Most babies start teething around 7 months old, though the first tooth can appear anywhere from 3 to 13 months. The clearest sign is a swollen or puffy area on the gums where a tooth is pushing through, but several other physical and behavioral changes show up in the days surrounding a new tooth.
The Most Reliable Physical Signs
The single best indicator is what you see and feel in your baby’s mouth. A swollen, puffy ridge on the gum means a tooth is close to breaking through. You may notice a bluish-white bump just beneath the surface. If you run a clean finger along the gum, you can often feel a hard edge before the tooth becomes visible.
Other physical signs that have been directly linked to tooth eruption in clinical studies include:
- Increased drooling. Drooling can start as early as 3 or 4 months, so extra saliva alone isn’t proof of teething. But a noticeable uptick in drooling combined with other signs is a strong clue.
- Biting and gum-rubbing. Babies press toys, fingers, and anything they can grab against their gums because counter-pressure relieves the sensation of a tooth pushing upward.
- Facial rash. All that extra drool can irritate the skin around the mouth and chin, causing a red, slightly bumpy rash.
- Ear-rubbing. The gums, jaw, and ear canal share nerve pathways, so babies sometimes tug or rub at their ears when a tooth is coming in.
- Decreased appetite for solid foods. Sore gums make chewing uncomfortable. Babies who were happily eating purees or soft solids may suddenly refuse them for a few days.
Behavioral Changes to Watch For
Irritability is the behavioral hallmark of teething. Your baby may be fussier than usual, particularly in the late afternoon and evening. A prospective study published by the American Academy of Pediatrics found that increased irritability and wakefulness were both statistically associated with tooth eruption, though these symptoms tend to be mild and short-lived, clustering in the few days right around when a tooth breaks through.
One widely believed sign, however, doesn’t hold up under scrutiny: disrupted sleep. A longitudinal study that used video recording to objectively measure infant sleep found no significant differences in sleep quality between teething and non-teething nights. More than half of the parents in the study reported that teething disturbed their baby’s sleep, but the actual recordings didn’t back that up. If your baby is suddenly waking more at night, teething is an easy explanation, but it’s worth considering other causes like illness, a growth spurt, or a schedule change.
What Teething Does NOT Cause
Teething gets blamed for a lot of symptoms it doesn’t actually produce. The AAP study specifically found that the following were not significantly associated with tooth eruption: true fever (over 102°F), congestion, cough, vomiting, diarrhea, and rashes on the body (as opposed to the face). None of the teething babies in the study had a fever of 104°F, and none had a serious illness.
A mild temperature bump, slightly above normal but below 100.4°F, can accompany teething. But if your baby has a rectal temperature of 102°F or higher, something else is going on. Babies between 6 and 24 months are constantly exposed to new viruses, and the timing often overlaps with teething. Attributing a real fever or significant illness to “just teething” can delay care your baby needs.
When Each Tooth Typically Appears
Teeth follow a fairly predictable sequence, though the exact timing varies widely from baby to baby. The lower front teeth (central incisors) usually come first, around 7 to 8 months. Here’s the general order:
- Lower central incisors: ~8 months
- Upper central incisors: ~9 months
- Upper lateral incisors: ~11 months
- Lower lateral incisors: ~12 months
- First molars (upper and lower): ~16 months
- Canines (upper and lower): ~17 to 18 months
- Second molars (lower then upper): ~23 to 25 months
By around age 2.5, most children have all 20 primary teeth. Molars tend to cause more discomfort than front teeth because of their larger, flatter surface area pushing through the gum. If your baby seemed fine during the front teeth but suddenly becomes very fussy around 15 to 16 months, the first molars are the likely culprit.
Safe Ways to Ease the Discomfort
The simplest and safest approach is cold and pressure. A chilled (not frozen) teething ring, a cold wet washcloth, or a clean finger rubbed firmly along the gums all provide relief. Solid silicone teething rings are a good choice because they can be refrigerated without becoming too hard. Avoid anything filled with liquid that could leak, and skip teething necklaces made of amber or beads, which pose a choking and strangulation risk.
If your baby seems genuinely miserable and cold pressure isn’t enough, infant acetaminophen is an option for babies 8 weeks and older, given every 4 to 6 hours based on weight. Ibuprofen is an option for babies 6 months and older, given every 6 to 8 hours. Both should be dosed by weight rather than age for accuracy. These are occasional tools for particularly rough teething days, not something to use around the clock for weeks.
Products to Avoid
Teething gels containing benzocaine or lidocaine are still sold in many stores, but the FDA has issued clear warnings against using them on infants. Benzocaine can cause a condition called methemoglobinemia, which severely reduces the blood’s ability to carry oxygen. It can be fatal. Prescription lidocaine solutions carry risks of seizures, heart problems, and brain injury in young children, particularly if too much is applied or accidentally swallowed. These products also don’t work very well. Saliva washes them off the gums within minutes, so the brief numbing effect comes with disproportionate risk.
Homeopathic teething tablets have also drawn FDA scrutiny after reports of adverse events. Some tested products contained inconsistent amounts of belladonna, a toxic plant. The safest teething remedies are also the most straightforward: cold, pressure, and if needed, a weight-appropriate dose of a standard pain reliever.