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Scientific Article

Safely Managing Teething Babies and Toddlers: Providing Guidance to Parents and Caregivers

Eileen Olderog-Hermiston, RDH, BS

What are signs of teething? How do you safely soothe a teething baby? In order to provide proper care, it is necessary to recognize the signs of teething as opposed to the signs of illness. When a baby or young child is experiencing teething symptoms, selecting safe soothing practices is imperative. Healthcare professionals can help provide teething guidance to parents and caregivers to help ensure babies and children are cared for safely and appropriately.

Teething Symptoms

Beginning around 5- 8 months, though timing can vary, the first primary teeth begin to emerge in the lower front arch of the mouth. Over the next two to three years, a total of 20 primary teeth will make their way from within the alveolar bone, through the gingiva, and into the mouth. Teething may cause intermittent localized discomfort, irritability, and excessive salivation.1 Illness symptoms such as fever along with diarrhea, vomiting or congestion are sometimes wrongly attributed to teething symptoms.2,3,4 If a teething child presents with coughing, diarrhoea, congestion or rashes, then it is best to advice parents to consult their healthcare provider. A temperature that is over 38 degrees Celsius is not associated with teething and is a sign of an illness or infection.5

Soothing a Teething Baby

There are several ways to safely treat teething symptoms.
  • Massaging the gums by applying pressure to the affected area can help provide relief. An oral massaging brush or a finger wrapped in a clean cloth make it easier to reach specific areas of the mouth. In addition, chewing on solid teethers, such as rubber, eases teething discomfort.
  • Chilled teethers or washcloths are useful at soothing teething pain because the coolness causes localized vasoconstriction which helps to decrease inflammation. On the other hand, frozen teethers can cause harm to the oral mucosa and additional pain. Therefore, teethers must never be put in the freezer.
  • Teething stimulates saliva production and can cause drooling. To prevent a skin rash around the mouth and chin, use a soft clean cloth to dry the area. In addition, if the child is using a pacifier for sucking needs, recommend a pacifier with extra-large air holes in the shield to help prevent saliva being trapped between the pacifier shield and skin.
  • Cuddle therapy, a proven method of soothing, includes extra attention, care and reassurance by parents.6
  • An age-appropriate dose of a pain reliever such as acetaminophen might be needed if other soothing methods are not providing relief.
  • Parents who are interested in using herbal and homeopathic remedies to help alleviate teething discomfort should first discuss options with their healthcare provider before using with an infant or young child

Not Recommended Practices

The following are ill-advised teething remedies. Using oral products that contain benzocaine, a topical pain reliever, can lead to methemoglobinemia, a life-threatening condition in young children.7 Oral viscous lidocaine 2% solution should not be used to treat children with teething pain because it can cause serious harm, including death.8  Other products to avoid are homeopathic teething remedies that contain Belladonna, a potentially toxic ingredient.9 In addition, teething necklaces made with various materials such as amber, wood, and marble should not be placed around a baby’s neck. There have been reports of children choking on beads that break off and strangulation during sleep.10

Supervise and Inspect

Teething biscuits should only be offered when the caregiver can provide direct supervision. Not only can pieces of the biscuit break off and pose a choking risk, but frequent and prolonged exposure to carbohydrates can lead to an environment that promotes tooth decay. Caution should be taken when using gel and fluid-filled teethers because if punctured, they may leak into baby’s mouth. Teethers need to be durable and free of toxic material such as Bisphenol-A, parabens, and antimicrobials.11  Parents should regularly inspect teethers for wear and tear. Also, soothers must be checked regularly during teething episodes as a young child might inappropriately use a soother as a teether and chew on it instead of suck. Recognizing when a child needs something to chew for comfort instead of suck is important.  

Conclusion

Teething can be overwhelming for parents. Healthcare professionals can help parents and caregivers identify teething symptoms and recommend safe methods to soothe teething babies and young children.

Eileen Olderog-Hermiston, RDH, BS

DENTAL HYGIENIST

Eileen Olderog-Hermiston is a Dental Hygienist and Research Specialist with the University of Iowa College of Dentistry. Her current research interests include treating severe early childhood caries with silver diamine fluoride, infant oral health, and a longitudinal study of diet, fluoride, and other factors related to dental caries – birth to 27 years. She spent many years of her career in the Pediatric Dentistry Department teaching dental students and conducting community outreach programs.

1American Academy of Pediatric Dentistry, Guideline on Infant Oral Health Care, 2014.
2Mary Kozuch, Erica Peacock, Jennifer P. D’Auria. Infant Teething Information on the World Wide Web: Taking a Byte Out of the Search. Journal of Pediatric Health Care, Volume 29, Issue 1, 38-45, 2015.
3Owais AI, Zawaideh F, Al-Batayneh OB. Challenging parents' myths regarding their children's teething. Int J Dent Hyg. 2010 Feb;8(1):28-34.
4Healthychildren.org, American Academy of Pediatrics. Symptom Checker – Teething.
5Massignan C, Cardoso M, Porporatti AL, et al. Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis. Pediatrics. 2016;137(3):e20153501.
6Memarpour, Mahtab, et al. “Signs and Symptoms Associated with Primary Tooth Eruption: a Clinical Trial of Nonpharmacological Remedies.” BMC Oral Health, vol. 15, no. 1, 2015, p. 88.
7Risk of serious and potentially fatal blood disorder prompts FDA action on over-the-counter benzocaine products used for teething and mouth pain and prescription local anesthetics. U.S. Food and Drug Administration May 2018.
8FDA drug safety communication: FDA recommends not using lidocaine to treat teething pain and requires new box warning. U.S. Food and Drug Administration June 2014.
9FDA warns consumers about homeopathic teething products. U.S. Food and Drug Administration Nov 2019.
10FDA warns against the use of teething necklaces, bracelets, and other jewelry marketed for relieving teething pain or providing sensory stimulation: FDA safety communication. U.S. Food and Drug Administration Dec 2018.
11Asimakopoulos AG, Elangovan M, Kannan K. Migration of Parabens, Bisphenols, Benzophenone-Type UV Filters, Triclosan, and Triclocarban from Teethers and Its Implications for Infant Exposure. Environ Sci Technol. 2016 Dec 20;50(24):13539-13547.