It usually starts with drool. A lot of it. Then a baby who was sleeping fine is up twice a night, everything within reach goes into the mouth, and somewhere in the middle of all that a grandparent says, "Oh, that's teeth coming in." Sometimes they are right. Sometimes it is something else wearing teething as a disguise. This guide is here to help you tell the difference, ease the rough nights, and skip the products that do more harm than good.
We see a lot of babies, and we hear the same questions from parents at every visit. So here are the honest answers.
When Teeth Actually Come In
Most babies get their first tooth somewhere around six months. The normal range is wide, though. Some babies have a tooth at four months and some are still gummy on their first birthday. Both are fine. Timing runs in families, so if you or your partner were late, your baby may be too.
The order is more predictable than the timing. The two bottom front teeth almost always arrive first, followed by the four top front teeth, then the teeth just beside them, then the first molars around the first birthday, then the pointed canines, and finally the second molars somewhere in the second or third year. By about age three, most children have all twenty baby teeth.
A tooth does not pop through in a day. It moves up through the gum over several weeks, and the days right before it breaks the surface are usually the sorest. Then it settles, and you get a break until the next one. That rhythm, a rough stretch followed by a calm one, is normal.
What Teething Really Causes
Here is what the research consistently finds when babies are watched closely during the days a tooth comes in:
- Drooling. Sometimes enough to soak through two bibs before lunch.
- Chewing on everything. Fingers, toys, your shoulder, the edge of the high chair. Pressure on the gum feels good.
- Fussiness and clinginess. Usually mild, and usually worst in the few days before the tooth appears.
- Sore, swollen gums. You may see a red or slightly bruised-looking spot where the tooth is about to come through.
- Lighter sleep. More night waking for a few days, not weeks.
- A slight rise in temperature. A little warm, not a fever.
- A rash around the mouth or chin. This is from the drool itself, not from the teeth.
What Teething Does Not Cause
This is the part that matters most, because blaming teeth for the wrong thing can mean a sick baby waits too long to be seen.
- A true fever. Teething can nudge the temperature up a little. It does not cause a fever of 100.4°F (38°C) or higher. A baby with a real fever needs a call to the pediatrician, teeth or no teeth.
- Diarrhea. Extra drool can loosen stools slightly, but real diarrhea is not teething.
- Vomiting, a cough, or a runny nose. Those are an illness, and teething is a coincidence.
- A rash on the body. A drool rash stays around the mouth and chin.
- Refusing to eat for more than a day or so. A sore-gummed baby may be picky for a meal or two. Turning down feeds for days is something else.
A simple rule: if you would be worried about the symptom in a baby with no teeth coming in, be worried about it now. Teething is not an explanation for a sick baby.
Relief That Actually Works
The good news is that the most effective comfort measures are the cheapest and simplest.
- Pressure. Wash your hands and rub the sore gum firmly with a clean finger. Many babies lean into it.
- Cold, not frozen. A solid rubber or silicone teething ring chilled in the refrigerator soothes swollen gums. Skip the freezer. Frozen rings get hard enough to bruise the gum and cold enough to hurt.
- A cold washcloth. Wet a clean washcloth, wring it out, chill it, and let your baby gnaw on it. Cheap and easy to wash.
- Cold food for babies already eating solids. Chilled applesauce or yogurt from a spoon, or a chilled piece of soft fruit in a mesh feeder.
- Extra comfort. Rocking, nursing, a bottle, and a little more patience than usual. Teething nights are short, even when they feel long.
- Pain relief when the rest is not enough. For a baby who is truly miserable, infant acetaminophen is an option at the dose your pediatrician gives you for your baby's weight. Ibuprofen can be used once a baby is six months old, again at the pediatrician's dose. Use medicine for the rough nights, not every night for weeks.
Products to Skip
Some teething products are sold in every drugstore and still are not safe. These are the ones we ask parents to leave on the shelf.
