Teething: Signs, Timeline, and Safe Ways to Soothe Sore Gums

Drool everywhere, fists in the mouth, and a baby who suddenly wants to chew on everything: welcome to teething. For some babies it’s barely noticeable. For others, it brings a few cranky days and unsettled nights.

Knowing what’s normal, what isn’t, and which remedies are actually safe can make the teething months much easier.

When Does Teething Start?

Most babies get their first tooth around 6 months, but anywhere from about 4 to 12 months is common. A few babies are even born with a tooth, and some don’t get their first until after their first birthday. Both can be normal.

Teeth usually appear in a predictable order:

• Bottom front teeth (lower central incisors): around 6 to 10 months
• Top front teeth (upper central incisors): around 8 to 12 months
• Teeth beside the front teeth (lateral incisors): around 9 to 16 months
• First molars: around 13 to 19 months
• Canines: around 16 to 23 months
• Second molars: around 23 to 33 months

By about age 3, most children have all 20 baby teeth.

Common Teething Signs

You might notice:

• More drooling than usual
• Chewing or gnawing on hands, toys and anything within reach
• Swollen, tender or red gums
• Irritability or fussiness
• Rubbing their cheek or ear on the same side as the erupting tooth
• Slightly disrupted sleep or feeding

Symptoms often show up a few days before a tooth breaks through and usually ease once it’s in.

What Teething Doesn’t Cause

It’s easy to blame every symptom on teething, but some things need a closer look. Teething may cause a slightly raised temperature, but it does not cause a true fever, which is generally 100.4°F (38°C) or higher. It also doesn’t cause diarrhea, vomiting, a runny nose with thick mucus, a rash all over the body, or a baby who seems very unwell.

If your baby has any of these, contact your pediatrician rather than assuming it’s teeth. For babies younger than 3 months, any temperature of 100.4°F (38°C) or higher needs a call to the doctor right away.

Safe Ways to Soothe Sore Gums

Simple remedies usually work best:

• Gentle pressure. Rub your baby’s gums with a clean finger.
• Something cool to chew. A chilled (not frozen) solid teething ring or a clean, damp washcloth cooled in the fridge can feel good.
• Firm teethers. Choose solid silicone or rubber teethers rather than liquid-filled ones, which can leak or break.
• Cool foods. If your baby is already eating solids, chilled purées or soft cold foods can help.
• Extra comfort. Cuddles, distraction and a little extra patience go a long way.

If your baby is very uncomfortable, ask your pediatrician about a pain reliever such as acetaminophen, or ibuprofen for babies 6 months and older, and the correct dose for their weight.

Teething Products to Avoid

Some popular teething products aren’t safe:

• Teething gels and creams with benzocaine or lidocaine. The FDA warns against using these for babies and young children because of rare but serious side effects.
• Homeopathic teething tablets. The FDA has warned about inconsistent amounts of certain ingredients in some of these products.
• Teething necklaces, bracelets and amber beads. These pose a choking and strangulation risk, and there’s no reliable evidence they ease pain.
• Frozen solid teethers. Very hard, frozen items can hurt gums. Chilled is better.

Caring for New Teeth

As soon as the first tooth appears, it’s time to start brushing. Use a soft, baby-sized toothbrush twice a day with a smear of fluoride toothpaste about the size of a grain of rice.

Wipe your baby’s gums with a clean, damp cloth before teeth arrive to get them used to the routine. Avoid putting your baby to bed with a bottle, and plan a first dental visit by their first birthday or within six months of the first tooth.

When to Call Your Pediatrician

Reach out if your baby:

• Has a fever of 100.4°F (38°C) or higher
• Seems very unwell, unusually sleepy or hard to comfort
• Is refusing to eat or drink, or has fewer wet diapers
• Has no teeth by around 18 months

Teething is a phase, and like most phases of babyhood, it passes. A cool teether, a clean finger and plenty of cuddles will get you through most of it.