Managing Discomfort Caused by Teething

December 5, 2013


Natural physiological phenomenon occurring in children. Problems are mostly in primary dentition.



Children 5 months to 2.5 years old (variation is common)


  • Increased salivation (drooling)
  • Rash and red face
  • Gum rubbing
  • Increased finger sucking
  • Low-grade fever
  • Decreased appetite for solid foods
  • Watery eyes
  • Disruption of eating and sleeping patterns
  • Irritability
  • Loose stools
  • Red gingiva with a little tearing
  • Bleeding gums
  • Inflammation


  • Pain severity: usually painful and tender gingiva
  • Itchiness


Rule Out Other Pathologies

  1. Ask parents about the duration and intensity of the signs and symptoms.
  2. Rule out other systemic diseases, particularly if body temperature is higher than 37.5oC and/or symptoms have persisted for more than 24 hours.


Based on the clinical examination, signs and symptoms can be attributed to teething.

Differential Diagnosis

  • Eruption cyst: Swelling of the soft tissue covering one tooth. It is usually not tender and resolves by itself. The swelling can last for 1 or 2 months, as cysts are filled with fluids.
  • Eruption hematoma: Most frequently seen in the primary second molar or the first permanent molar region. May also occur following the eruption of primary molars when canines are erupting. It causes fiery red inflammation from the region of the laterals to the molars and can be painful, particularly if the 4 canines are erupting simultaneously.
  • Eruption sequestrum: Tiny spicule of hard tissue of odontogenic or osteogenic etiology, embedded in the soft tissue that covers the central fossa of first permanent molars. It is of little or no clinical significance. Dentist may dislodge hard tissue with topical/local anesthetics if it is causing local irritation.
  • Riga-Fede disease: Ulceration of the lingual frenum in teething infants, related to abrasion of the tissue against the new central mandibular incisors.
  • Systemic conditions: Association with systemic disturbances (e.g., fever, diarrhea, respiratory tract infections, sleep disturbances, primary herpetic gingivostomatitis) is considered coincidental rather than related to the teething.


Use acetaminophen or analgesics (other than ASA) to manager pain/fever, if needed.


Advice for Clinicians

  • Do not recommend topical teething gels.
  • The surgical removal of the covering tissue of the tooth is not indicated.

Advice for Parents

  • Continue to gently brush and clean the erupting tooth area to reduce the risk of secondary gingivitis due to plaque accumulation.
  • Give child chilled teething toys (rings) or cool cloths to chew on. Ensure toys are lead free, washed, kept clean and stored in the refrigerator prior to use.
  • Keep child well hydrated.
  • Seek medical advice if symptoms are serious or persist for more than 24 hours, to rule out upper respiratory infection and other common conditions.
  • First dental visit should occur within 6 months of eruption of first tooth or by age 1.



Dr. Hatibovic-Kofman is an associate professor and chair of the division of orthodontics and paediatric dentistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario.


Dr. Ari is an assistant professor in the division of orthodontics and paediatric dentistry, Schulich School of Medicine & Dentistry, Western University, London, Ontario.

Correspondence to: Dr. Sahza Hatibovic-Kofman, Schulich School of Medicine & Dentistry, Dental Sciences Building, Division of Orthondontics and Paediatric Dentistry, 1151 Richmond Street, DSB Room 1012, London, ON  N6A 5C1. Email:

The authors have no declared financial interests.

This article has been peer reviewed.

Suggested Resources

  1. American Academy of Pediatric Dentistry. AAPD Clinical Guidelines: Infant Oral Health Care [accessed 2013 Jul 9]. Available:
  2. Wake M, Hesketh K. Teething symptoms: cross sectional survey of five groups of child health professionals. BMJ. 2002;325(7368):814.
  3. Eruption of the teeth: local, systemic, and congenital factors that influence the process. In: Dean JA, Avery DR, McDonald RE, editors. McDonald and Avery‘s Dentistry for the Child and Adolescent.9th ed.St Louis (MO): Mosby; 2011. p. 150-76.
  4. Weber-Gasparoni K. Examination, diagnosis, and treatment planning of the infant and toddler. In: Casamassimo PS, Fields Jr HW, McTigue DJ, Nowak A, editors. Pediatric Dentistry; Infancy through Adolescence. 5th ed. Elsevier Saunders; 2012.

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