Teething: Symptoms, Timeline, and What Actually Helps
Teething gets blamed for a lot of things in babyhood — runny noses, fevers, rashes, diarrhea, and every bout of unexplained fussiness between 4 months and 3 years. Some of that blame is justified, and some isn't. Let's sort out what's real, when to expect it, and most importantly, what you can actually do to help your baby through it.
The Teething Timeline
Most babies get their first tooth sometime between 4 and 7 months, though the range of normal is wide — some babies are born with a tooth (natal teeth), while others don't cut their first until 12 months or later. If your baby has no teeth by 18 months, mention it to your pediatrician, but in most cases late teething is just normal variation.
Here's the general order teeth tend to come in:
- 6–10 months: Bottom front teeth (lower central incisors)
- 8–12 months: Top front teeth (upper central incisors)
- 9–13 months: Upper lateral incisors (the teeth on either side of the top front two)
- 10–16 months: Lower lateral incisors
- 13–19 months: First molars — these are often the most painful because of their larger surface area
- 16–22 months: Canines (the pointy teeth)
- 23–33 months: Second molars — another rough one
By around age 3, most children have all 20 primary (baby) teeth. The process doesn't really stop until then, which means you may have a toddler who seems to always be teething — because they basically are.
Real Teething Symptoms
Research on teething symptoms is surprisingly mixed. Studies suggest that while teething does cause some discomfort and behavioral changes, many symptoms commonly attributed to teething may actually be coincidental or related to other factors (like developmental leaps or minor viruses). Here's what the evidence supports:
Real teething symptoms include:
- Drooling — often a LOT of drooling
- Chewing on everything
- Gum swelling and sensitivity where the tooth is emerging
- Mild irritability and fussiness
- Disrupted sleep around the time a tooth is cutting through
- A slight elevation in temperature (up to 99°F / 37.2°C)
- A drool rash around the mouth, chin, or chest from excessive saliva
- Reduced appetite (sore gums make eating uncomfortable)
Symptoms NOT caused by teething:
- True fever (above 100.4°F / 38°C) — this always has another cause and needs attention
- Significant diarrhea — while loose stools can occur from swallowed saliva, true diarrhea should be evaluated
- Runny nose or congestion — coincidental, not caused by teething
- Ear pulling — this can be teething-related discomfort radiating upward, but it can also be an ear infection; if in doubt, see a doctor
What Actually Helps
Cold Pressure
The most effective non-medication relief for teething is cold, firm pressure on the gums. Options that work well:
- A chilled (not frozen) teething ring — frozen teething rings can be too hard and may damage gum tissue
- A clean, cold washcloth that your baby can chew on
- For babies who have started solids, chilled (not frozen) cucumber spears, carrot sticks, or cold fruit in a mesh feeder are popular options
Gum Massage
Clean your finger, then gently rub your baby's gum with firm, circular pressure where the tooth is emerging. Many babies find this instantly soothing — though some will bite down hard, so be prepared for that.
Pain Relief Medication
For more severe discomfort, particularly with molars, infant acetaminophen (Tylenol) or ibuprofen (for babies over 6 months) can provide real relief. Always use the dose appropriate for your baby's weight, and follow the package instructions. If you're unsure, call your pediatrician.
Extra Cuddles and Patience
Sometimes your baby just needs to be held and comforted. Teething hurts, and the emotional reassurance of being close to you is genuine comfort, not a "bad habit."
What to Avoid
Teething Gels Containing Benzocaine
The FDA has warned against using over-the-counter teething gels and gums containing benzocaine (like Orajel) on infants and young children. Benzocaine can cause a rare but serious condition called methemoglobinemia, which reduces the blood's ability to carry oxygen. Skip these entirely.
Amber Teething Necklaces
These are popular in many parenting communities, but there is no scientific evidence that they work, and they present a very real strangulation and choking hazard. The American Academy of Pediatrics recommends against them. They look cute — but they're not worth the risk.
Homeopathic Teething Tablets
The FDA has also warned against homeopathic teething tablets and gels. Some products have been found to contain inconsistent amounts of belladonna (a toxic plant), and several infant deaths have been associated with them. Avoid.
Frozen Whole Foods
A frozen banana or frozen strawberry can break off into chunks and become a choking hazard. Chilled is fine; frozen is not.
Caring for Those New Teeth
As soon as teeth appear, start cleaning them. For the first tooth, a soft cloth or a finger brush works well. Once more teeth arrive, transition to a small, soft-bristled baby toothbrush with a tiny smear of fluoride toothpaste — a grain-of-rice-sized amount for children under 3.
The American Academy of Pediatric Dentistry recommends the first dental visit within 6 months of the first tooth appearing, or by age 1 — whichever comes first. Starting dental visits early establishes good habits and lets the dentist catch any early issues.
