Teething

Our boy's new teef!

Our boy’s new teeth!

Teething

  • Is a normal process
  • Occurs when an infant first cuts teeth (primary dentition)
  • First teeth appear (on average): 6 months – 3 years old
teething - tooth eruption chart

Tooth Eruption Chart (essentialbaby.com.au)

 

History of Teething

  • Teething has been around as long as teeth have (duh!)
  • Back in the day, people associated teething with death, as many children died before age 1 year (which happens to be the time teething occurs)
  • Treatment for teething has been around just as long – papers from 16th century England report remedies such as anti-inflammatory herbal ointments, soothing fomentations, periodic mouthwashes, and minor surgery
  • Problem is, the teething treatments could be more dangerous than the teething itself
  • Teething powders used to contain mercury – it was removed from most powders in the 1950s when it was shown to cause acrodynia (a type of mercury poisoning)
  • Gum lancing – still practised to this day in some cultures. One (relatively recent) study from Nairobi Kenya reports children being brought into hospital after gum lancing with a mortality approaching 10%
1940s Chippewa baby teething on a magazine. Thankfully nomenclature has changed since then.

1940s Chippewa baby teething on a magazine. Thankfully nomenclature has changed since then. (Now defunct Office of Indian Affairs)

 

20th Century Teething Ring (Wikimedia)

20th Century Teething Ring (Wikimedia)

Epidemiology

  • A Polish study found that children from richer families had a better state of health and earlier teething of the lower central incisors than children from poor families (good nutrients = good teeth)
  • The same study found that boys and girls started teething at the same time
  • A Turkish study follows on in this vein, finding that later teething occurs in babies (1) With weight/height < 50% of normal (2) Fed with cow’s or formula milk in the 1st year

Pathophysiology

  • Cytokines are small proteins that aid cell-to-cell communications relating to immunity – eg. They can cause the increase of cells towards inflammation, infection or trauma/pain
  • Researchers in Israel found more cytokines are found in the mouths of teething infants, and increased cytokine levels correlate with an increased severity of teething symptoms
Cytokine Signalling. I don't expect you to understand this diagram, just appreciate its pretty colours and the fact that cytokine researchs are obviously ultra clever. And nerdy.

Cytokine Signalling. I don’t expect you to understand this diagram, just appreciate the pretty colours and the fact that cytokine researchers are obviously ultra clever. And nerdy. (So am I, so I can say that…)

 

Teething Symptoms

  • Teething symptoms are more frequent in the 4 days before / the day of / 3 days after tooth emergence (8 days in total)
  • Symptoms significantly associated with teething: biting, drooling (12%), gum-rubbing/ irritation (present in 85%), sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation (16%)
  • NOT significantly* associated with tooth emergence: runny nose, sleep disturbance, diarrhoea (8%), decreased appetite for liquids, cough, rashes other than facial rashes, fever 38.9 deg C, and vomiting (*these symptoms may be present but in some studies haven’t been found to approach significance, meaning that their appearance may be due to chance alone)
  • Teething symptoms are more likely to be reported:

– For children from nuclear families
– For children from families with higher income
– With eruption of the primary incisors

Weirder Symptoms Associated with Teething

  • Teething Diarrhoea – it turns out that belief in Teething Diarrhoea is not limited to your local witch doctor (or grandmother) – a study in Florida found that one third of their sample of >200 paediatricians believed in Teething Diarrhoea as a real entity (doctors that believe in Teething Diarrhoea are more likely to be younger, female and practice in metropolitan areas, where they can access crack more easily*)
  • Suggested explanations for Teething Diarrhoea: change in eating habits, increased salivation, and stress

*obviously that last bit is untrue… just seeing if you’re still awake 🙂

Treatment of Teething Symptoms

  • Doctors and dentists have little say; parents and carers usually take this into their own hands
  • Rubbing gums (one group of researchers found that providing first-time mothers with information on teething resulted in them using gum-rubbing more, and medications less)
  • Teething toys or rings
  • Cold teething rings (popular in Western cultures, less so in others – for instance a study in Udaipur India found that less than 1/3 of parents allowed their children to bite on a chilled object to relieve symptoms associated with teething)
  • Teething analgesic/ anaesthetic gels (Bonjela teething gel can be used from 4 months of age): not to scare you BUT studies from Harvard Medical School and Sydney Children’s Hospital have reported both methaemoglobinaemia and salicylate intoxication from using teething gels
  • Analgesia (paracetamol over 1 month of age, ibuprofen over 3 months of age). Do not give aspirin (Reye’s syndrome)
teething - treatment

Teething Treatment (from L to R): towel, rusks, rails, toy, own fingers, beads

 Bottom line:

  • There aren’t any proper studies looking at the efficacy of teething treatment (probably because people don’t consider it ethical to experiment on babies and/or mothers aren’t generally excited at the prospect of having their children treated like guinea pigs). Seriously, what’s wrong with people…
  • For our bub’s teething, we generally try physical methods first (rubbing gums, teething toys, cold stuffs) and if that doesn’t work, we try some gel / simple analgesia (carefully following the manufacturer’s instructions)
  • If symptoms are excessive / persist, please seek medical attention (your baby’s symptoms may be due to something more serious than teething)

As always, the information provided here is based on the current best available literature and in no way replaces the need for a proper medical consultation in case you (1) Overdose your poor child on unnecessary medications (2) Ignore serious symptoms that are not attributable to teething.

