Teething: Symptoms, Timeline, and the Best Remedies

Teething Timeline: Tooth by Tooth

Most babies get their 20 primary (baby) teeth in a predictable order, though the timing varies considerably between children. Genetics plays the biggest role — if you or your partner teethed early or late, your baby likely will too.

The molars (arriving around 13–19 months and again at 23–33 months) are typically the most uncomfortable — they are larger and push through the gum over a longer period.

If your baby has no teeth by 18 months, mention it to your dentist or paediatrician. This is rarely a cause for concern but worth noting.

Real Teething Symptoms (Confirmed by Research)

Research confirms these symptoms are genuinely associated with teething:

✅ Drooling — often increased significantly 2–3 months before the first tooth appears; can cause a drool rash around the mouth and chin

✅ Chewing and gnawing — on hands, toys, your fingers, the cot bars — anything firm provides counter-pressure relief

✅ Gum swelling and redness in the area where the tooth is erupting; you may be able to feel a hard bump under the gum

✅ Fussiness and irritability — particularly in the 4 days before and after eruption (the "window of discomfort" identified in research)

✅ Sleep disruption — may wake more frequently at night; discomfort is often worse lying down

✅ Mild temperature rise (under 38°C) due to gum inflammation — this is not a true fever

✅ Reduced appetite — sore gums make feeding uncomfortable, particularly direct breastfeeding

✅ Pulling at ears or cheeks — referred pain along the jaw nerve

Symptoms NOT Caused by Teething

This is important. The following are not caused by teething and require medical assessment if they occur:

❌ High fever (38°C or above) — teething does not cause true fever; if present, look for illness

❌ Diarrhoea — not caused by teething; a common myth, possibly explained by increased hand-mouthing spreading viruses

❌ Vomiting — always investigate another cause

❌ Rash on the body (other than drool rash around the mouth and chin)

❌ Severe inconsolable crying that doesn't respond to comfort

❌ Runny nose, cough, or ear infection — co-occurring with teething coincidentally (babies this age have 6–8 colds per year)

Teething coincides with the period when maternal antibodies are declining and babies are most vulnerable to viral infections. It is very common for illness and teething to occur at the same time — but the illness needs its own treatment.

Effective Remedies

Cold and Pressure (Most Evidence-Supported)

Counter-pressure and mild numbing from cold are the most effective natural remedies:

• Chilled (not frozen) teething ring — refrigerate for 30 minutes before use; never freeze as frozen rings can damage delicate gum tissue
• Cold flannel — wet a clean face flannel, wring out, and chill in the fridge; let your baby chew on it
• Clean finger massage — gentle, firm circular pressure on the gum provides direct relief; wash your hands first
• Cold food (from 6 months) — chilled fruit pouches, cold cucumber strips, chilled melon, refrigerated yoghurt

Teething Toys

Look for:

• Food-grade silicone or natural rubber — avoid PVC or soft plastic that may contain phthalates
• Simple, solid designs your baby can grip easily
• No small parts or detachable pieces
• No liquid-filled designs (can burst)

Pain Relief Medicine

For significant discomfort that disrupts sleep or feeding — teething doesn't always require medicine, but there is no reason to withhold it when a baby is clearly uncomfortable:

• Infant paracetamol (Calpol) — from 2 months (minimum 4kg, not premature)
• Infant ibuprofen — from 3 months (not under 5kg; do not use if baby is dehydrated or unwell)

Follow the dosage instructions for your baby's current weight, not age. Do not give both medicines simultaneously unless directed by a doctor.

What to Avoid

Teething gels containing lidocaine or benzocaine

Avoid in babies under 2 years. Benzocaine has been linked to methaemoglobinaemia — a rare but serious condition that reduces the blood's ability to carry oxygen. Both the NHS and AAP advise against use. Lidocaine is also not recommended for infants.

Amber teething necklaces

There is no scientific evidence they work. Succinic acid (the supposed active compound) does not penetrate the skin in meaningful amounts. Meanwhile, amber necklaces pose real strangulation and choking hazards — a bead can break off and be inhaled. Major paediatric organisations including AAP, NHS, and Safe Sleep UK recommend against them.

Homeopathic teething tablets and gels

The FDA and MHRA have issued warnings about some products for inconsistent and potentially dangerous ingredient levels (including belladonna). The evidence for efficacy is absent.

Frozen items directly from the freezer

Frozen teething rings or frozen fruit directly can cause gum damage and ice burns. Chilled is the right temperature — cold but not frozen.

Managing Teething at Night

Night-time teething disruptions are particularly hard because you're already sleep-deprived. Practical approaches:

• Give infant pain relief (if appropriate) 20–30 minutes before the normal bedtime — don't wait for the baby to wake
• A chilled teething ring before the bedtime feed gives short-term relief
• Keep the bedtime routine the same — consistency helps babies resettle
• Accept that some night disruption is temporary — it passes when the tooth is through (usually 3–5 days)

Drool Rash: Prevention and Treatment

Heavy drooling can cause a red, chapped rash around the mouth, chin, and neck. The skin breaks down from constant moisture.

Prevention:

• Gently pat dry frequently — don't rub, which worsens irritation
• Apply a thin layer of barrier cream before sleep: petroleum jelly, Bepanthen, or a fragrance-free balm
• Use a bib to protect the neck and chest during waking hours

Treatment:

• Barrier cream as above
• If the rash is very red or spreading, or if there are blisters, it may be impetigo — see your GP

Dental Care from the First Tooth

As soon as the first tooth appears:

• Wipe it twice daily with a damp cloth or soft baby toothbrush
• Once a few teeth have appeared, use a tiny smear of fluoride toothpaste — a grain-of-rice amount for under 3s (1000ppm fluoride minimum)
• Book a first dental appointment — most dentists recommend as soon as the first tooth erupts or by age 1 at the latest

Starting early establishes the habit and allows your dentist to spot any issues early. NHS dental care is free for babies and children.

Teething and Breastfeeding

Many breastfeeding mothers worry their baby will bite during teething. Biting typically happens at the end of a feed when milk flow slows and the baby loses interest.

• Watch for the signs a feed is ending — the sucking rhythm changes, they start to pull away
• End the feed before they lose interest
• If they bite, a calm, firm "no" and ending the feed immediately is the most effective response — no yelling, which can startle them and lead to nursing strikes

Most babies go through a biting phase and most mothers and babies come through it without weaning.

When to See a Doctor or Dentist

Contact your doctor if:

• Your baby has a temperature of 38°C or above (not caused by teething)
• Your baby has diarrhoea, vomiting, or a widespread rash alongside tooth eruption
• Your baby is inconsolable despite pain relief and comfort measures
• You notice a blue or purple swelling on the gum (an eruption cyst) — usually harmless but worth checking
• No teeth have appeared by 18 months

Contact your dentist if:

• You notice white or brown spots on the teeth (early tooth decay)
• A tooth is coming in at an unusual angle or position
• You have concerns about your child's bite or jaw development