Teething is the process of a baby’s first teeth pushing through the gums, typically starting between 6 and 10 months of age when the lower front teeth appear. Most babies have all 20 primary teeth by age 3. While teething is a normal part of development, it can cause discomfort, fussiness, and sleep disruption that leaves parents searching for answers.
How Teething Works
Long before you see a tooth, it’s already forming inside your baby’s jawbone. Tooth eruption happens in three stages. First, the tooth develops and grows within the jaw, with only minimal movement. In the second phase, the tooth begins pushing upward through bone tissue, which breaks down ahead of it to create a path. Finally, the tooth pierces through the gum and continues rising until it meets the opposing tooth.
As the tooth tip breaks through the gum surface, it triggers a localized inflammatory response in the surrounding tissue. This inflammation is what causes the redness, swelling, and tenderness you’ll notice on your baby’s gums. It’s also why symptoms tend to come and go: they flare up as each new tooth pushes through, then settle once the tooth is fully out.
When Each Tooth Appears
Teeth generally arrive in a predictable order, though the exact timing varies from baby to baby. According to the American Dental Association, here’s the typical schedule:
- Lower central incisors (bottom front teeth): 6 to 10 months
- Upper central incisors (top front teeth): 8 to 12 months
- Upper lateral incisors: 9 to 13 months
- Lower lateral incisors: 10 to 16 months
- First molars: 13 to 19 months (upper), 14 to 18 months (lower)
- Canines: 16 to 23 months
- Second molars: 23 to 33 months
The lower front teeth almost always come first. If your baby hasn’t started teething by 12 months, that’s still within the normal range, but it’s worth mentioning at a checkup.
What Teething Looks and Feels Like
The hallmark signs are drooling and red, swollen gums where a tooth is about to break through. Your baby may become fussy or irritable, have trouble sleeping, lose interest in eating, or constantly chew on fingers and objects. These symptoms tend to peak in the days just before and after a tooth emerges, then fade.
Not every baby is dramatically affected. Some teeth slip through with barely any fuss, while others (especially molars, which have a larger surface area) seem to cause more discomfort. You might notice symptoms come in waves over weeks or months as different teeth move through the gums at different rates.
Fever and Diarrhea Are Not Teething Symptoms
One of the most persistent beliefs about teething is that it causes fever and diarrhea. Research doesn’t support this. A systematic review and meta-analysis found no overall association between fever and tooth eruption. At most, teething may cause a very slight rise in temperature, but not a true fever.
The timing is often a coincidence. Babies begin teething around the same age that protection from maternal antibodies fades, making infections more common. They’re also putting everything in their mouths, which introduces bacteria. Parents who assume diarrhea is “just teething” are less likely to watch for signs of dehydration, which is a real concern regardless of the cause. If your baby has a rectal temperature above 100.4°F or persistent diarrhea, those symptoms deserve attention on their own.
Safe Ways to Ease Teething Pain
The simplest and most effective relief is pressure on the gums. Use a clean finger or a piece of wet gauze and rub your baby’s gums for about two minutes. You can do this as often as needed. The counter-pressure helps offset the sensation of the tooth pushing from below.
Cold also helps. Chill a teething ring, pacifier, or wet washcloth in the refrigerator and let your baby gnaw on it. The cold reduces inflammation and has a mild numbing effect. A few important details: don’t freeze these items, because frozen objects can cause frostbite on delicate gum tissue. Choose teething rings filled with distilled water rather than gel, in case your baby bites through one. For babies older than 1, you can offer chilled soft fruit like banana or berries in a mesh feeder, but avoid hard foods that pose a choking risk.
For pain that’s clearly interfering with sleep or feeding, infant acetaminophen is an option for babies 8 weeks and older, and infant ibuprofen can be used for babies 6 months and older. Both are dosed by weight rather than age. Follow the dosing instructions on the package, and don’t combine or alternate the two without guidance from your pediatrician.
What to Avoid
The FDA warns against using any topical numbing gels or liquids containing benzocaine or lidocaine on infants’ gums. These products offer little actual benefit for teething and carry serious risks. Benzocaine can trigger a condition where the blood’s ability to carry oxygen drops dangerously low. Lidocaine solutions, if accidentally swallowed or over-applied, can cause seizures, heart problems, and severe brain injury. The FDA’s warning extends to homeopathic teething tablets as well.
Amber teething necklaces are another product to skip. The claimed mechanism is that body heat releases a pain-relieving compound called succinic acid from the amber beads. None of that holds up. Succinic acid only releases from amber at temperatures near 392°F, nowhere close to skin temperature. Even if it did release, there’s no evidence it gets absorbed through skin, and no evidence it relieves pain. What is well-documented is the strangulation risk. Multiple children have been strangled by amber teething necklaces, and the American Academy of Pediatrics strongly warns against them.
Caring for New Teeth
Start cleaning your baby’s teeth as soon as the first one appears. Use a soft-bristled infant toothbrush with a smear of fluoride toothpaste about the size of a grain of rice. That tiny amount is safe to swallow and effective at protecting enamel. Continue using this rice-grain amount until age 3.
Schedule your baby’s first dental visit by their first birthday, or within six months of the first tooth appearing, whichever comes first. This early visit is less about treatment and more about checking that teeth are developing normally and getting personalized guidance on oral care.