Timing of emergence of milk teeth

• symptoms associated with teething are more significant in the 4 days before tooth eruption (1)
  • during this period the gums are swollen and tender

Timing of teething varies widely:

• a child's first tooth usually erupts between 4 and 10 months of age, and the full complement of 20 deciduous teeth is almost always present by 30 months
  • thus, on average, roughly one tooth erupts per month between 6 and 30 months of age, closely coinciding with a period during which infants are known to experience frequent minor illnesses and rapid developmental change (2). Average deciduous teething dates include:
    • lower central incisors 5-7 months
    • months upper central incisors 6-8 months
    • upper lateral incisors 9-11 months
    • lower central incisors 10-12 months
    • canines 16-20 months
    • first molars 12-16 months
    • second molars 20-30 months (3)
  • some children (1%) develop their first tooth before the age of four months and another 1% get their first tooth after the age of 12 months (3).
  • in some children teeth are present at birth (natal teeth) or develop during the first month of life (neonatal teeth) (3)

teething is uncomfortable and painful for most infants and a very distressing experience for parents

• immediately prior to teeth eruption, the gums swell up and are tender to palpation
  • infants become irritable and restless, and drool excessively. They try to find relief from their pain by applying pressure on the gums, chewing their fingers and biting on anything at hand
• in a prospective study, Tanasen found that teeth eruption was linked with daytime restlessness, thumb-sucking, gum-rubbing, drooling, and perhaps, a loss of appetite, but found no association with infection, diarrhoea, fever, rash, sleep disturbances, convulsions, cough, or rubbing of the ear or cheek
• a prospective study found that increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething (in this study symptoms were only significantly more frequent in the 4 days before a tooth emergence, the day of the emergence, and 3 days after it, so this 8-day window was defined as the teething period) (4)
  • congestion, sleep disturbance, stool looseness, increased stool number, decreased appetite for liquids, cough, rashes other than facial rashes, fever over 102 degrees F, and vomiting were not significantly associated with tooth emergence

Reference:

• 1. Merkley K. The Crying Infant in the Emergency Department. Journal of Emergency Nursing 2006;32 (6): 535-540.
• 2. Sarrelll M et al. Parents' and medical personnel's beliefs about infant teething. Patient Education and Counseling 2005; 57 (1): 122-125
• 3. Ashley MP. Personal View: It's only teething... A report of the myths and modern approaches to teething. British Dental Journal 2001;1914-8
• 4. Tanasen A. General and local effects of the eruption of deciduous teeth. Ann Paediatr Fenn 1968;14(Suppl. 29):1-40
• 5. Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics 2000;105:747-52.