The first teeth are usually the bottom two front teeth, followed by the top four teeth, then the other two bottom teeth on each side of the first two. About one year of age kids will get the four “one year” molars.  Between 12 and 18 months kids will get the teeth between the molars and the front teeth.  Around the 2^nd birthday kids will get the “two year” molars.  Some kids will get them out of order, or a little later, and that is perfectly fine.  Most kids will have 20 teeth by their third birthday. 

Many parents assume when babies start chewing and drooling all the time they are teething, but most babies are simply in an oral phase so chew on anything they can.  Their salivary glands are maturing so that the saliva will be around to help break down food when they start solids, but they don’t know how to swallow all that extra saliva, so it drools out of their mouth.  It often has nothing to do with teething.  Be sure to wipe off extra saliva often because it is irritating to the skin.  Overnight you can protect the skin with petrolatum jelly or other thick cream/ointment.

Gums appear to swell in the shape of the tooth underneath before the tooth erupts, but even this isn’t a sure sign that a tooth will appear soon.  Some babies take their own sweet time to work the tooth out.  I’ve seen many babies who break a tooth… parents can see the white of the tooth… but then the gum swells back over it, and you no longer see the tooth.  That’s fine.  Just be patient!  If the gum becomes purple and bruised appearing (common with molars), firmly rub on the gums with your finger or a clean washcloth.  This often will help the tooth break through the gum, and allow the blood that is collecting under the gums to release, which relieves the pain/pressure associated with that. 

Although tender and swollen gums could cause your baby's temperature to be a little higher than normal, teething doesn't usually cause temperatures over 100.5F. If your baby does develop a fever over 100.5F, it could be related to an illness.  If it persists for more than 5 days over 100.5F, have your child evaluated to be sure there isn’t an illness that needs treatment.

Treating pain and fussiness can be done several ways. 

• Massaging the gums with your finger, a cloth, or a baby toothbrush often helps.  
• Offer your baby many things to chew on, such as a frozen washcloth or teether, or firm toys without small parts.   
• Overnight many parents prefer a pain medication for more long-acting relief.  Acetaminophen provides 4-6 hours of pain relief.  Ibuprofen provides 6-8 hours of pain relief.  Click here for dosing. 
• Benzocaine products (brand names include Oragel, Baby Oragel, Hurricaine, Anbesol, and more) are no longer recommended.  They can cause serious harm, including shortness of breath, blue skin, rapid heart rate, and more. 
  
• Teething products made with clove oil are not recommended.  Not only has clove oil been shown to be ineffective for teething pain, it has been linked to seizures, liver damage, and fluid imbalances in children. Click here for more.
  

If your child is not drinking well, is in inconsolable pain, or you have concerns, please bring him in for an appointment to be sure teething is the only issue.