ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(2):75-77

INTERNA TIONA L JOURNA L OF D ENTAL CLIN ICS VOLU ME 3 ISS UE 2 APRIL - JUNE 2011 75

Teething trouble and its management in children Zakirulla Meer, Allahbaksh Meer

Abstract

Teething is the process by which an infant's teeth sequentially appear by breaking through the gums.

This article aims to describe the clinical signs and symptoms, parents belief about teething and myths and modern approaches to teething.

Key Words: Teething;Primary Teeth;Tooth Eruption;Pain;Infant

Received on: 13/08/2010 Accepted on: 13/11/2010

Teething was known as dentition difficilis, Latin for pathologic dentition or d ifficult

dentition. Even though teething is a normal part of

infant development, surprisingly little is known

about the causes and management of teething signs

and symptoms.(1, 2) It is widely believed that pain

and other discomfort associate with tooth eruption

in infants should and can be managed by

pharmacological and non-pharmacological means.

Teething pain is the commonest symptom

associated with the eruption of the primary

dentition.(2)

The eruption of primary teeth usually

begins around 4-8 months of age with the eruption

of the lower incisors, and is complete at around 30-

36 months of age when second primary molars

erupt. The timing of tooth eruption varies by as

much as six months.(3) Early intervention is to

help establish good dental hygiene and decrease the

risk of dental caries.(4)

The relat ionship between the eruption of

the deciduous teeth and the general health of

infants has been documented for over 5,000

years.(5) The signs and symptoms associated with

teething may be local or systemic. Local teething

symptoms are; gingival swelling, irritation, redness

of the gum, thumb sucking and gum rubbing.(6-8)

The systemic d isturbances that are associated with

teething include; loss of appetite, crying, increased

salivation, drooling, d iarrhea, boils, general

irritability(9) and fever, runny nose, conjunctivitis,

and some day-time restlessness. Moreover,

increased biting, wakefu lness, ear rubbing and

facial rashes have also been reported to be

associated with teething.(10) Generally, the

eruption of deciduous teeth begins when other

changes in the infants immune system, growth and development are also occurring; that is, around six

months of age. This predisposes an infant to a

variety of in fections like respiratory t ract

infections, urinary tract infections, middle ear

infections, etc.(11)

The teething period has been described as

an 8-day window, including the 4 days before tooth

eruption and the 3 days following. The two most

recent prospective cohort studies found only a

weak, if any, association between teething and

many previously reported symptoms.(4)

Neaderland described three common perceptions of

teething: i) teething is pathological and has cause-

effect relationships with symptoms, ii) teething is

physiological, symptoms are merely co-incidental;

and iii) teething is predominantly physiological,

and discomfort is a normal consequence. For many

people, teething is perceived to cause significant

discomfort to infants and substantial distress to the

parents.(2, 4)

The symptoms of teething vary from baby

to baby. The list below describes symptoms that a

teething baby may experience. (4)

Irritability: As tooth rises closer to the

surface, gums may become increasingly sore and

painful. The pain and discomfort usually worsen

when the first teeth and molars come out. This is

due to the fact that molars are bigger in size.(12) In

most cases, the baby becomes accustomed to the

teething sensation and over time to lerates the pain

better.(13)

Drooling: From three to four months of

age, drooling is increased than normal. Teething

stimulates drooling, and it can be worse for some

babies than others.(5)

Coughing: The extra saliva can cause

occasionally cough or gag. This is usually nothing

to worry about, as long as baby does not seem to be

in any discomfort, show signs of a cold or flu and

run a high fever.(5)

Chin rash: If infant drools a lot, the

constant contact with saliva can cause the skin

around the chin and mouth to become irritated. To

help prevent this, gently wipe your babys mouth and chin periodically throughout the day.(5)

Biting and gnawing: A teething baby will

gnaw on anything he or she can get their mouth

around. The counter pressure from b iting or

gnawing on an object helps to relieve the pressure

from under the gums.(13)

REVIEW ARTICLE

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INTERNA TIONA L JOURNA L OF D ENTAL CLIN ICS VOLU ME 3 ISS UE 2 APRIL - JUNE 2011 76

Cheek rubbing and ear pulling: Pain in

the gums may travel to the ears and cheeks,

particularly when the back molars begin coming

out. It is fo r this reason that you may see your baby

rubbing his or her cheeks or pulling at the ears.

However, keep in mind that pulling at an ear can

also be a sign of an ear infection. (5)

Diarrhea: Most parents usually notice

slightly looser bowel movements when a baby is

teething. It is believed that the most likely cause of

this is the extra saliva swallowed, which then

loosens the stool. (4)

Low-grade fever: A low-grade fever can

be defined as a temperature above 36.5 degrees and

fluctuating constantly but not exceeding 38.5

degrees. It is important to notify your doctor if a

fever lasts more than two days.(5)

Not sleeping well: With teething pain

occurring during the day and night, you may find

your child wakes more often at night when the pain

becomes too much. Most parents agree that the

child wakes more often at night during the first set

of teeth and when the molars come out.(13)

Cold-like symptoms: Runny noses,

coughing and general cold symptoms are believed

to be caused by the baby regularly having his or

her hands in their mouth. Play it safe and always

notify your doctor if these symptoms occur.(13)

Teething is associated with increased

drooling, sucking of dig its and rubbing of gingiva.

