When a baby is cutting a tooth, the gum over the emerging tooth becomes swollen, red, and slightly raised, often with a visible white or pale line where the tooth is pressing upward. The whole process unfolds over days, with distinct visual stages you can spot if you know what to look for.
What the Gums Look Like Before the Tooth Appears
The earliest visible sign is a change in the gum tissue itself. The area where the tooth is pushing up becomes puffy and redder than the surrounding gum. You might notice a firm, slightly raised ridge along the gumline. If you run a clean finger over it, you can often feel a hard bump beneath the surface before you can see anything.
As the tooth gets closer to the surface, the gum directly over it may look stretched and shiny, sometimes turning whitish or pale where the pressure is greatest. This whitish area is the tooth crown showing through the thinning tissue. For front teeth (incisors), it often looks like a tiny grain of rice just beneath the skin. For molars, the gum becomes more broadly raised and reddened over a wider area, since the tooth surface pushing through is much larger.
These visual changes typically start about 3 to 5 days before the tooth actually breaks through, though mild symptoms can come and go for one to two months before eruption. Once the tooth pokes through the gum surface, discomfort usually improves quickly.
Eruption Cysts: The Bluish Bump
Sometimes, instead of a red or white bump, you’ll see a bluish or translucent fluid-filled lump on the gum. This is an eruption cyst, a small pocket of fluid that collects in the tissue just above the incoming tooth. It looks like a soft, dome-shaped blister sitting right where the tooth should come in.
Eruption cysts can look alarming, but they’re harmless. The tooth almost always breaks through on its own, and the cyst resolves without treatment. If the fluid inside the cyst mixes with a small amount of blood, it can appear darker, more purple or brownish. This is sometimes called an eruption hematoma. Neither version requires intervention unless it persists for several weeks without any tooth appearing.
The Moment the Tooth Breaks Through
When the tooth finally cuts through, you’ll see a small, sharp white edge poking out of the gum. Front teeth emerge as a thin, slightly translucent white line, almost like a sliver of eggshell. Molars appear as one or more white points (the cusps of the tooth) breaking through the gum surface, sometimes with a ring of reddened tissue around them.
The tooth doesn’t pop out all at once. It slowly works its way up over days or weeks. During this time, the gum around the emerging tooth may look uneven, with tissue still partially covering parts of the crown. This is completely normal. The body produces enzymes that gradually break down the overlying gum and bone tissue, creating a path for the tooth to move through. If that process is inefficient, eruption can stall temporarily.
What Cutting a Tooth Doesn’t Look Like
A few things get confused with teething but look distinctly different. White, irregular patches that coat the inside of the cheeks, inner lips, or tongue and don’t wipe off easily are signs of oral thrush, a yeast infection. Teething changes are localized to the gumline, not spread across the mouth’s soft tissue. A white tongue by itself in a baby on a milk diet is usually just milk residue, not thrush or teething.
Epstein pearls, tiny white or yellowish bumps on a newborn’s gums or palate, can also be mistaken for incoming teeth. These are harmless cysts that disappear on their own within a few weeks and have nothing to do with tooth eruption.
Typical Order and Timing
Most babies cut their first tooth between 4 and 7 months, usually one of the two lower front teeth. The upper front teeth follow shortly after. From there, the lateral incisors (the teeth flanking the front two) come in, followed by first molars, canines, and finally second molars. Most children have all 20 baby teeth by age 3. There’s wide variation in timing, so a baby who doesn’t cut a tooth until 10 or 12 months is still within the normal range.
Behavioral Signs That Match the Visual Ones
Alongside the gum changes, you’ll likely notice increased drooling, a strong urge to chew on anything available, and general fussiness. Some babies pull at their ears or rub their cheeks on the side where a tooth is coming in. These behavioral signs often start and stop in the days before the tooth appears, which can make it hard to tell if teething is actually the cause.
One important distinction: teething does not cause a true fever. A baby’s temperature may rise very slightly, but anything at or above 100.4°F (38°C) is a fever caused by something else, likely an infection. Because teething happens during the same months when babies lose maternal antibodies and start putting everything in their mouths, illnesses and teething often overlap by coincidence.
Soothing Sore Gums Safely
The American Academy of Pediatrics recommends rubbing your baby’s gums with a clean finger or offering a firm rubber teething ring to chew on. Chilling the ring in the refrigerator (not the freezer) can add extra relief.
The FDA warns against using numbing gels or creams containing benzocaine or lidocaine on children’s gums. Benzocaine products, sold under names like Orajel and Anbesol, can cause a rare but serious condition that reduces the blood’s ability to carry oxygen. Lidocaine solutions carry risks of seizures, heart problems, and severe brain injury in young children. Homeopathic teething tablets have also been flagged as potentially dangerous. None of these products offer meaningful benefit for teething pain, and the risks far outweigh any temporary relief.