When babies start teething, the most obvious sign is a change in their gums: the area where a tooth is about to break through becomes red, swollen, and puffy compared to the surrounding tissue. You might also notice a small white spot just beneath the gum surface where the tooth is pushing upward. Most babies show their first signs of teething between 4 and 7 months old, though some start earlier or later.
What the Gums Look Like
Before you ever see an actual tooth, you’ll see changes in your baby’s gum line. The tissue directly over an incoming tooth becomes noticeably redder and more swollen than the gums around it. If you gently run a clean finger along the ridge, you may feel a hard bump just below the surface. In some cases, you can see a lighter or whitish area on the gum where the tooth is closest to breaking through.
As the tooth gets closer to the surface, that swollen patch becomes more pronounced. The gum tissue may look stretched and shiny. Once the tooth finally cuts through, you’ll see just the thin white edge of the crown poking out. Over the following days, more of the tooth gradually becomes visible as it continues to emerge.
Eruption Cysts
Occasionally, a bluish or clear fluid-filled bump appears on the gum right where a tooth is coming in. This is called an eruption cyst, and while it can look alarming, it’s harmless. These cysts are most common toward the back of the lower jaw and typically resolve on their own once the tooth pushes through. They don’t need treatment unless they become very large or don’t go away.
The Drool Rash
One of the most visible signs of teething isn’t in the mouth at all. Teething triggers a surge in drooling, and all that moisture sitting on skin causes a distinctive rash around the mouth, chin, and sometimes down the neck. It shows up as red, slightly raised patches with dry or chapped skin, sometimes with small bumps scattered through it. Keeping the area dry with a soft cloth and applying a barrier cream like petroleum jelly helps prevent it from worsening.
Behavioral Signs to Watch For
Beyond what you can see on the gums and skin, your baby’s behavior shifts in predictable ways during teething. The NHS lists three hallmark signs: increased drooling, constant gnawing and chewing on objects, and disrupted sleep. Your baby may also become fussier than usual, especially in the hours before bed, and show less interest in feeding because the sucking motion can put pressure on sore gums.
These symptoms tend to come and go. They’re usually worst in the days just before and just after the tooth breaks through the gum, then ease off until the next tooth starts moving. Since babies get 20 primary teeth over roughly two years, this cycle repeats many times.
Which Teeth Come In First
The lower front two teeth (central incisors) are almost always first, typically appearing between 6 and 10 months. The upper front two follow shortly after. From there, the pattern generally moves outward and backward: the teeth next to the front ones, then the first molars, the canines, and finally the second molars, which usually arrive around age 2 to 3. Knowing which teeth come next helps you predict where to look for gum swelling.
Teething vs. Something More Serious
A common concern is whether fussiness and ear-pulling mean teething or an ear infection. Babies sometimes tug at their ears during teething because gum pain can radiate to the ear area, but there are clear differences. Teething may cause a very slight rise in temperature, but it should stay below 100.4°F. A fever above that threshold points to something else, such as an ear infection or viral illness. Ear infections also tend to follow a cold, come with a runny nose or cough, and cause pain that worsens when the baby lies flat. If you see drainage from the ear, that’s not teething.
More broadly, teething doesn’t cause high fevers, diarrhea, or severe irritability. A 2017 meta-analysis in the International Journal of Clinical Pediatric Dentistry found no clear overall association between fever and tooth eruption. If your baby seems genuinely sick rather than just uncomfortable, it’s worth looking beyond the gums for an explanation.
Safe Ways to Help With Discomfort
The FDA warns against using topical numbing gels or liquids containing benzocaine or lidocaine on teething babies. These products offer little benefit for gum pain and carry serious risks, including a rare but potentially fatal blood condition that reduces the blood’s ability to carry oxygen. Homeopathic teething tablets have also drawn safety warnings.
What does work is simpler. Rubbing your baby’s gums with a clean finger applies gentle counterpressure that many babies find soothing. A teething ring made of firm rubber, especially one that’s been chilled in the refrigerator (not the freezer), gives your baby something safe to gnaw on. A cold, wet washcloth works the same way. The American Academy of Pediatrics recommends these approaches as the safest options for managing teething discomfort at home.