By a baby’s first birthday, most have between one and eight teeth visibly erupted — and quite a few cranky weeks behind them. Teething begins for most infants somewhere between 4 and 7 months, though a small minority cut their first tooth before 3 months or wait until after their first birthday. Despite being one of parenting’s most discussed milestones, much of the conventional advice is wrong, some of it is dangerous, and the actual evidence is more reassuring than the internet suggests.
What Teething Actually Is
Teething is the eruption of the 20 primary (deciduous) teeth through the gums, beginning with the lower central incisors and ending around age 2-3 with the second molars. The pressure from a tooth pushing through gum tissue causes localized inflammation, mild discomfort, and reflexive drooling and chewing. According to the American Academy of Pediatrics, teething is a normal developmental process — not an illness — and does not cause high fevers or severe systemic symptoms.
Each tooth’s eruption typically lasts about a week of mild discomfort: a few days before, the day of, and a couple of days after. Despite its reputation, teething does not reliably cause specific symptoms with high accuracy in any individual baby.
Teething Timeline Month by Month
While babies vary, the typical eruption pattern follows a predictable sequence. Lower central incisors appear at 6-10 months; upper central incisors at 8-12 months; upper lateral incisors at 9-13 months; lower lateral incisors at 10-16 months. First molars come in around 13-19 months, canines at 16-22 months, and second molars at 23-33 months.
By age 3, most children have a complete set of 20 primary teeth. Significant deviation — no teeth by 18 months, or first tooth before 3 months — warrants a check-in with the pediatrician or pediatric dentist, though most variation is normal.
Real Teething Symptoms vs Myths
Genuine teething symptoms documented in well-designed studies include mild gum swelling and tenderness, mild irritability, increased drooling, increased biting and chewing, mild rise in temperature (rarely above 100.4°F / 38°C), and decreased appetite for solid food. A 2016 systematic review in Pediatrics confirmed mild temperature elevation but no true fevers attributable to teething.
What teething does not cause: high fever (over 100.4°F), diarrhea, vomiting, rash other than mild drool rash on the chin, prolonged sleep disruption beyond a couple of nights, severe congestion, or ear pulling on its own. These symptoms in a teething-age infant should not be dismissed as “just teething” — they may signal an infection. Our guide to fever in children explains when to be more concerned.
Safe Ways to Soothe a Teething Baby
Cold pressure on the gums is the most reliably effective home remedy. Options include a chilled (not frozen) silicone or rubber teether, a clean, cool wet washcloth twisted and chilled in the refrigerator, or a refrigerated pacifier. Gentle gum massage with a clean finger also helps many babies. For older infants eating solids, chilled cucumber sticks or banana pieces (with supervision) provide both relief and nutrition.
If discomfort interferes with sleep or feeding, the AAP supports occasional acetaminophen for infants over 2 months and ibuprofen for those over 6 months at appropriate weight-based doses. Doses are typically given at bedtime rather than around the clock. Always confirm the dose with your pediatrician — concentration of infant drops varies by brand.
What to Avoid
Several traditional teething remedies are now considered unsafe. The FDA has issued warnings against benzocaine teething gels (Orajel and similar) for children under 2, due to the risk of methemoglobinemia — a rare but potentially fatal blood disorder. Homeopathic teething tablets containing belladonna were recalled in 2017 after reports of seizures.
The FDA and AAP also warn against amber teething necklaces — they pose strangulation and choking hazards and have no scientific evidence of pain relief. Frozen (not refrigerated) teethers can damage gum tissue. Avoid teething biscuits and crackers in young infants due to choking risk and added sugar. The AAP HealthyChildren guidance summarizes safe options.
Caring for the First Teeth
Once the first tooth erupts, dental care begins. The American Academy of Pediatric Dentistry and AAP recommend the first dental visit by age 1 or within 6 months of the first tooth, whichever comes first. Twice-daily brushing should begin with the first tooth using a soft infant toothbrush and a smear (rice-grain size) of fluoride toothpaste for children under 3.
Avoid putting babies to bed with a bottle of milk or juice. Pooled liquid on erupting teeth dramatically raises the risk of “baby bottle tooth decay,” a leading cause of early childhood caries. Water in a bottle is fine; anything with sugar (including breastmilk on already-erupted teeth) should be brushed off.
When Teething Isn’t the Real Issue
The most common parenting mistake is attributing infection symptoms to teething and delaying care. Ear infections, urinary tract infections, viral illnesses, and even more serious conditions can produce fussiness in this age group. If symptoms feel out of proportion to teething or include fever, true diarrhea, vomiting, decreased wet diapers, lethargy, or persistent crying that cannot be consoled, the symptoms are not teething.
For inconsolable crying patterns that started before tooth eruption, see our colic in babies guide. For broader pediatric concerns, our medical conditions library covers what to expect across infancy.
When to seek emergency care: Call your pediatrician same-day or seek emergency care if your infant has a rectal temperature of 100.4°F (38°C) or higher under 3 months of age, a temperature above 102°F at any age, persistent vomiting, signs of dehydration (dry mouth, fewer than 4-6 wet diapers in 24 hours, sunken fontanelle), unusual lethargy, or a seizure. Do not assume these are teething symptoms.
Frequently Asked Questions
Can teething cause a fever?
Teething can cause a mild temperature elevation — rarely above 100.4°F (38°C). True fever (over 100.4°F rectal in an infant or 102°F in older children) suggests illness, not teething, and should be evaluated.
Is excessive drooling a sign of teething?
Increased drooling around 3-4 months is normal and often precedes any visible tooth eruption. Drool rash on the chin is common and resolves with gentle wiping and bland barrier ointments like petroleum jelly.
How long does teething pain last for each tooth?
Studies suggest about 4 days of mild discomfort per tooth — typically 2 days before eruption, the day of, and 1 day after. Pain that lasts longer or is severe usually has another cause.
Are teething necklaces safe?
No. The FDA has warned against amber, wood, marble, and silicone teething necklaces because of strangulation and choking risks. There is no credible evidence they relieve pain.
The Bottom Line
Teething is a normal milestone, not a medical event. Cold, pressure, and patience handle most of it. Skip benzocaine gels, homeopathic tablets, and amber necklaces — they are either unsafe, unhelpful, or both. If your baby seems sicker than fussy — high fever, vomiting, diarrhea, lethargy — call your pediatrician rather than blame the gums. And book that first dental visit by the first birthday.