Baby teething typically shows up as red, swollen gums with a visible bulge where a tooth is pushing through. You might notice the gum looks puffy and slightly inflamed in one spot, and if you run a clean finger along it, you can often feel a hard ridge just beneath the surface. The first teeth usually appear between 4 and 10 months, starting with the two bottom front teeth.
What the Gums Look Like
The clearest visual sign of teething is localized swelling on the gum ridge. The area directly over an incoming tooth looks redder and puffier than the surrounding tissue, and it feels tender to the touch. As the tooth gets closer to breaking through, you may see a whitish spot or a thin, pale line where the tooth’s edge is pressing against the gum from below.
In some cases, a fluid-filled bump forms over the erupting tooth. This is called an eruption cyst, and it looks like a bluish or clear blister sitting on top of the gum. It can look alarming, but it’s generally harmless and resolves on its own once the tooth breaks through. These cysts are more common over molars than front teeth.
Drool Rash Around the Mouth
Teething triggers a noticeable increase in saliva production, and all that extra drool often causes a rash on the skin around your baby’s mouth. A drool rash shows up as red, slightly raised patches on the chin, lower cheeks, and sometimes the neck and chest. The skin in those areas may look dry, chapped, or dotted with small bumps. It’s not the teething itself causing the rash. It’s the constant moisture sitting on delicate skin. Gently patting the area dry throughout the day and applying a thin layer of petroleum jelly can help protect the skin.
Behavioral Signs That Accompany Teething
Beyond what you can see on the gums, teething changes how your baby acts. The most obvious shift is an intense desire to chew. Babies who are teething gnaw on their fingers, fists, toys, and anything else they can get into their mouths with real determination. This pressure on the gums provides counter-stimulation that temporarily eases the discomfort.
Sleep disruption is common during active eruption. Pain and discomfort tend to flare at night when there are fewer distractions, so a baby who previously slept well may start waking more frequently. Fussiness and irritability during the day are typical too, especially in the days right before a tooth cuts through.
Feeding patterns often shift. Some babies want to nurse or bottle-feed more frequently but for shorter periods, using the sucking motion as comfort. Others temporarily refuse feeds because the pressure in their mouth feels uncomfortable. Breastfeeding parents sometimes worry about biting, but when a baby is actively latched and feeding, the tongue covers the lower teeth, making it difficult for a baby to bite without also biting their own tongue. Biting is more likely to happen at the end of a feed or during a pause.
Ear Pulling and What It Means
Many teething babies tug, rub, or pull at their ears, which can look a lot like an ear infection. The nerves serving the back teeth and the ears are connected, so pain from incoming molars can radiate to the ear area. If ear pulling is the only symptom and your baby doesn’t have a fever, ear discharge, or signs of hearing trouble, teething is the more likely explanation. Ear infections typically come with additional symptoms like fever above 100.4°F, visible fluid draining from the ear, or significant distress when lying down.
Temperature Changes vs. True Fever
One of the most persistent myths about teething is that it causes fever. Teething can produce a very slight rise in body temperature, but it does not cause a true fever. A normal body temperature sits around 98.6°F (37°C), and fever is defined as 100.4°F (38°C) or higher. If your baby’s temperature reaches 100.4°F or above, something other than teething is responsible, and it’s worth investigating rather than writing it off. The same applies to diarrhea and vomiting, which parents commonly attribute to teething but aren’t caused by it.
Safe Ways to Ease the Discomfort
The simplest relief is pressure on the gums. Rubbing your baby’s gums with a clean finger works well, and so does offering a teething ring made of firm rubber. Chilling the ring in the refrigerator (not the freezer) adds a mild numbing effect. A clean, cold washcloth to chew on serves the same purpose.
What you should avoid matters just as much. The FDA warns against using any topical gels or liquids containing benzocaine or lidocaine for teething pain in infants. Benzocaine can trigger a rare but serious condition that reduces the blood’s ability to carry oxygen, and lidocaine can cause seizures, heart problems, and severe brain injury if too much is absorbed or swallowed. Homeopathic teething tablets have also drawn FDA warnings for inconsistent ingredient levels and reports of adverse effects. The American Academy of Pediatrics recommends sticking with mechanical soothing (clean fingers, firm rubber rings) rather than any medicated product.
The Order Teeth Typically Appear
Teeth generally arrive in a predictable sequence, though the exact timing varies widely from baby to baby. The lower central incisors (bottom front two) usually come first, followed by the upper central incisors. The lateral incisors on either side fill in next, then the first molars, canines, and finally the second molars. Most children have all 20 primary teeth by age 3. Some babies are born with a tooth already visible, while others don’t cut their first tooth until after their first birthday. Both extremes are normal.
Each new tooth follows the same pattern of gum swelling, fussiness, and chewing, but molars tend to cause more discomfort than front teeth because of their larger surface area pushing through the gum tissue. The eruption cysts mentioned earlier are also more common with molars. Parents often notice that the first few teeth cause the most disruption, partly because everything is new to the baby, and later teeth sometimes pass with less drama.