Most babies start teething between 4 and 7 months old, and the earliest clues are usually increased drooling, swollen gums, and a sudden urge to chew on everything in reach. Not every fussy baby is teething, though, and not every teething baby is fussy. Here’s how to tell what’s actually going on.
The Five Main Signs of Teething
Teething looks a little different in every baby, but the most reliable signs cluster together in a pattern you’ll learn to recognize:
- Heavy drooling. Drooling can start as early as 3 or 4 months, sometimes weeks before a tooth actually appears. On its own, drooling isn’t proof of teething, but combined with other signs it’s a strong clue.
- Swollen or puffy gums. This is the most direct sign. Run a clean finger along your baby’s gums. If you feel a hard bump or see a reddish, swollen ridge, a tooth is likely pushing through.
- Chewing on hands, fists, and toys. The counter-pressure of biting down feels good on sore gums. Babies love to chew on things regardless, but during teething the drive becomes noticeably more intense.
- Fussiness or irritability. Teething discomfort tends to come and go rather than staying constant. You might notice crankiness for a few days around each new tooth, then a return to normal.
- Trouble sleeping. Gum pain can flare at night when there are fewer distractions. If your baby was sleeping well and suddenly starts waking more, teething is worth considering.
What Teething Does Not Cause
One of the most persistent myths in parenting is that teething causes fevers, diarrhea, rashes, or cold symptoms. It doesn’t. Teething can produce a slightly elevated body temperature, but that reading stays below 100.4°F. Anything at or above 100.4°F is a true fever and points to something else, like an infection.
The confusion is understandable. Babies start teething around the same age they lose the immune protection passed on during pregnancy, so infections become more common right when teeth start appearing. The timing overlaps, but one doesn’t cause the other.
Teething vs. Ear Infection
Ear pulling is the symptom that trips up the most parents, because both teething and ear infections can cause it. The differences are subtle but real.
With teething, ear pulling is usually mild and one-sided, matching the side where a tooth is erupting. The baby’s temperature stays below 100.4°F, there are no cold symptoms, and fussiness comes and goes throughout the day. Feeding might be slightly disrupted because of gum soreness, but the baby still eats.
An ear infection looks different. Fussiness tends to spike suddenly and is often worse when the baby lies flat. Fever climbs above 100.4°F. You may notice cold symptoms like a cough or runny nose. The baby might refuse to eat because swallowing creates pressure in the ears. In some cases, fluid or pus drains from the ear canal. If you’re seeing that combination, especially the high fever and feeding refusal, it’s worth a call to your pediatrician.
Safe Ways to Ease Teething Pain
The simplest remedies work best. A clean, chilled (not frozen) washcloth gives your baby something safe to gnaw on, and the cool temperature helps numb sore gums. Solid silicone teething rings work the same way. Avoid teething rings filled with liquid, which can break and leak. You can also rub your baby’s gums gently with a clean finger for a couple of minutes; most babies find the pressure soothing.
If your baby seems genuinely uncomfortable, ask your pediatrician about an appropriate dose of infant pain reliever. Beyond that, the discomfort from each tooth typically lasts only a few days and resolves on its own once the tooth breaks through the gum surface.
Products to Avoid
Several popular teething products carry serious safety risks. The FDA has issued direct warnings about the following:
Numbing gels and creams containing benzocaine (sold under brand names like Orajel, Anbesol, and others) should not be used in young children. Benzocaine can cause a rare but life-threatening condition that reduces the blood’s ability to carry oxygen. The FDA’s position is clear: these products offer little to no benefit for teething pain and carry risks that far outweigh any possible relief.
Prescription lidocaine solutions are equally dangerous for babies. Even small amounts, accidentally swallowed or over-applied, can cause seizures, heart problems, and severe brain injury.
Homeopathic teething tablets and gels fall into the same category. The FDA warns they can be dangerous to children, and multiple reports have linked them to serious adverse events.
Amber teething necklaces are marketed with claims that body heat releases a pain-relieving substance from the amber beads. There is no scientific evidence supporting this. The real risk is strangulation and choking. The FDA issued a warning in 2018 after reports of children choking on loose beads and an 18-month-old dying from strangulation during a nap. The American Academy of Pediatrics recommends that infants not wear any jewelry. If you choose to use amber beads despite these warnings, never let your child sleep with them on, and consider wearing them on the ankle or wrist rather than the neck.
When to Expect Each Tooth
The bottom two front teeth usually arrive first, somewhere around 6 months, followed by the top two front teeth. From there, teeth generally fill in from front to back, with the first molars appearing between 12 and 16 months. The pointed canine teeth come in around 16 to 20 months, and the second set of molars typically arrives between 20 and 30 months. By age 3, most children have a full set of 20 baby teeth.
These timelines vary widely. Some babies are born with a tooth already visible, while others don’t get their first until after their first birthday. Both extremes are normal. What matters more than timing is the overall pattern: teeth generally appear in pairs, and symptoms tend to flare for a few days around each eruption before settling down.
Your Baby’s First Dental Visit
The American Academy of Pediatric Dentistry recommends scheduling your child’s first dental exam within six months of the first tooth appearing, or by their first birthday, whichever comes first. This visit is less about treatment and more about establishing a baseline, checking that teeth are coming in normally, and getting guidance on cleaning those new teeth as they arrive.