The earliest and most reliable sign that your baby is teething is red, swollen gums with visible white bumps where a tooth is pushing through, combined with a noticeable increase in drooling and a strong urge to chew on everything. Most babies start teething around 6 months of age, though it can begin as early as 4 months or as late as 12 months.
The Most Common Teething Signs
Teething produces a cluster of symptoms that tend to show up together. The gums where a tooth is about to break through will look red, swollen, and puffy. You may be able to feel a hard bump just beneath the surface if you run a clean finger along the gum line. Drooling picks up significantly, often enough to soak through bibs and shirts throughout the day.
A prospective study published by the American Academy of Pediatrics tracked babies through actual tooth eruptions and found that the following symptoms were statistically linked to teething: increased biting, drooling, gum rubbing, sucking, irritability, wakefulness, ear rubbing, facial rash, decreased appetite for solid foods, and a mild rise in body temperature. The facial rash is typically caused by constant moisture from drool irritating the skin around the mouth and chin.
Your baby will likely want to gnaw on fingers, toys, or anything firm they can get into their mouth. This pressure on the gums actually helps relieve the discomfort, which is why the chewing instinct ramps up so dramatically during teething.
Why Teething Hurts
As a tooth moves upward through the jawbone and toward the surface, proteins from the developing tooth are released into the surrounding tissue. These proteins trigger a mild inflammatory reaction in the gum, which is what causes the redness, swelling, and tenderness your baby feels. The tooth eventually merges with the outer layer of gum tissue and breaks through, and the discomfort fades once the tooth fully emerges. Symptoms are typically worst in the days just before and during the breakthrough itself.
Which Teeth Come In First
Babies are born with 20 primary teeth already formed inside the jawbone. The lower front teeth (central incisors) usually appear first, around 6 months. The upper front teeth follow shortly after. From there, teeth generally erupt outward from the center, with the first molars and canines arriving between 12 and 20 months. The second set of molars, the ones farthest back, typically come in between ages 2 and 3. Each new tooth can bring a fresh round of symptoms, so teething is not a single event but an intermittent process that stretches over about two years.
Teething vs. Ear Infection
One of the trickiest parts of teething is that babies often tug at their ears, which looks a lot like an ear infection. The key differences come down to severity and accompanying symptoms.
- Ear pulling: Teething causes mild, usually one-sided pulling on the ear closest to the erupting tooth. An ear infection causes more persistent tugging, often on both sides.
- Fever: Teething may cause a slight temperature increase, but not a true fever. A temperature above 100.4°F points toward illness, not teething.
- Cold symptoms: Ear infections frequently follow a cold, so a runny nose and cough alongside ear pulling suggest infection. Teething does not cause congestion or cough.
- Ear drainage: Any fluid or pus coming from the ear is a clear sign of infection. Teething never causes this.
- Sleep disruption: Teething causes on-and-off fussiness at night. Ear infections cause more intense pain that worsens when lying flat, making sleep consistently difficult.
- Feeding: A teething baby may be mildly fussy during meals. A baby with an ear infection may refuse to feed entirely because swallowing increases pressure in the ear.
What Teething Does Not Cause
There is a persistent belief that teething causes high fevers, diarrhea, and vomiting. The AAP study found no significant association between tooth eruption and fevers above 102°F, vomiting, diarrhea, cough, or congestion. None of the teething babies in the study developed a fever of 104°F, and none had a life-threatening illness. If your baby has a fever above 100.4°F, persistent diarrhea, or vomiting, something other than teething is likely going on.
The timing of teething, between 6 and 24 months, overlaps with a period when babies are highly susceptible to viral infections. It is easy to blame a virus on teething simply because the two happen at the same time. A good rule of thumb: if the symptom would concern you in a non-teething baby, it should still concern you now.
Safe Ways to Ease Teething Pain
The simplest and most effective relief is pressure on the gums. A clean, chilled (not frozen) teething ring or a cold, damp washcloth gives your baby something safe to gnaw on. Gently rubbing the swollen gum with a clean finger also helps. For babies who have started solids, chilled foods like cold fruit in a mesh feeder can serve double duty.
If your baby is clearly uncomfortable and non-drug options are not enough, infant acetaminophen is an option for babies 3 months and older, and infant ibuprofen can be used starting at 6 months. Both are dosed by weight, not age, so check the packaging or ask your pediatrician for the right amount.
Products to Avoid
The FDA warns against using topical numbing gels containing benzocaine or lidocaine on teething babies. These are the active ingredients in products like Orajel, Anbesol, and similar over-the-counter gels marketed for mouth pain. They provide little measurable benefit for teething and carry a serious risk: benzocaine can cause a condition called methemoglobinemia, which sharply reduces the blood’s ability to carry oxygen. The FDA considers this risk severe enough that it has advised these products should not be used for teething in children at all.
Homeopathic teething tablets have also drawn FDA scrutiny. Amber teething necklaces pose choking and strangulation hazards. Stick to teething rings, cold washcloths, and weight-appropriate pain relievers when needed.
When to Start Dental Visits
Both the American Academy of Pediatric Dentistry and the American Dental Association recommend scheduling your child’s first dental visit within 6 months of the first tooth appearing, and no later than their first birthday. This initial visit is less about treatment and more about establishing a baseline, checking that teeth are developing normally, and getting guidance on cleaning those new teeth as they come in.