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By Lexi Dwyer

Teething is one of those mixed-bag milestones. You anxiously await for baby's first tooth, and then realize it comes with plenty of drool, sleep disruption and crankiness.

Here's what you need to know about teething, from tooth timing to symptoms to dental care.

WHEN DO BABIES START TEETHING?

According to Anastasia Williams, a pediatrician at Olde Towne Pediatrics in Manassas, Virginia, parents can generally expect to see the first tiny white chompers poking through between 4- and 7-months-old. (That said, it can also happen earlier or much later.

"It's a process, and it's not like babies have read the timelines — I've seen children who didn't get their first two teeth until they were past one year," Williams says. Although there are some cases where late teething might signal a health issue such as a genetic disorder, as long as your child doesn't have other health concerns, it's nothing to stress about.

WHICH TEETH WILL COME FIRST?

"The first teeth that emerge in a baby are either her upper or lower front teeth, which are also called the central incisors," says Christina Johns, a pediatrician and senior medical advisor at PM Pediatrics in Lake Success, New York.

The exact order can vary, but the American Academy of Pediatrics has a teething timeline chart that gives the typical progression. After the two pairs of central incisors, parents might see the lateral incisors (the four teeth that flank them), the first molars, the canines (also called cuspids, which aare the pointy ones) and, finally, second molars. Most children finish cutting teeth between the ages of 2 and 3.

IS IT TRUE SOME BABIES ARE BORN WITH TEETH?

Yes. A "natal tooth," as it's called, is simply a baby tooth that's made an early debut. According to Johns, it's extremely rare, occuring in about one in every 2000 newborns. "If the tooth is loose at birth, it will likely need to be removed because a baby can choke on it," she says.

SIGNS OF TEETHING:

Teething babies are often fussy, especially in the days right before the tooth pokes through, with pain that may seem to be especially bothersome at night. Williams shared a few of the main symptoms she sees.

  1. Drooling
  2. Fist biting
  3. Visible swelling in the gums
  4. Ear pulling: "Babies tend to grab the first thing they encounter in the general area of the mouth and cheek, which is the ear," says Johns. However, ear pulling is not a sign of any other ear problem. "Some parents also ask me if teething causes ear infections, and the answer is most definitely not," says Williams.

CAN TEETING CAUSE A FEVER?

The short answer: If the fever is higher than 100.4 degrees, you can't blame teething. "Sometimes with teething we may see very slightly elevated temperatures of say 100 or 100.2, but we don't consider this a true fever," says Williams, who adds that a temperature reading of 100.4 or greater warrants at least a call to your doctor, as it's more likely that your baby has picked up a virus. "A popular saying in pediatrics is 'the only thing that teething truly causes is teeth,' which is a simplification because you do also have increased saliva and discomfort, but the spirit is true," says Johns.

HOW TO HELP A TEETHING BABY:

  1. Over the counter pain meds: Both doctors suggest Tylenol for younger babies and ibuprofen for those older than six months. "That pain is real and can wake them—Tylenol really does help and ibuprofen, which lasts up to eight hours, can get them through almost a full night," says Williams.
  2. Gum massage: Williams suggests simply washing your hands and massaging your baby's gums.
  3. Chewing/gnawing at frozen things: Johns suggests a frozen wet washcloth or frozen fruit in a mesh feeder bag designed especially for babies. "Anything that is cold and cannot easily break off into a piece that could be a choking hazard will do the trick," she says. Williams cautions against using liquid filled teething toys because they can leak.

THINGS TO AVOID GIVING TEETHING BABIES:

  1. Homeopathic remedies and teething tablets: Doctors are adamant about avoiding these since they aren't regulated by the Food & Drug Administration (FDA).
  2. Necklaces: Both doctors noted that necklaces, such as amber teething beads, may break and become choking hazards.
  3. Numbing agents: Any teething remedies (such as gels) with numbing agents like lidocaine or benzocaine, which can, according to the Food & Drug Administration, cause as "life-threatening" reactions in infants and young children by reducing the amount of oxygen in the blood.

HOW LONG DOES TEETHING LAST?

Although it can feel like it's going to go on forever, there is an end in sight. According to the American Academy of Pediatrics, children get their final two pairs, the second (or back) molars, sometime between 23 and 33 months, with the lower ones generally coming in first. By age three, your little one should have a complete set of 20 teeth, and kids tend to lose the first baby tooth around age 6.

WHEN SHOULD BABIES HAVE THE FIRST DENTIST VISIT?

"Babies should be seen by a pediatric dentist after their first tooth erupts or by 12 months," says Johns, and then typically every six months. If you're worried about your little one getting wiggly or anxious, Williams suggests finding a pediatric dentist, who will be especially skilled at dealing with younger kids and can offer fun incentives like videos during the exam and toys at the end.

HOW DO I CLEAN MY BABY'S TEETH? IS FLUORIDE TOOTHPASTE SAFE?

It's never too early to start getting your little one used to the idea of having her mouth cleaned. "Even before the first tooth appears, I suggest that parents start by using a clean, wet washcloth to wipe down their baby’s mouth and gums in the morning and before bedtime, and after meals," says Johns. Once those pearly whites come in, an infant toothbrush and the tiniest dab of fluoride toothpaste (about the size of a grain of rice) is all you need, morning and night.

Once children can be trusted to spit out toothpaste, usually around age 3, you can switch to about a pea-sized drop. "It’s a good idea to supervise until they are at least 6 or 7 so that they are using the proper method and not swallowing the toothpaste," says Johns.

Another way to prevent cavities is by drinking fluoridated water, which the American Dental Association says can prevent up to 25 percent of cavities in both children and adults. "So many people drink bottled water now, but starting at six months, babies should have a few ounces of filtered tap water each day," says Williams.