Teething
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Direct answer
Teething — the emergence of primary teeth between about six months and two and a half years — genuinely produces local gum tenderness, irritability, increased drooling, an urge to bite on things and disturbed sleep, all mild and self-limiting. What it does not produce is high fever, diarrhoea or a genuinely unwell child; studies attribute at most a tiny rise in temperature around eruption days, so a febrile, sick infant needs a paediatric cause sought, not a teething diagnosis. Safe management runs from chilled (never frozen) teething rings and clean-finger gum massage through weight-appropriate paracetamol at 10-15 mg per kilogram. Topical benzocaine and viscous lidocaine gels carry an FDA warning in young children for methaemoglobinaemia and are avoided, as are amber bead necklaces and honey on gums.
What you must remember
- Timeline: symptoms begin days before crown emergence; first tooth around six months, dentition complete by 30-36 months.
- True teething symptoms: gum redness and swelling over the erupting tooth, fussiness, biting behaviour, drool with perioral rash, mild appetite change and restless sleep.
- Not teething: fever above about 38 degrees, diarrhoea, vomiting, dehydration — each demands an alternative diagnosis; the classic masquerader is primary herpetic gingivostomatitis with its fever and gingival ulcers labelled "teething" for days.
- Management ladder: chilled teething ring or clean cold washcloth, gum massage with a clean finger, dry the chin for drool rash, then paracetamol 10-15 mg/kg every 4-6 hours for bad nights.
- Never list: benzocaine gels and viscous lidocaine (methaemoglobinaemia, FDA warning in children under two), amber bead necklaces (strangulation and aspiration), and honey on gums (botulism risk under one year).
- Eruption cyst: a bluish, dome-shaped swelling over an erupting molar from fluid in the follicular sac; observe — most resolve spontaneously, marsupialisation only if infected or persistent.
- Natal versus neonatal teeth: natal teeth are present at birth, neonatal teeth erupt within the first 30 days; usually mandibular incisors, often with a family history.
- Riga-Fede disease: a traumatic ulcer on the ventral tongue created by a natal or neonatal incisor during suckling; treated by smoothing the sharp incisal edge or extracting an over-mobile tooth, protecting breastfeeding.
The fever that was called teething
An 18-month-old reaches the clinic with four days of "teething trouble" — except the chart says temperature 39 degrees, the mother reports refusal of fluids, and the examination shows clustered yellow-grey ulcers on the tongue and gingiva with swollen, bleeding interdental papillae. This is primary herpetic gingivostomatitis, and the teething label has cost the child two days of hydration. Management shifts at once: fluids measured and recorded, paracetamol dosed by weight, a soft bland diet, and acyclovir considered if presentation is within about 72 hours of onset at commonly cited paediatric doses. The dentist's real intervention is the safety net — naming the red flags that send the child to a paediatrician tonight.
Ordinary teething management is almost anticlimactic beside that case. A seven-month-old with a bulging, tender lower ridge gets a chilled ring, a clean knuckle to bite, and a mother told exactly which symptoms belong to teeth and which do not. Two structures earn a sentence each in the notes: no eruption cyst here (a blue fluctuent swelling over an erupting molar is observed, not treated), and no loose natal incisor. The discipline of the topic is refusing the diagnostic wastebasket: teeth cause discomfort, not illness.
Where candidates lose marks
The direct viva question — "Does teething cause diarrhoea and fever?" — punishes both extremes: an unqualified yes contradicts evidence, and a flat no ignores genuine local inflammation and the small temperature bumps reported in diary studies. The scoring answer separates mild local symptoms (real) from systemic illness (look elsewhere). One-mark MCQs harvest the definitions: natal versus neonatal teeth at the 30-day boundary, Riga-Fede on the ventral tongue, eruption cyst over an erupting molar. The management MCQ is a set trap — among chilled rings, gum massage, paracetamol, benzocaine gel and amber necklace, the last two are there to be crossed out. Indian families often attribute any infant illness to teething; a good answer acknowledges the belief while firmly relocating the sick child to a paediatrician.
Frequently asked questions
Which symptoms can genuinely be attributed to teething?
Gum tenderness and redness, irritability, increased drooling, biting on objects, mild appetite disturbance and restless sleep — all self-limiting.
Does teething cause fever and diarrhoea?
High fever and diarrhoea are not caused by teething; at most a slight temperature rise accompanies eruption, and systemic symptoms require an alternative diagnosis.
What treatments are considered unsafe for teething?
Benzocaine and viscous lidocaine gels (methaemoglobinaemia risk), amber bead necklaces, and rubbing honey or alcohol on the gums.
How do natal and neonatal teeth differ?
Natal teeth are present in the mouth at birth; neonatal teeth erupt within the first 30 days of life — both usually mandibular incisors.
What is an eruption cyst?
A blue-tinged, fluid-filled follicular swelling over an erupting tooth, managed by observation in most cases, with marsupialisation reserved for persistent or infected cysts.