Updated: Jun 4, 2021
Irritability and fever and drool, oh my! Ask most parents and they'll tell you that these symptoms add up to a teething baby, but what actually are the signs of teething? According to experts, most of us are misinformed. Read on to discover which symptoms are associated with teething and which require further diagnosis.
First up, let's cover teething basics. "Tooth Eruption (teething) is a normal physiological process defined as the process whereby a tooth moves from its developmental position within the jaws to emerge into the oral cavity" (Owais et al., 2010). The timing of tooth eruption varies widely, but most children get their first tooth (lower central incisor) around 6 months of age and their last tooth (molar) between 24 and 30 months of age (Sood and Sood, 2010). Girls often get teeth earlier than boys, but a fun rule of thumb is "the average number of teeth a child should have is roughly his or her age in months minus 6 until 24 months of age" (Sood and Sood, 2010). So at 8 months baby might have 2 teeth, while a 24-month-old baby will typically have 18 teeth. A full set of baby teeth is comprised of 20 teeth.
Now on to teething symptoms. Historically, teething has been associated with a wide array of symptoms including pain, inflammation/bleeding of the gums, mouth ulcers, drooling, biting, sucking, ear rubbing, face rash, general irritability, disturbed sleep, diarrhea, mild fever, and loss of appetite/alteration in volume of fluid intake (Sood and Sood, 2010; Owais et al., 2010). While experts agree that teething can lead to local tenderness, inflammation, and pain, they argue that "severe systemic upsets [such as fever, diarrhea, and disturbed sleep] are unrelated to teething despite parents’ perception and beliefs" (Owais et al., 2010). A meticulous study performed in Melbourne, Australia followed 21 children aged 6 to 24 months and recorded tooth eruption (as judged by a dental therapist) and symptoms (according to both parents and daycare staff) every day (Wake et al., 2000). The results showed that although caregivers reported many "teething" symptoms and many teeth erupted over the course of the study, there was no significant relationship between the arrival of teeth with fever, mood disturbance, drooling, or rashes. One confounding factor in this study is that the use of Tylenol and teething gel was not restricted, which may have minimized potential symptoms.
Alternatively, a large cohort study of 125 healthy children with 475 tooth eruptions demonstrated that the teething period (8 days around tooth eruption) was positively associated with biting, drooling, gum rubbing, irritability, sucking, and temperature >99.5°F (Macknin et al., 2000). However, no single symptom was present in all teething cases and many were often present outside of the teething window. This suggests that babies experience variable mild "teething" symptoms, whether they are teething or not. Diarrhea, cough, vomiting, sleep disturbance, facial rashes, and fever >102°F were not significantly associated with teething. These more serious symptoms are likely not a result of teething and may require a visit to the pediatrician to diagnose. In fact, "the timing of eruption of the primary teeth (6 months onwards) coincides with age when the baby starts to crawl and explore his environment. During this phase babies put various objects and also their dirty hands into their mouth which may lead to diarrhea or vomiting which has been wrongly attributed to teething. [O]ther possible causes of diarrhea should be ruled out and it should be managed accordingly rather than attributing it to teething." (Sood and Sood, 2010).
In conclusion, babies will drool, be fussy, have fevers, and many other symptoms over the course of their infancy. Sometimes this may be a sign of an impending tooth and sometimes not. If baby has more severe symptoms such as vomiting, diarrhea, or a high fever, don't assume it's caused by a tooth. Check in with your pediatrician to get to the root of the problem. (For more information of soothing a teething baby, check out this post.)
Owais AI, Zawaideh F, Al-Batayneh OB. Challenging parents' myths regarding their children's teething. Int J Dent Hyg. 2010 Feb;8(1):28-34.
Sood S, Sood M. Teething: myths and facts. J Clin Pediatr Dent. 2010 Fall;35(1):9-13.
Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: A cohort study. Pediatrics. 2000 Dec;106(6):1374-9.
Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics. 2000 Apr;105(4 Pt 1):747-52.