Teething is one of those parenting milestones that can turn a perfectly pleasant baby into a drooly, cranky, sleep-fighting little gremlin overnight. It's not fun for them, and it's not fun for you. But understanding what's happening and what actually helps (versus what's just marketed to desperate parents) can make the whole experience a lot more manageable.
When Do Teeth Come In?
Most babies get their first tooth between 4 and 7 months, though some don't get one until after their first birthday — and that's perfectly normal. In rare cases, babies are even born with a tooth (called a natal tooth).
Here's the general order:
- 6-10 months: Lower central incisors (the bottom front two)
- 8-12 months: Upper central incisors (the top front two)
- 9-13 months: Upper lateral incisors (next to the top front teeth)
- 10-16 months: Lower lateral incisors
- 13-19 months: First molars (back teeth — these are often the most painful)
- 16-23 months: Canines (the pointy "fang" teeth)
- 23-33 months: Second molars (the very back teeth)
By age 3, most children have a full set of 20 primary (baby) teeth. Keep in mind this timeline varies widely — there's no cause for concern if your child's teeth come in earlier, later, or in a slightly different order.
Actual Teething Symptoms
Here's where things get murky, because teething gets blamed for everything. Researchers have studied this extensively, and here's what the evidence actually supports:
Real teething symptoms:
- Increased drooling. Sometimes dramatically so — bibs become a full-time accessory.
- Gum swelling and sensitivity. The gum where a tooth is about to emerge may look red and swollen. You might be able to feel a hard lump under the surface.
- Chewing on everything. Counter-pressure on the gums feels good, so babies gnaw on hands, toys, furniture — anything they can get in their mouths.
- Fussiness and irritability. The discomfort is real, especially right before a tooth breaks through. Nighttime can be worse because there are fewer distractions.
- Slight decrease in appetite. Sore gums can make eating less appealing, especially for babies on solids.
- Disrupted sleep. Pain tends to be worse at night. You may see more wake-ups and shorter naps.
- Mild temperature elevation. Teething can cause a very slight increase in body temperature, but...
What teething does NOT cause:
- High fever (over 100.4°F). A persistent or high fever is not teething — it's illness. This myth causes many parents to dismiss real fevers as "just teething," which can delay treatment for infections.
- Diarrhea. Despite being one of the most common teething myths, research does not support a link. Teething often coincides with the age when babies start putting everything in their mouths (hello, germs) and when maternal antibodies start declining — both of which increase illness.
- Rashes beyond mild chin irritation from drool. A drool rash around the mouth is teething-related. A body rash is not.
- Ear pulling. Sometimes attributed to teething pain radiating to the ear, but ear pulling is also a sign of ear infections. If it's accompanied by fever or unusual fussiness, have the ears checked.
The bottom line: teething causes local gum discomfort and irritability. If your baby seems genuinely sick — high fever, persistent diarrhea, vomiting, rash — see your doctor. Don't chalk it up to teething.
Safe Remedies That Actually Help
Cold washcloths: Wet a clean washcloth, wring it out, and put it in the fridge (not the freezer — frozen is too hard on tender gums). Let your baby chew on it. The cold and the pressure together are soothing.
Teething rings and toys: Choose solid silicone or rubber rings. Refrigerate them for extra relief. Avoid liquid-filled teething rings, which can break and leak.
Gum massage: Wash your hands and gently rub your baby's gums with a clean finger. The pressure often provides immediate relief. Some babies love this; others want nothing touching their mouth.
Cold spoon: A chilled (not frozen) metal spoon pressed against the gums can feel good.
Cold foods (for babies on solids): Chilled cucumber spears, cold applesauce, frozen breast milk in a mesh feeder, or refrigerated fruit in a silicone teether feeder. Always supervise closely.
Pain medication: Infant acetaminophen (Tylenol) or infant ibuprofen (Advil/Motrin, for babies 6 months and older) can help with significant discomfort, especially at bedtime. Use the dosage recommended by your pediatrician based on your baby's weight. Don't use these around the clock for days — they're best for acute flare-ups.
What to Avoid
Amber teething necklaces: These are marketed with the claim that succinic acid in Baltic amber releases a pain-relieving substance when warmed against the skin. There is zero scientific evidence that this works. More importantly, the FDA has warned against them due to serious risks: strangulation, choking if the necklace breaks and beads are swallowed, and aspiration. The AAP does not recommend any jewelry on infants. If a product has both no proven benefit and a documented risk of death, the answer is clear.
Benzocaine (Orajel) and lidocaine products: The FDA has warned against using benzocaine products in children under 2 due to the risk of methemoglobinemia — a rare but potentially fatal condition where oxygen levels in the blood drop dangerously. Lidocaine-based teething gels have also caused seizures and death in infants. Topical numbing agents wash away with saliva in minutes anyway, providing minimal benefit.
Homeopathic teething tablets: In 2016 and 2017, the FDA issued warnings about certain homeopathic teething tablets and gels after reports of seizures and deaths in children. Testing found inconsistent levels of belladonna (a toxic plant) in some products. The FDA advises against using them.
Frozen items that are too hard: Fully frozen washcloths or rock-hard teething toys can actually bruise tender gums. Chilled is better than frozen.
Caring for New Teeth
Start oral care before the first tooth appears by wiping your baby's gums with a soft, damp cloth after feedings. Once teeth arrive:
- Brush twice a day with a soft-bristled infant toothbrush and a rice-grain-sized smear of fluoride toothpaste. Yes, fluoride — the AAP, ADA, and AAPD all recommend it from the first tooth.
- Avoid putting baby to bed with a bottle of milk or juice. Sugary liquids pooling around teeth cause early childhood cavities (sometimes called "bottle rot").
- Don't share utensils if you have active cavities — cavity-causing bacteria can transfer from parent to child.
The First Dentist Visit
The American Academy of Pediatric Dentistry recommends a first dental visit by age 1 or within 6 months of the first tooth, whichever comes first. This visit is mostly about:
- Checking for early signs of decay
- Assessing how the teeth and jaw are developing
- Getting your child comfortable with the dentist environment early
- Teaching you proper brushing technique and discussing fluoride
Many parents are surprised by how early this recommendation is, but establishing a "dental home" early is one of the best things you can do for your child's long-term oral health. Pediatric dentists are specially trained to work with babies and toddlers, and these early visits are gentle and quick.
The Light at the End of the Tunnel
Teething is temporary, even though it doesn't feel like it when you're in the thick of it. The worst discomfort typically lasts only a few days around each tooth eruption. By the time your child is around 3, all 20 baby teeth will be in, and the teething chapter will be behind you — until the molars start falling out and the tooth fairy era begins.
In the meantime, extra cuddles, patience, and a well-chilled washcloth go a long way.
Track your baby's emerging teeth and teething symptoms with Evo — spot patterns, note which remedies work best, and keep a record to share with your pediatrician or dentist.