Introduction  

Teething is an important milestone in a child’s development. It is the beginning of the emergence of their first, primary teeth and is the model for their adult teeth.

While the process is often predictable, some variations may indicate underlying health concerns. 

Understanding the signs of abnormal teething and knowing when to seek professional help from your dentist can help prevent long-term dental complications. 

In this article, we will explore normal teething and its process, the signs of abnormal teething, and when parents should consult a pediatric dentist. 

Regular teething timeline and variations 

Most infants begin teething around six months, although every infant is different, and the same happens with children. Some may develop their first teeth as early as three months.  

While teething typically begins around 4 to 7 months of age, every baby is different, so some babies may start earlier and some may start later, but by the age of three, most children will have their complete set of 20 primary teeth.¹

As mentioned earlier, there is room for variations which are commonly influenced by genetics, diet, and overall health.² While these slight delays or early eruptions are usually harmless, significant changes may be a sign of an underlying issue.  

Signs of abnormal teething  

So, what should you, as a parent, be concerned about, and what signs should you look for as your child enters this new stage of development? 

Delayed teething  

If your child has no teeth by 13-14 months or fewer than four teeth by 18 months, this is a cause for concern. Delayed teething may be caused by several factors, including;

• Genetic factors: a family history of late teething
• Nutritional deficiencies: delayed teething can be caused by a lack of vitamins A, C, and D [3]. Aside from those vitamins, a deficiency or lack of calcium or phosphorus can also affect your baby.  
• Medical conditions: Hypothyroidism, Down syndrome, or rickets.⁴

Early teething (Premature eruption)  

Your child's teeth appearing before three months is also a bad sign, as it is so far from the normal range in the first place. It has the potential to lead to several complications:  

• Weaker enamel is the building block of our teeth, and its early appearance can leave it weak, making teeth more prone to decay⁵ 
• There is an increased risk of injury since the early teeth may be fragile due to weak enamel
• Feeding difficulties, especially for breastfed babies 

Missing or extra teeth  

As your baby grows, their teeth will come out following a pattern and with an expected number by the end of the teething period. So, cases of abnormal tooth count could indicate teething abnormalities that are genetically linked. Hypodontia (missing teeth) may suggest conditions like ectodermal dysplasia. [6]  Hyperdontia (extra teeth) will cause crowding and misalignment of teeth that may lead to speech difficulties.

Discolouration or weak enamel  

If your child's teeth appear yellow, brown, or chalky white, it may indicate:  

• Enamel hypoplasia is a defect in enamel formation.  
• Early childhood tooth decay, due to prolonged bottle-feeding or sugary diets⁷

Excessive pain or swelling beyond normal teething  

While mild discomfort or pain and a fever of at most 38C is expected when your baby is teething, any severe pain, swelling or fever above 38C may suggest 

Malformed or crooked teeth  

Irregularly shaped or misaligned teeth can affect your child's chewing and speech patterns, so going to your dentist early is a good step. Common causes include:  

• Genetic predisposition: when you, as parents, had a dental misalignment
• Thumb-sucking or pacifier use: While it may not seem like a big deal, if your baby develops long-term habits of sucking their thumb or on a pacifier, those habits can alter the tooth's position.⁹ 

Bleeding or inflamed gums  

Teething should not cause excessive bleeding or inflammation, so consistent symptoms may indicate gum disease, which is uncommon in infants but possible with poor oral hygiene. It may also suggest oral infections, requiring you to make a visit to the pediatric dentist. 

When to consult a pediatric dentist  

As your child grows out their teeth, they inevitably need to get checked out by the dentist; The American Dental Association recommends that your child visit the dentist at one year old.[10].

However, in the cases where they are abnormal signs of growth, parents are advised to seek professional advice, especially if they notice:  

• No teeth by age 12–18 months
• Persistent pain, swelling, or fever unrelated to teething discomfort
•  Discolouration of their tooth or signs of decay
• Overcrowding or missing teeth
• Difficulty in chewing, biting, or speaking
• Excessive drooling beyond infancy

If you notice any of these symptoms, early check-ups will help detect potential concerns and ensure proper oral development.  

Conclusion  

Since teething is a significant part of a child's development, any signs of abnormalities should be taken very seriously, as they could indicate other health issues. 

Recognising the signs of delayed, early, or irregular tooth eruption will allow timely intervention. Make sure to consult a pediatric dentist and ensure that any concerns are addressed promptly.

Frequently asked questions  

What is the difference between a pediatric dentist and my family dentist?

A pediatric dentist specialises in children's dental care, whereas a family dentist treats patients of all ages. Unlike general dentists, pediatric dentists undergo an additional two to three years of specialised training after dental school, focusing exclusively on children's oral health. Their practice is limited to treating infants, children, and adolescents, including those with special healthcare needs.  

How can I find a pediatric dentist in my area?  

You can use the Find a Pediatric Dentist search tool by clicking the link below. Enter your city, state, and ZIP code to find nearby pediatric dentists. If no results appear, try expanding your search by entering only the state or the nearest major city.  

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My child has a toothache. What can I do? 

Start by rinsing the affected area with warm salt water and applying a cold compress to the child's face if there is swelling. Give acetaminophen (e.g., Children's Tylenol) for pain relief, but avoid placing aspirin directly on the teeth or gums. It is essential to see a dentist as soon as possible for proper evaluation and treatment.