The most common signs of teething are red, swollen gums, extra drooling, and a fussy baby who wants to chew on everything. Most infants start teething around 4 months of age, though some begin earlier or later. Each tooth typically causes about 3 to 8 days of discomfort, starting a few days before the tooth breaks through and tapering off shortly after.
The Most Reliable Signs
A large prospective study published in Pediatrics tracked infants through multiple tooth eruptions and found that the most frequent signs were irritability, increased salivation (drooling), runny nose, and loss of appetite. Sleep disturbance, rash, and diarrhea also showed up more often during teething windows, though less consistently.
Here’s what you’re most likely to notice:
- Red, swollen gums where the tooth is pushing through
- Excessive drooling, sometimes enough to soak through bibs and shirts
- Chewing and gnawing on fingers, toys, or anything within reach
- Fussiness and irritability, especially in the evenings
- Disrupted sleep, including more frequent night waking
- One flushed cheek on the side where the tooth is coming in
- A facial rash, often caused by constant drool irritating the skin around the mouth and chin
- Ear rubbing or pulling on the side of the erupting tooth
- Decreased appetite, particularly reluctance to nurse or take a bottle
Not every baby experiences all of these, and some infants sail through teething with barely any fussiness at all. The intensity varies from tooth to tooth in the same child, too.
Why Teething Causes These Symptoms
A tooth doesn’t just slide through the gum. The body has to actively dissolve bone to create a path for it. Cells in the tissue surrounding the developing tooth release signaling proteins that recruit specialized bone-dissolving cells to clear the way. This process triggers a genuine inflammatory response in the gum tissue, complete with swelling, redness, and tenderness.
That same inflammation releases proteins that can nudge your baby’s body temperature slightly upward and make the gum tissue more sensitive. The extra drooling is partly a response to the irritation inside the mouth. And because the nerves in the jaw, ear, and cheek are closely connected, pain from a swollen gum can radiate outward, which is why babies tug at their ears or rub their cheeks even though nothing is wrong with those areas.
What Teething Does Not Cause
Teething does not cause a true fever. It may raise your baby’s temperature slightly, but it won’t push it to 100.4°F (38°C) or above. That threshold marks a fever, and a fever signals an infection, not teething. The NHS states directly that there is no evidence teething causes diarrhea, and while the Pediatrics study did find a slight statistical association with loose stools, the effect was mild enough that pediatricians still recommend treating significant diarrhea as a separate issue.
Teething also does not cause vomiting, high fevers, or severe illness. Because babies start teething around the same age they lose maternal antibodies and begin picking up common infections, it’s easy to blame a cold or stomach bug on a new tooth. If your baby has a fever over 100.4°F, persistent diarrhea, vomiting, or seems genuinely unwell, something else is going on.
Ear Pulling: Teething or Ear Infection?
Babies tug at their ears during teething because the pain radiates along shared nerve pathways. On its own, ear pulling with mild fussiness and visible gum swelling is almost certainly teething. But if the ear pulling comes with a fever above 100.4°F, intense or persistent crying (especially when lying down), fluid draining from the ear, or your baby not responding to sounds normally, those point toward an ear infection. The key distinction is that teething discomfort is intermittent and mild, while an ear infection tends to produce more sustained distress and a real fever.
What Normal Gums Look Like During Teething
You’ll typically see a raised, reddened ridge on the gum where the tooth is about to appear. Sometimes you can spot the white edge of the tooth just beneath the surface. This is the most reassuring sign that the fussiness actually is teething and not something else.
Occasionally, a bluish or clear fluid-filled bump appears on the gum right before a tooth breaks through. This is called an eruption cyst, and it looks more alarming than it is. It forms when fluid gets trapped between the emerging tooth and the tissue around it. Most eruption cysts are painless and resolve on their own once the tooth comes in. If one bleeds, oozes pus, causes real pain, or lasts longer than two weeks, it’s worth having a provider look at it.
How Long Each Episode Lasts
Each teething episode runs about 3 to 8 days total. Symptoms usually peak in the day or two before the tooth actually cuts through the gum, then ease quickly afterward. Children’s Hospital Los Angeles notes that most discomfort falls within a roughly one-week window centered on the eruption itself. If your baby has been irritable for weeks on end, teething alone is unlikely to explain it.
Safe Ways to Ease Teething Pain
The simplest and safest relief is pressure on the gums. A clean finger, a chilled (not frozen) teething ring, or a cold, wet washcloth all give your baby something firm to bite down on, which counteracts the pressure building underneath. Chilling the object adds a mild numbing effect. If your baby is eating solids, chilled foods like refrigerated fruit in a mesh feeder can serve the same purpose.
Gently rubbing your baby’s gums with a clean finger can also help. Many parents find this calms fussiness quickly, especially right before sleep.
Products to Avoid
The FDA warns against using numbing gels or creams containing benzocaine or lidocaine on teething babies. Benzocaine can cause a rare but serious condition that reduces the blood’s ability to carry oxygen. Lidocaine, even in prescription form, has been linked to seizures, heart problems, and severe brain injury in infants when too much is applied or accidentally swallowed. These products also wash out of the mouth quickly with saliva, offering little real benefit.
Homeopathic teething tablets and gels carry their own FDA warning. Testing has found inconsistent levels of active ingredients in some products, and the FDA has received reports of serious adverse events, including deaths, in children given homeopathic teething products. Despite their “natural” branding, they are not considered safe for infants.
Amber teething necklaces pose a strangulation and choking hazard and have no evidence supporting their claimed pain-relieving properties.