Treating the Toothache

Teething, like many other things “baby” has so many different suggested treatments that it can get really confusing. Are you currently struggling with a teething monster? Read my previous post to understand more of what is going on in your little one’s mouth. Do you want to know what is really worth your money and time? What is safe for baby? What really works?? I will try to answer these questions by looking at the most used treatments in more detail. If you are short of time skip down to the end to see my tips to calm your teething baby and to keep those teeth white and bright!

As I read about the history of teething, I was horrified at some of the treatments that were used in the past! Substances containing lead and mercury, opioids that caused babies to stop breathing, rubbing of alcohol on the gums (this is from the not too distant past) and even cutting into the gums to ‘relieve the pressure’ were common managements and caused more harm than good. I am wondering what our children’s children will think about the treatments we are using today…

So which medical treatments are available?

Teething gels / drops:

There are two broad groups of gels or drops that causes local pain relief:

  • Local anaesthetic (contains either benzocaine or lidocaine)

These gels / drops (Orajel, Prodol) causes numbing of the gums and tongue only for a short time (about 20 minutes) and although this could bring some relief for the irritation of the gums it may also cause more irritation for your baby. Have you ever had your gums numbed by a dentist? It is not a nice feeling. Some of these drops have a stronger alcohol-content than your glass of wine! Apart from that there is also a risk for a very serious side effect: methemoglobinaemia prevents the red blood cells from carrying any oxygen. The FDA and American Association of Pediatrics has strongly advised against the use of these gels and drops in babies.

  • Local analgesic or homeopathic gels

Some of these gels (Bonjela, Teejel) contain aspirin-like analgesics (choline salicylate) which could cause chemical burns on the gums or even add to the risk factors of Reye syndrome. Homeopathic gels could contain unknown amounts of Belladonna which could also cause severe side effects.

My conclusion would be to know what is in the gel you are using, know the possible side effects, weigh the risk vs benefit for your baby and then only use VERY SPARINGLY.

Systemic analgesia

These are safe to use at the specified dose and intervals, for not more than 5-7 days at a time. Remember that they can affect the liver and kidneys if misused, so only give when it is really necessary. Please consult your doctor or pharmacist about the correct dose for your little one as it should be calculated by weight and thus differs for different children of the same age.

  • Paracetamol (Panado, Calpol): for moderate pain and rise in body temperature
  • Ibuprufen (Nurofen): for inflammatory pain and rise in body temperature
  • Mefenamic acid (Ponstel): for inflammatory pain and rise in body temperature

As you can see all these medications treat roughly the same symptoms, so it works well to use paracetamol with either ibuprufen or mefenamic acid as you can then give analgesia more frequently while giving less of each individual drug. (Eg Paracetamol at 8am, Ibuprufen at 12pm, Paracetamol at 4pm, Ibuprufen at 8pm.) Be careful of combination preparations as you cannot work out the dose of each individual drug perfectly, and it usually contains some form of anti-histamine which is not safe to give to babies under 2years as it can have a lot of side effects.

So what should you do???,

“We have to do the best we can. This is our sacred human responsibility.”

Albert Einstein

A recent meta-analysis done in 8 different countries showed that there are some symptoms associated with teething, and yes, babies feel some discomfort and has a raise in their body temperature (NOT fever >38°C). However, when choosing what to give your baby, try to remember that teething is not a disease!

Instead of spending more money at the pharmacy, here are a few tips to try at home:

  • TLC: Tender, Loving Care. This works for anything from a broken heart to man-flu, it will definitely work for teething too. So amp up the cuddles and know that this will be over all too soon.
  • Chewing or rubbing the gums: let your baby chomp down on his favourite teether / sugar-free teething biscuit or massage his gums with a clean finger. This reduces the pain by overwhelming the pain-receptors in the gums, thus effectively blocking the pain-signal.
  • Cooling: we all know an icepack does wonders for a twisted ankle or a bump on your head. Giving your baby a cool washcloth or raw carrot to chew on also does wonders for irritated gums. Make some “breastmilk-ice lollies”, these are a huge hit for teething babes! The cold numbs the gums, and it also decreases the inflammation in the area.

“Weeping may endure for a night, but joy comes in the morning. “

Psalm 30:5 (AMPC)

The last teething-strategy I would like to address is the amber necklaces / bracelets. Although many moms have claimed that these worked for their babies, there is no scientific evidence to prove that they work better than the above-mentioned tips, and nobody can seem to prove exactly how they work. Add to that the big risk of choking or strangulation, and you can understand why the FDA and American Association of Pediatrics strongly advise parents to not use them. We all try to keep our babies away from plastic bags, peas and small toys exactly for this reason, so please do not attach something to their body that can end up in their airways!

When those little white pearls finally pop out, be sure to take good care of them from the start. We used a silicone brush that fits over our fingers from about 4months to get Eran used to the texture and feel of a toothbrush on his gums. Once the teeth are out brush twice a day with a soft-bristled toothbrush. In South Africa the water is supplemented with Fluoride, thus it is not necessary to use Fluoride containing toothpaste before 2yrs of age. While fluoride helps to protect the teeth against cavities, too much can cause spotting and weakening of the enamel of the permanent teeth. When you do start using fluoride-containing toothpaste make sure to only use a pea-sized smear. Take your little one to the dentist around their first birthday to get more advice and tips to keep those teeth in tip-top shape.

I hope this will help you to have a happier teether! Please share any other tips you have in the comments below or via Instagram / Facebook, I love to hear the creative ways you keep your little teething monster happy!

  1. 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
  2. Memarpour M, Soltanimehr E, Eskandarian T; “Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies”; BMC Oral Health. 2015; 15: 88.
  4. Tshang AKL; “Teething, teething pain and teething remedies”INTERNATIONAL DENTISTRY SA VOL. 12, NO. 5 pg48-61

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 6th 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.