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Teething

By Christopher P. Raab, MD, Associate Professor of Pediatrics;Attending Physician, Diagnostic Referral Division, Sidney Kimmel Medical College at Thomas Jefferson University;Nemours/Alfred I. duPont Hospital for Children

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Teething is the process of tooth eruption through the gums.

A child's first tooth usually erupts by 6 mo of age, and a complete set of 20 deciduous teeth usually develops by 2½ yr.

Before a tooth erupts, the child may cry, be fussy, and sleep and eat poorly. During tooth eruption, the child may drool, have red and tender gums, and chew constantly on objects such as toys and crib rails. Teething does not cause fever.

Tooth Eruption Times

Teeth

Number

Age at Eruption*

Deciduous (20 total)

Lower central incisors

2

5–9 mo

Upper central incisors

2

8–12 mo

Upper lateral incisors

2

10–12 mo

Lower lateral incisors

2

12–15 mo

1st molars

4

10–16 mo

Canines

4

16–20 mo

2nd molars

4

20–30 mo

Permanent (32 total)

1st molars

4

5–7 yr

Incisors

8

6–8 yr

Bicuspids

8

9–12 yr

Canines

4

10–13 yr

2nd molars

4

11–13 yr

3rd molars

4

17–25 yr

*The age at eruption varies greatly.

Molars are numbered from the front to the back of the mouth (see Figure Identifying the teeth.).

Children who have fever and who are especially fussy should be evaluated for a viral or bacterial infection, because these symptoms are not caused by teething.

Teething infants get some relief from chewing on hard (eg, teething biscuits) or cold objects (eg, firm rubber or gel-containing teething rings). Massaging the child's gums with or without ice also may help. Children may be treated with weight-based doses of acetaminophen or ibuprofen.

Teething gels are not recommended because they are not any more effective than other measures, and some contain benzocaine. Benzocaine can rarely cause methemoglobinemia.

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Drugs Mentioned In This Article

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  • ADVIL, MOTRIN IB
  • TYLENOL
  • ANBESOL