Teething is the process of a baby’s first teeth pushing through the gums, typically starting between 6 and 12 months of age. It’s a normal developmental milestone, not a medical condition, but it can cause days of fussiness that leave parents searching for answers. Most babies will have all 20 primary teeth by age 3.
How Teeth Push Through the Gums
Teeth begin forming in the jaw long before they’re visible. Each tooth sits inside a protective sac called a follicle, surrounded by bone. As the root starts to develop, the follicle gradually breaks down the bone tissue above it, clearing a path upward. At the same time, pressure builds in the tissue around the root, pushing the tooth toward the surface. Once the tooth reaches the gum line, it pierces through the soft tissue and emerges into the mouth.
This process happens 20 separate times over roughly two years, which is why teething can feel like a never-ending phase. Each individual tooth typically causes discomfort for about 48 hours, peaking right around the time the tooth breaks through.
Which Teeth Come In First
The two bottom front teeth (lower central incisors) almost always arrive first, usually between 6 and 10 months. The two upper front teeth follow shortly after. From there, teeth generally fill in from front to back:
- Central incisors: bottom pair first, then top pair
- Lateral incisors: the teeth on either side of the front four
- First molars: the broader teeth further back in the mouth
- Canines: the pointed teeth between the incisors and molars
- Second molars: the very back teeth, usually the last to arrive
By age 2.5 to 3, most children have a complete set of 20 primary teeth. These stay in place until around age 6 or 7, when they begin falling out in roughly the same order they came in.
What Teething Looks and Feels Like
A prospective study tracking infants through the teething process found several symptoms that consistently showed up in the days surrounding tooth eruption. The most common signs include increased drooling, biting or chewing on objects, gum rubbing, irritability, and disrupted sleep. Some babies also rub their ears on the side where a tooth is coming in, develop a mild rash around the mouth or chin from excess drool, or temporarily lose interest in solid foods.
One of the most misunderstood symptoms is temperature. Teething can cause a slight rise in body temperature, but it stays below 100.4°F. Anything at or above 100.4°F is a true fever and is not caused by teething. Babies in the teething age range are also losing the immune protection they received from their mother and encountering new germs constantly, so it’s easy to blame an illness on teething when the two just happen to overlap. Diarrhea, vomiting, and high fevers are not teething symptoms.
Safe Ways to Ease the Discomfort
The simplest and most effective relief is pressure on the gums. You can rub your baby’s gums with a clean finger or a piece of damp gauze for about two minutes. The counter-pressure helps offset the sensation of the tooth pushing upward, and you can do this as often as your baby seems to need it.
Cold also helps. Chill a teething ring, a clean wet washcloth, or a pacifier in the refrigerator and let your baby gnaw on it. The cold numbs the gum tissue slightly and reduces inflammation. A few important details here: refrigerate these items, don’t freeze them. Frozen objects can actually cause frostbite on delicate gum tissue. For the same reason, skip ice and frozen pops for babies under 1. If you use teething rings, choose ones filled with distilled water rather than gel, since a new tooth can puncture the ring.
For babies older than 1, you can wrap a small piece of ice in a wet cloth and rub it along the gums, or offer chilled soft fruit like banana slices in a mesh feeder. Avoid hard foods that pose a choking risk.
Products to Avoid
The FDA has issued direct warnings against several popular teething products. Topical gels and creams containing benzocaine or lidocaine provide little to no benefit and carry serious risks. Benzocaine can trigger a condition where red blood cells lose their ability to carry oxygen effectively, which can be fatal. Lidocaine solutions, even prescription ones, can cause seizures, heart problems, and severe brain injury if too much is applied or accidentally swallowed. Homeopathic teething tablets have also drawn FDA concern.
Teething jewelry, including amber teething necklaces, has been linked to reports of strangulation and choking deaths. The beads can break free and become a choking hazard, and the necklace itself poses a strangulation risk during sleep or unsupervised play. There is no scientific evidence that amber releases any pain-relieving substance through skin contact.
Caring for New Teeth
Dental care should start before the first tooth even appears. From birth, you can gently wipe your baby’s gums with a clean, damp washcloth or gauze after feedings. This removes bacteria and gets your baby accustomed to having their mouth cleaned.
Once that first tooth breaks through, switch to a baby toothbrush with a rice-grain-sized smear of fluoride toothpaste, twice a day. When two teeth start touching each other, begin cleaning between them daily. At age 3, increase to a pea-sized amount of fluoride toothpaste and aim for two minutes of brushing. Most children need supervision with brushing until around age 6, when they can reliably spit out toothpaste instead of swallowing it.