When baby teeth come in, you’ll typically see red, swollen gums followed by a small white edge or point breaking through the surface. The process usually starts around 6 months of age, though some babies start earlier or later. Knowing what to look for helps you tell the difference between normal teething and something that needs attention.
What the Gums Look Like Before a Tooth Appears
The first sign is usually a change in the gums. The area where a tooth is about to push through becomes red, swollen, and slightly puffy compared to the surrounding tissue. If you run a clean finger along your baby’s gum ridge, you may feel a hard bump just below the surface before anything is visible.
As the tooth gets closer to the surface, you’ll notice a small whitish or pale area forming on top of the swollen gum. This is the crown of the tooth pressing upward. In the final stage before eruption, the gum may look stretched and almost translucent over the tooth tip. Then a thin white line or point breaks through, and the tooth slowly works its way out over the next few days.
Eruption Cysts: Bluish Bumps on the Gums
Sometimes a fluid-filled lump appears on the gum right where a tooth is about to come in. These eruption cysts look bluish or clear and can alarm parents who aren’t expecting them. They form when fluid collects in the space around a tooth as it pushes toward the surface.
Eruption cysts are harmless in most cases and resolve on their own once the tooth breaks through. If one lasts longer than two weeks, it’s worth mentioning to a dentist. Rarely, if a cyst persists beyond a month, a dentist may recommend a minor procedure to help the tooth along.
Which Teeth Come In First
Babies are born with 20 primary teeth hidden beneath their gums. The lower front two teeth (central incisors) almost always arrive first, usually between 6 and 10 months. The upper front two follow shortly after. From there, the teeth generally fill in from front to back, with the first molars appearing around 12 to 16 months, the canines (the pointy ones) between 16 and 22 months, and the second molars arriving last, typically between 23 and 33 months.
Not every baby follows this exact schedule. Some babies cut their first tooth at 4 months, while others don’t see one until closer to their first birthday. Both ends of that range are normal.
Other Signs That Accompany Teething
Beyond what you see on the gums, teething tends to come with a cluster of behavioral and physical changes. Your baby may drool more than usual, chew on anything within reach, become fussier, or have trouble sleeping. Some babies pull at their ears on the side where a tooth is emerging.
A slight rise in body temperature can happen around the time a tooth is coming in, but it doesn’t reach the level of a true fever. A fever is defined as a body temperature of 100.4°F or higher. Research has confirmed that while teething may nudge body temperature up slightly, readings stay below that threshold. If your baby has a temperature of 100.4°F or above, something else is going on.
Drool Rash
All that extra drool can irritate your baby’s skin, creating a rash on the chin, cheeks, and neck. Drool rash appears as flat or slightly raised patches that may have small red bumps or look chapped and dry. You can prevent and treat it by gently patting the area dry throughout the day and applying a barrier ointment like petroleum jelly or Aquaphor over clean, dry skin. This protects the surface from ongoing moisture and lets the rash heal.
Bumps That Look Like Teeth but Aren’t
Not every white bump on a baby’s gums is a tooth coming in. A few common look-alikes can cause confusion, especially in newborns.
- Epstein pearls are small, white or yellow bumps that appear along the gums or on the roof of the mouth. They’re only about 1 to 3 millimeters across, feel hard to the touch, and closely resemble unerupted teeth. They’re completely harmless and disappear on their own within a few weeks.
- Bohn’s nodules are similar small bumps that form along the inner or outer edge of the gums, more often on the upper jaw. Like Epstein pearls, they resolve without treatment.
- Dental lamina cysts sit along the gum ridge and can look remarkably like teeth about to erupt. They also go away on their own.
- Natal teeth are actual teeth that a baby is born with. They’re rare, appearing in roughly 1 in 2,000 to 3,000 newborns, and sometimes need to be evaluated by a dentist if they’re loose or interfering with feeding.
If you’re unsure whether a bump is a tooth or something else, the timing is your best clue. Epstein pearls and Bohn’s nodules are present from birth and typically fade within the first few months, while teething bumps appear at 6 months or later and are accompanied by the swelling and fussiness described above.
Caring for New Teeth
Start cleaning as soon as that first tooth appears. Use a baby toothbrush with a tiny smear of fluoride toothpaste, about the size of a grain of rice. Brush twice a day, paying attention to the gum line where bacteria collect. Even a single tooth can develop a cavity if it’s consistently exposed to milk or formula residue overnight.
The American Academy of Pediatric Dentistry recommends scheduling your baby’s first dental visit within six months of that first tooth appearing, or by their first birthday, whichever comes first. This early visit is mostly about establishing a baseline and catching any issues before they become problems.