I shouldn’t need to type that, but common sense is seriously uncommon.

REFERENCES
Coreil J, Price L, Barkey N. Recognition and management of teething diarrhea among Florida pediatricians. Clin Pediatr (Phila). 1995 Nov;34(11):591-8.
Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics. 2000 Apr;105(4 Pt 1):747-52.
Jones M. Teething in children and the alleviation of symptoms. J Fam Health Care. 2002;12(1):12-3.
Shapira J, Berenstein-Ajzman G, Engelhard D, Cahan S, Kalickman I, Barak V. Cytokine levels in gingival crevicular fluid of erupting primary teeth correlated with systemic disturbances accompanying teething. Pediatr Dent. 2003 Sep-Oct;25(5):441-8.
Kurlej W, Porwolik K, Porwolik M, Puzyński M. The effect of an infant’s environmental conditions and state of health on the teething of the primary incisors. Folia Morphol (Warsz). 2004 Feb;63(1):59-61.
Cunha RF, Pugliesi DM, Garcia LD, Murata SS. Systemic and local teething disturbances: prevalence in a clinic for infants. J Dent Child (Chic). 2004 Jan-Apr;71(1):24-6.
Sahin F, Camurdan AD, Camurdan MO, Olmez A, Oznurhan F, Beyazova U. Factors affecting the timing of teething in healthy Turkish infants: a prospective cohort study. Int J Paediatr Dent. 2008 Jul;18(4):262-6. doi: 10.1111/j.1365-263X.2007.00893.x. Epub 2008 Feb 20.
Bong CL, Hilliard J, Seefelder C. Severe methemoglobinemia from topical benzocaine 7.5% (baby orajel) use for teething pain in a toddler. Clin Pediatr (Phila). 2009 Mar;48(2):209-11. doi: 10.1177/0009922808324491. Epub 2008 Oct 3.
Feldens CA, Faraco IM, Ottoni AB, Feldens EG, Vítolo MR. Teething symptoms in the first year of life and associated factors: a cohort study. J Clin Pediatr Dent. 2010 Spring;34(3):201-6.
Williams GD, Kirk EP, Wilson CJ, Meadows CA, Chan BS. Salicylate intoxication from teething gel in infancy. Med J Aust. 2011 Feb 7;194(3):146-8.
Plutzer K, Spencer AJ, Keirse MJ. How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial. Child Care Health Dev. 2012 Mar;38(2):292-9. doi: 10.1111/j.1365-2214.2011.01215.x. Epub 2011 Mar 6.
Noor-Mohammed R, Basha S. Teething disturbances; prevalence of objective manifestations in children under age 4 months to 36 months. Med Oral Patol Oral Cir Bucal. 2012 May 1;17(3):e491-4.
Dominguez-Rodriguez MV. Baby teething in early modern England: theory and therapeutic practice. J Hist Dent. 2011 Winter;59(3):117-25.
Kakatkar G, Nagarajappa R, Bhat N, Prasad V, Sharda A, Asawa K. Parental beliefs about children’s teething in Udaipur, India: a preliminary study. Braz Oral Res. 2012 Mar-Apr;26(2):151-7.
Agbaje MO, Ayankogbe OO, Wright KO, Adeniyi AA. The perception of caregivers attending a Nigerian teaching hospital on teething. Nig Q J Hosp Med. 2012 Apr-Jun;22(2):94-8.
Agbaje MO, Ayankogbe OO, Wright KO, Adeniyi AA. The perception of caregivers attending a Nigerian teaching hospital on teething. Nig Q J Hosp Med. 2012 Apr-Jun;22(2):94-8.
Ispas RS, Mahoney EK, Whyman RA. Teething signs and symptoms: persisting misconceptions among health professionals in New Zealand. N Z Dent J. 2013 Mar;109(1):2-5.
Olabu BO, Okoro DO, Thigiti JM, Oramisi VA. Impact of socio-cultural practice of infant/young child gum lancing during teething. J Clin Pediatr Dent. 2013 Summer;37(4):355-9.

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