- Numbing gels with benzocaine. The FDA warns against these for children under two. Benzocaine can cause a rare but serious blood condition called methemoglobinemia, which reduces the oxygen the blood can carry. The gel also washes away in seconds and numbs the tongue and throat, which can affect swallowing.
- Teething necklaces and bracelets. Amber, wood, silicone, or beads of any kind worn around a baby's neck or wrist. The FDA has reported strangulation and choking injuries, including deaths. Amber does not release anything that relieves pain. It is a necklace on a baby.
- Homeopathic teething tablets and gels. Some have been found to contain inconsistent amounts of belladonna, a toxic plant. There is no benefit that outweighs that.
- Liquid-filled teething rings. They can leak or be bitten through. Solid rings are safer.
- Frozen anything. Cool is soothing. Frozen is hard and can bruise.
- Alcohol on the gums. An old family remedy that has no place with a baby.
Caring for Teeth Before and After They Arrive
Good habits start before the first tooth. Wipe your baby's gums once a day with a clean, damp washcloth or a soft finger brush, especially after the last feeding at night. It clears milk residue and gets your baby used to having their mouth touched, which makes brushing and dental visits easier later.
The day the first tooth appears, start brushing it. Use a soft, baby-sized toothbrush and a smear of fluoride toothpaste about the size of a grain of rice, twice a day. That small amount is safe to swallow and it protects the enamel from the start. At age three, move up to a pea-sized amount. If you have questions about fluoride, our guide on whether fluoride is safe for kids walks through it.
Two habits to watch from the beginning:
- No bottle in the crib. Milk or juice pooling around new teeth all night is the most common cause of early cavities we see.
- Watch the sugar in "baby" foods. Pouches, puffs, and teething biscuits can be sticky and sweet. Rinse with water after, or save them for times you can wipe or brush.
Thumbs and pacifiers are a comfort during teething and that is fine at this age. If you are wondering when they become a problem for the bite, our guide on thumb-sucking and pacifiers covers the timeline.
The First Dental Visit: Earlier Than Most Parents Expect
The American Academy of Pediatric Dentistry recommends a first dental visit by the first birthday, or within six months of the first tooth, whichever comes first. That surprises a lot of parents. One tooth hardly seems like enough to look at.
The first visit is not really about the tooth. It is about you. We check that the teeth are coming in normally, look at the gums and the bite, and apply a fluoride varnish if it is time. Then we spend most of the appointment answering questions: how to brush a squirming baby, what to do about the bottle at bedtime, whether that white spot is anything, and what to expect from the next batch of teeth. Babies who start visits early tend to grow into children who are relaxed in the dental chair, because it has never been strange or scary. Our guide on preparing your child for the first dental visit has more on what that day looks like.
When to Call
Call your pediatrician for a fever of 100.4°F or higher, vomiting, diarrhea, a rash beyond the chin, a baby who will not take fluids, or a baby who is inconsolable for hours. Those are not teething.
Call us if a tooth has been visible under the gum for weeks without breaking through, if a gum looks dark purple or has a fluid-filled bump over it, if a new tooth looks discolored or chipped, if teeth are coming in at a strange angle, or if your baby has passed the first birthday with no teeth at all. Most of these turn out to be nothing, and we would rather look and tell you so.
The Short Version
- First tooth around six months, with a wide normal range. Bottom front teeth first.
- Teething causes drool, chewing, sore gums, fussiness, and lighter sleep for a few days at a time.
- Teething does not cause a fever, diarrhea, vomiting, or a cough.
- A clean finger, a chilled solid ring, and a cold washcloth do more than any product.
- Skip benzocaine gels, teething necklaces, homeopathic tablets, and anything frozen.
- Wipe gums daily, brush from the first tooth with a rice-grain smear of fluoride toothpaste, no bottle in the crib.
- First dental visit by the first birthday.
Teething is a season, and it passes. We are glad to be part of it with you, starting with that very first tooth. We have four locations across North Carolina in Greensboro, Winston-Salem, Raleigh, and Monroe, and we love seeing babies.