Overview

The way a tooth moves down in the mouth is called teething.

In the mouth, the back teeth, or molars, come out last.

At this time, little kids or toddlers feel pain, have red gums, get gum swelling, fever, and drool a lot.

Teething makes kids fussy, and this can stress out parents.³

To ease these teething pains, many old and well-known tips are used.

Medicine can ease this pain, but parents worry about the harm it might do to their child's health.

Also, how parents think and feel can change how they see and talk about what happens when a tooth comes up, along with healthcare things.

Understanding baby teeth development

Baby teeth start to come in between six and thirty months.

Teeth move inside the jaw, a normal body action, until they push through the gums into the mouth. 

It takes about eight days for a tooth to come in: four days before it pops out, one day for it to show up, and three days after.¹

Signs of teeth coming in can be seen as swelling of the gums where teeth have not yet come out, redness of one or both cheeks (with a "hectic spot" in the middle of the red area), gum swelling, mouth sores, and more drool.²

With an average eruption rate of 0.7 mm per month, primary teeth take an average of two months to achieve full eruptive position.

Importance of primary teeth

• facilitates mastication
• aids in the growth of muscles and jawbones
• makes room for permanent teeth
• Directs the incoming permanent tooth in a proper direction
• Helps in speech and communication
• Aesthetic appearance

Why do molars hurt the most when they come in?

The first day you can feel or see the top of a molar or the side of a front tooth breaking through the gum is called an eruption day.⁶ 

Yet, this eruption of the first big teeth hurts more. It is very painful because these teeth are bigger and have more surface area.

The process is also slow compared to others. They sit at the back of the mouth, where the gums are tough, making the experience more painful. They tend to show up two at a time, which can intensify the discomfort..

Signs and symptoms

Some signs of it are fever, pain, being upset, not sleeping well, wanting to bite things, wetness coming from the mouth, red face, not eating much, sore gums, a wet nose, and bad stomach.

General agitation, disruptions, crying, fussiness, rhinorrhea, facial flushing, fever, diarrhoea, loss of appetite, drooling, rubbing of the ear on the side of the erupting tooth, inflammation of the gingiva covering the tooth, gum irritation, and increased biting are all signs and symptoms that are attributed to primary tooth eruption, both locally and systemically.^1,3

A big sign of teeth coming in is drooling.

When spit touches the skin near the mouth, it can cause a rash on the chin and make the kid cough or choke. It helps to clean the kid's mouth and chin area to stop the rash.

During intraoral examination, four stages of swelling on the alveolar ridge can be defined:

• S0 - normal alveolar ridge without swelling
• S1 - slight soft tissue swelling - slight enlargement of the soft tissue on or lingual to the alveolar ridge
• S2 - soft tissue swelling present (fluctuant swelling over the tooth)
• S3 - eruption cyst (fluid-filled enlargement which might be blue in colour if filled with blood

Five stages of eruption can be defined intra-orally as:

• E0 - no signs of eruption
• E1 - palpable - firm enlargement of tissue suggesting imminent eruption
• E2 - emergent - incomplete incisal edge emergence (incisors) or incomplete cusp visibility (molars)
• E3 - partial eruption—the incisal edge and cuspal height are fully revealed, but less than a quarter of the height is visible

Redness is recorded as

• R1 – presence of redness on the alveolar ridge
• R0 - absence of redness on the alveolar ridge

Why do these symptoms occur?

Gum soreness and pain may cause irritation.

Weight loss and appetite loss may result from this reaction, along with elevated interleukin (IL-1beta) levels.¹

By controlling the periodontal ligament's metabolic activity, HGH might have an impact on the eruption pattern.²

As the connective tissue between the decreased dental epithelium and the oral epithelium degenerates, redness occurs due to a temporary increase in vascularisation in the area.

Before the tooth comes out, its top part is coated in a hard layer. As the tooth moves up in the mouth, this hard layer breaks, letting the tooth show up. The tooth sac makes some things that cause and send pain signals. 

High levels of interleukin-1ß and tumour necrosis factor near the teeth might be why this happens. Fever, tummy upset, bad sleep, and no hunger have been tied to high levels of certain pain markers.⁷ 

Biting helps cut down on teething pain by taking the edge off sore spots.⁵

Myths about teething symptoms

Some of the symptoms might be linked to teething, and parental false beliefs may interfere with the diagnosis of teething.

Actual fever may be caused by developmental changes in the kid, such as lower maternal immunity and greater susceptibility to infection, which might be misinterpreted as fever while teething.

The main teeth come in when the baby starts to crawl and look around.

During this stage, toddlers put different things and their unclean hands in their mouths, which can cause vomiting and diarrhoea that has been mistakenly linked to teething.

Other causes of diarrhoea need to be checked and dealt with right, rather than just blaming it on teething, as diarrhoea with dehydration is the number one reason kids die early in countries with limited access to healthcare.

Management

Both drug-based and non-pharmacological ways help with these signs. But other plans, like rings and necklaces for teething, seem easy and safe. 

Many teething rings are sold for babies to bite on. Drugs may be used, such as pain-easing gels. Quick pain help comes from topical gels like benzocaine or lignocaine, as they soak fast through gums.

More topical gel choices have choline salicylate in them. Their anti-inflammatory and antipyretic effect reduces swelling.

Painkillers often use a sugar-free paracetamol mix as the best pick.

Some parents pick nature-filled and simple healing ways, such as soft massaging, and rubbing the gums with a cold, wet cloth, or letting kids chew on cool, clean things like a cold teething ring or toy, or fruits like bananas, apples, or cucumbers.

The gums and the skin over the new teeth can be made to feel better with ice held in a cloth for a short time. Parents should softly rub their baby's gums briefly using a very soft brush or clean hands. 

The toddlers get a hard plastic ring to chew or bite on as a teething ring. This teething ring is better than rings filled with fluid and does not cause tooth holes or choking.

Studies show that the soft, spongy feel of a teether likely helps soothe because it can rub the gums.⁴

Positive mood effects have been noted in reaction to the sweet taste, lavender scent, and vanilla scent, suggesting that the flavour of the edible teether may also have positive benefits

Behaviour therapy and smart thinking can fix kids' sleep and mood problems. The top ways to ease pain are to rub the gums, use a teething ring, and hold the little one close.

Summary

Both parents and primary care physicians must rule out other potential causes before attributing any symptoms of a potentially hazardous illness to teething.

In addition to a number of signs and symptoms, the time during a toddler's molar eruption can be challenging and upsetting for both the child and their parents.

It's time to let go of our ingrained cultural views on teething, accept the substantial evidence that tooth eruption is not closely linked to noticeable symptoms, and begin better managing late infancy and toddlerhood problems.

Parents should learn that while teething might cause minor signs of pain or redness, it is not the real cause of significant sicknesses in the body. Since teething is often wrongly tied to substantial health problems in kids, knowing how parents see this is key.