Nevertheless, more recent prospective studies

reveal that most systemic teething signs and

symptoms (fever, vomiting, facial rashes, sleep

disturbances, stool looseness, decreased appetite

for liquids, and cough) are due to other causes.(5)

Many of the historical misconceptions about

teething and the related dangerous remedies

persist.(4)

The largest study by Macknin showed

significant associations with biting, drooling, gum

rubbing, irritability, sucking and temperature

37.5C.(10) However, attributing these symptoms

to teething was not possible as no symptom

occurred in 35% of infants during each teething

period, and no symptom occurred 20% more often

in the teething period than in the non-teething

period. The results presented by Jaber et al

considered only temperature and only included

children before the emergence of their first

tooth.(14)

Survey was conducted among Finnish

mothers to know their belief bout teething, they

found that 90% of mothers believed teething causes

gum rubbing and finger sucking, 77% that it causes

drooling, and 50% that it leads to fever, sleep

disturbance and daytime restlessness.

Recently

Coreil, cit ing 18 studies from the Americas, Asia,

Africa, and Australia, commented on the near-

universal belief across folk cu ltures worldwide that

teething is related to diarrhea. Many Australian

parents likewise believe that teething causes

numerous symptoms in young children even when

such symptoms may be indicative of other serious

conditions.(15)

The conclusions of all the prospective

studies are that no specific symptoms or clusters of

symptoms can reliably predict the emergence of a

tooth. Furthermore, symptoms that might be

attributed to teething are not serious, and the

presence of fever (38.5C) or other clinically

important symptoms are very unlikely to be caused

by teething. This is borne out by Swann, who

reviewed 50 children admitted to hospital with a

presenting complaint of teething.(16) In 48

children, a medical condition was diagnosed,

including one case of bacterial meningit is.

Although delayed teething may be associated with

several disease-related conditions such as

hypopituitarism, hypothyroidism, and rickets, and

syndromes like Down syndrome and cleidocranial

dysplasia, 1% of healthy children may not have had

their first tooth by 12 months of age.(17) Teething

is viewed by parents as a significant event in the

growth and development of a ch ild , and they

usually get concerned when their in fants dont have

a tooth by 910 months.(11) Pharmacological strategies for teething

generally aim to achieve analgesia, anesthesia,

sedation or a combination of these. The

conservative use of acetaminophen and ibuprofen

can aid in the d iscomfort caused by teething.

Benzocaine at a concentration of 20% gives

temporary relief of pain on mucosal tissues. These

local anesthetics agents are found commonly in

teething preparations. Benzocaine should be used

with caution and generally is not recommended

because of the risk of methemoglobinemia and can

interfere with the gag reflex and cause your infant

to choke.(4)

Cuddle Therapy: A little extra tender

loving care goes a long way when infant is having

a hard time teething. If in fant gets distressed, hugs

and cuddles will help comfort and reassures if he or

she is distressed. Distract your child from the pain

with activ ities such as reading, singing or

playing.(3)

Rubbing Gums: Lightly massaging babys gum with a clean finger for one to two minutes can

aids in alleviat ing the discomfort. Keep infants

mouth and gums clean even if does not have any

teeth.(5)

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Teething Rings: Teething babies love to

chew and bite on anything. Teething rings are

made of different types of plastic. Approved

teething rings do not cause cavities or choking.(3)

Food for Chewing: If infant is over six

months old, try offering them a sugar free teething

biscuit or unsweetened rusk. It is also preferable to

avoid foods that are too hard as these could bruise

the gums and cause further pain.

Teething Gels: Teething gels massaged

into the gums with a clean finger can prov ide

relief. (5)

Soothing Sore Chins: Excessive dribbling

caused by teething can irritate babies chin, neck

and chest which may become dry, chapped and

sore. Applying a simple barrier cream can also help

keep their skin soft and smooth and may ease any

chapped skin.

Cognitive management of teething should

be considered. Behavioral therapies such as sleep

management can be used to combat sleep

disturbances, wakefulness and irritation.(11)

Young children are exposed to a wide variety of

situations, environments, illnesses and are

guaranteed to have multip le episodes of fever,

congestion, and diarrhea. The inclusion of teething

and its management as a topic in antenatal classes,

in professional health programs and in continuing

professional education for health professionals and

childcare workers should be considered. Authors Affiliations: 1. Dr. Dr. Zakirulla Meer. M.D.S.,

M.B.A, Assistant Professor, Dept. of Pediatric

Dentistry, College of Dentistry, King Khalid University, ABHA, Kingdom of Saudi Arabia, 2. Dr. Allahbaksh

Meer, (M.P.H), Post Graduate Student, Anglia Ruskin

University, United Kingdom.

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Address for Correspondence

Dr. Zakirulla Meer. M.D.S., (M.B.A)

Assistant Professor,

Dept. of Pediatric Dentistry, College of Dentistry,

King Khalid University, ABHA,

Kingdom of Saudi Arabia.

E mail: drzak786@yahoo.co.in

Source of Support: Nil, Conflict of Interest: None Declared