The Teething Monster

In the second month of our stay in Belgium Eran had flu almost continuously for 3-4weeks. He also acquired 8 new teeth during this time! It made me wonder what to believe: all the millions of mothers who say that teething is to blame for all the fever, drooling, crying, sleepless nights and diarrhea, or the literature that says that none of these symptoms can be scientifically proven to be caused by teething. I set out to find an explanation and this is what I have learned:

Dental development already starts in the 6^th week in utero, that is even before there is a heartbeat! It is very important that the mother’s diet contains enough calcium, phosphorus, Vitamin C and Vitamin D for the baby to develop strong teeth. Illnesses and fever of the mother during pregnancy can also influence the teeth in utero. The primary teeth (also called milk teeth) are already formed under the gums prior to birth. From there an amazing physiological process follows: there is bone breakdown above the tooth to form an eruption pathway, and build-up below the tooth to fill in the gap, which pushes the tooth upwards in the jaw to where it will fulfill its function. (1,2) There is no actual “cutting” of the gums, the whole process is driven by genes, hormones, growth factors and inflammatory agents which also causes some cells in the gums to break down and allow the teeth to grow through. (2)

“Watching teething babies is like watching over a thermo-nuclear reactor-it is best done in shifts, by well-rested people.” Anthony Doerr

But why do they need to get teeth so early? Teeth are already vital in babies as it contributes to a normal facial appearance, creates space for adult teeth, aids in speech development and most importantly enables a baby to chew food!

There is a huge variety of normal when trying to predict when babies will get their teeth, but there is a general order that most teeth appear in:

• The two front teeth (central incisors) in the lower jaw usually emerge first anywhere between 6-10months, followed by the two front teeth in the upper jaw (8-13months)
• The lateral incisors (just next to the central incisors) also appear between 8-16months
• The first set of molars appear between 13-19months
• The eye teeth (canines) sit in between the lateral incisors and the molars and usually show themselves between 16-23 months
• The second set of molars appear between 25-33months

A child thus has 20 teeth by the age of 3 years. If your baby’s teeth has not erupted 6months after the norm, or if there is an assymetrical eruption that lasts more than 6 months (for example the left central incisor is present, but there is no sign of the right central incisor for more than 6months), consult your Pediatrician or dentist for further workup.

Ok, so those are the physiological facts, but does teething actually cause symptoms? Over the years many symptoms, witchery and even death was contributed to teething, but what does the science say?

Due to the increase in inflammatory agents (cytokines) in the saliva during the eruption of a tooth, I believe that a baby can have some symptoms similar to a mild flu (these symptoms are also mostly caused by your body fighting a virus with inflammatory agents). The combination of an increase of saliva and cytokines also activates the gastro-intestinal system and can change the consistency of the stools. (This explains those soft, sour-smelling nappies, but is not the same as runny diarrhea!)

A large meta-analysis looked at 16 studies from 8 different countries done between 1969-2012. (3) Overall it was found that 70% of teething babies do have some symptoms: red, swollen gums, general irritability and drooling was the most frequent. Other associations that was found with lower statistical significance was sucking of fingers, decreased appetite, agitated sleep, running nose and an increase of body temperature. These symptoms usually appear over 8 days (usually 4 days before and 3 days after the actual eruption of the tooth).

Teething does NOT cause fever (>38°C), vomiting, diahroea, dehydration or convulsions. (4, 5) The problem with blaming every symptom on teething is that more serious symptoms are ignored and potentially dangerous diseases missed. At 6 months when most babies start teething many other things are also happening in their tiny bodies. By 6 months maternal antibodies start to drop in their blood, making them more susceptible to viral and bacterial infections. Many symptoms thought to be due to teething was proven to be a viral infection causing sores in the mouth (Herpes simplex gingivitis). Babies start to explore the world around them at this age and part of the exploration is to put everything in their mouths, introducing more “germs” to their immune system. There is also a mental leap and a growth spurt around 6 months which could affect their eat and sleep routines. So before blaming teething when your baby is fussy / hot / not drinking well, please exclude and treat other causes first.

Is teething painful? This is hard to prove as each baby responds differently to pain. If you look at a “teething” 6 year old child, tooth eruption certainly does not seem painful. Yes, it does cause some irritability and discomfort, but try to remember that it is a natural process of child development, not a disease and needs to be treated as such.

“But as for me, afflicted and in pain – may your salvation, God, protect me.” Psalm 69:29

So when should you be worried? Danger signs in any baby would be fever > 38°C, severe vomiting and diahroea, dehydration, changes in level of consciousness (severe irritability, high pitched cry, very sleepy or cannot wake), abnormal breathing and convulsions. These are NOT caused by teething and should be investigated further, preferably by your GP / Pediatrician that knows your baby.

I hope that I could give you more insight into what is happening in that “tightly shut-, will not let me look or feel- mouth” of your little one, and that this knowledge will equip you the next time when you have to soothe and cuddle your teething baby.

I will discuss baby teeth care and the management of teething in my next blogpost, so be sure to subscribe to the email-list or follow along on Instagram so that you can read the follow-up too!

Which symptoms have you noticed when your baby is teething?

1. Marks SC Jr; “The basic and applied biology of tooth eruption.” ; Connect Tissue Res. 1995;32(1-4):149
2. Tshang AKL; “Teething, teething pain and teething remedies”INTERNATIONAL DENTISTRY SA VOL. 12, NO. 5 pg48-61
3. Massignan C, Cardoso M, Porporatti AL, Aydinoz S, Canto GD, Mezzomo LAM, Bolan M; Signs and Symptoms of Primary Tooth Eruption: A Meta-Analysis; Pediatrics March 2016, VOLUME 137 / ISSUE 3
4. Swann IL; “Teething complications, a persisting misconception.” Postgrad Med J. 1979;55(639):24.
5. Wake M, Hesketh K, Lucas J; “Teething and tooth eruption in infants: A cohort study.”; Pediatrics. 2000;106(6):1374.