Commonly Asked Teething Questions Answered
by John Toth, M.D.
Question 1.) How do I tell the difference between teething and an ear infection?
Answer 1.) Ear tugging is not a reliable indicator of an ear infection as the nerve that goes to the ear also goes to the jaw. In my experience, teething is typically preceded by several days of drooling and gnawing whereas an ear infection is usually preceded by a cold. I have found that teething may be associated with low grade temperatures (never above 100.4F) while ear infections can be accompanied by a higher fever or no fever at all. The fussiness with teething varies throughout the day and is almost always worse at night or nap time when the infant is lying in their crib in a dark room with nothing to distract them. This is in contrast to the the pain of an ear infection which tends to be present throughout the day no matter what distractions are present. Possibly, paying attention to the above can save you from an office visit for teething, but know that the combination of teething plus a cold is always going to be difficult for you to judge at home. When in doubt, please schedule a non-urgent, next day ill visit for your infant.
Question 2.) How should I treat teething symptoms in my baby?
Answer 2.) Over the years a number of “traditional” treatments have fallen out of favor. Previous generations of parents have tried rubbing brandy or whiskey on the gums to soothe teething pain; however, no amount of alcohol is considered safe for infants, so please resist any urges you have to follow in this tradition. As of September 30, 2016 the FDA has issued a warning to consumers that homeopathic teething tablets and gels pose a risk to babies and children so I would advise you to remove these from your medicine cabinet. The FDA has further warned that readily available numbing gels or creams containing benzocaine shouldn’t be used on children under age two years without the guidance of a doctor. There are two reasons for this. First is the theoretical risk that the benzocaine may accidentally numb the throat and interfere with the gag reflex. Second is that benzocaine could cause methemoglobinemia which is a serious (but rare) condition where the amount of oxygen carried in the blood drops dangerously low. Safer options for managing teething pain are chilled but not frozen teething rings or safe toys made of rubber or cotton terrycloth. Occasional use of OTC pain relievers such as Acetaminophen or Ibuprofen (in those older than 6 months) may also be helpful. If all else fails, you could always try holding your baby as you rock them or sing to them.
Question 3.) When should I worry if my baby’s teeth haven’t come in yet?
Answer 3.) The average age for a first tooth to erupt is 6 months but they can come as early as 4 months. I see a fair number of kids whose first tooth erupts at 14-15 months. If no teeth have erupted by 18 months, this probably should be investigated and possibly referred to a pediatric dentist.
Question 4.) Should I be concerned that my baby’s fang teeth are coming in first?
Answer 4.) No, this is generally not something I would worry about. If I could give you a bit of advice though, it would be to avoid exposing your infant to direct sunlight, do not put garlic in their mesh feeder/teether, and be sure to encourage their love of counting!