Teething is a long haul, but your baby is building the tools they'll need to eat, speak, and smile for years to come. Hang in there — it gets better.
Teething Timeline: What to Expect and When
Teething typically begins between 4–7 months, though some babies start as early as 3 months and others don't cut their first tooth until after their first birthday — all within the normal range. The full set of 20 primary (baby) teeth usually arrives by age 3. Here's a general sequence, though individual variation is wide:
| Teeth | Typical Age of Eruption | Notes |
|---|---|---|
| Lower central incisors | 6–10 months | Usually first to appear |
| Upper central incisors | 8–12 months | The classic "toothy grin" emerges |
| Upper and lower lateral incisors | 9–16 months | 4 teeth close together |
| First molars | 13–19 months | Often the most uncomfortable — largest surface area pushing through |
| Canines (cuspids) | 16–23 months | Sharp pointed teeth on either side |
| Second molars | 23–33 months | Final baby teeth; often causes the most discomfort in toddlers |
What Teething Actually Feels Like (For Your Baby)
Teething causes inflammation in the gum tissue as the tooth pushes through. This is a legitimate source of discomfort — not imaginary. At the same time, teething is widely over-blamed for symptoms it doesn't cause. A large study in Pediatrics found that teething is associated with: drooling, gum rubbing, irritability, and mild sleep disruption. It is NOT reliably associated with: high fever (above 101°F/38.3°C), diarrhea, ear pulling, or rash. If these symptoms occur during a teething period, look for another cause.
Evidence-Based Teething Remedies
- Cold teething rings: Chilled (not frozen) silicone or rubber teething rings provide counterpressure and mild numbing. Freeze-solid rings are too hard and can damage gum tissue. Always supervise use and inspect regularly for cracks
- Cold washcloth: Dampen, wring out, and refrigerate. The texture and cold provide double relief. Can be tied in a knot for easier gripping
- Counterpressure with a clean finger: Gentle firm pressure on the gum with a clean finger can provide temporary relief and lets you feel where the tooth is emerging
- Cold foods (for babies on solids): Chilled purées, cold yogurt, or refrigerated mesh feeder with frozen fruit all deliver cold directly to the gum. Appropriate for babies 6+ months on solids
- Acetaminophen or ibuprofen: For moderate-severe discomfort, infant acetaminophen (any age) or ibuprofen (6+ months only) dosed by weight is safe and effective. Use as directed; don't give ibuprofen before 6 months
What to Avoid
- Benzocaine teething gels (Orajel, Anbesol): The FDA has warned against using these in children under 2. Benzocaine can cause methemoglobinemia — a serious blood oxygen disorder. Not worth the risk when safer options work
- Teething tablets with belladonna: The FDA recalled several brands due to inconsistent and potentially toxic levels of belladonna alkaloids. Avoid entirely
- Amber teething necklaces: No scientific evidence they work; significant strangulation and choking hazard. The AAP and CPSC both advise against them
- Clove oil: Used in high concentrations, clove oil can irritate or damage gum tissue in infants
First Tooth = First Dental Visit
The American Academy of Pediatric Dentistry recommends scheduling your baby's first dental appointment when the first tooth appears or by their first birthday — whichever comes first. Early dental visits establish a "dental home," allow fluoride varnish application (which reduces cavity risk by 30–40%), and catch any early alignment or developmental issues. Night feeding after teeth emerge and bottles of juice are the leading causes of early childhood tooth decay.
Frequently Asked Questions
Can teething cause fever?
Teething may cause a very slight temperature elevation (up to 100.4°F/38°C) due to gum inflammation. A true fever — above 100.4°F rectally in infants or above 101°F orally in toddlers — is not caused by teething and requires evaluation for another cause. Don't attribute fever to teething and wait it out; investigate the cause with your pediatrician.
My baby's gum looks bruised or has a dark blue bump. Is that normal?
This is called an eruption cyst or eruption hematoma — a small, fluid-filled sac that can form over an emerging tooth. It's benign and usually resolves on its own as the tooth breaks through the gum. Cold teething relief and gentle pressure can help. In rare cases where it persists, a pediatric dentist can drain it if needed. It looks alarming but is not dangerous.
When should I start brushing my baby's teeth?
Start as soon as the first tooth appears. Use a soft-bristled infant toothbrush with a rice-grain sized smear of fluoride toothpaste (yes, fluoride — even for babies). At age 3, increase to a pea-sized amount. Brushing twice daily — especially before bed — is critical from the start. Cavities in baby teeth are not harmless: they cause pain, affect speech development, and can damage the developing permanent teeth beneath them.