fluoride. Infants over six months of age may have some water daily; however, infants less than six months need only breast milk or formula.

Oral hygiene starts with you. Take good care of your teeth as a parent by brushing, flossing, and seeing your dentist twice yearly. You can clean your babies’ gums with a clean wet washcloth. After teeth erupt, brush twice daily with a soft toothbrush and a dab of fluorinated toothpaste, the size of a grain of rice. (After they turn three years old, that amount of fluoride toothpaste can increase to the size of a pea.) Always brush teeth in the morning and again before bedtime. Never put a baby to bed with a bottle. This can cause baby bottle tooth decay. Dental decay can look like white or brown spots near the gum line. Avoid juices which also increase the risk for cavities.

Teething can be distressing, but comforting your baby can make you both feel better. Be proactive with routine dental hygiene and dental care. Tooth decay is preventable. Find a pediatric dentist here: or

Melanie J. Wilhelm, DNP, CPNP

Dr. Melanie J. Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner as well as core faculty member at Walden University. Her book, Raising Today’s Baby: Second Edition, is available on


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