Teething: Timeline, Symptoms, and Safe Soothing

—————————————————————-

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 genuinely dangerous, and the actual evidence is more reassuring than the internet suggests. This guide is educational and is not a substitute for advice from your pediatrician, who knows your child.

What Teething Actually Is

Teething is the eruption of the 20 primary (deciduous) teeth through the gums, usually beginning with the lower central incisors and ending around age 2–3 with the second molars. The pressure of 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 involves 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 produce specific, predictable symptoms in any individual baby, and symptoms vary a great deal from child to child.

Teething Timeline Month by Month

While babies vary, the typical eruption pattern follows a fairly 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 about 18 months, or a first tooth before 3 months — is worth a check-in with the pediatrician or pediatric dentist, though most variation is normal and not a cause for alarm.

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, a mild rise in temperature (rarely above 100.4°F / 38°C), and decreased appetite for solid food. A 2016 systematic review in Pediatrics found a mild temperature elevation but no true fevers attributable to teething.

What teething does not reliably cause: high fever (over 100.4°F), diarrhea, vomiting, a 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 brushed off as “just teething” — they may signal an infection or another illness. 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. Good 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 — the AAP specifically recommends rubbing the gums with a clean finger. For older infants already eating solids, chilled (not frozen) soft foods such as cucumber or banana pieces can provide relief, but only with close, constant supervision because of the choking risk.

If discomfort clearly interferes with sleep or feeding, the AAP notes that occasional infant acetaminophen (for infants over 2 months) or ibuprofen (for those over 6 months) can be used at appropriate weight-based doses, usually at bedtime rather than around the clock. Infant drop concentrations vary by brand and formulation, and dosing errors in infants can be dangerous, so always confirm the correct product and dose with your pediatrician or pharmacist before giving any medication. Do not use adult products or guess the dose.

What to Avoid

Several traditional teething remedies are now considered unsafe, and this is the most important section for safety. The FDA warns against benzocaine teething gels and liquids (Orajel and similar over-the-counter numbing products) for children younger than 2, because of the risk of methemoglobinemia — a rare but potentially life-threatening blood disorder that reduces how much oxygen the blood can carry. The FDA has linked benzocaine teething products to serious cases and deaths in young children and asked manufacturers to stop marketing them for teething in this age group. Methemoglobinemia has been reported even at low benzocaine concentrations, so the safest choice is to avoid these products in babies and toddlers entirely.

The FDA has also cautioned against homeopathic teething tablets and gels; certain products were found to contain inconsistent, potentially unsafe amounts of belladonna (a toxic substance), and some Hyland’s homeopathic teething products were recalled after reports that included seizures. Do not use them.

Avoid amber teething necklaces and any beaded teething necklaces (amber, wood, marble, or silicone). The FDA and AAP warn that these pose real strangulation and choking hazards, and there is no credible evidence they relieve pain — the risk is serious and the benefit is unproven. Also skip frozen (rather than refrigerated) teethers, which can damage or burn gum tissue, and avoid hard teething biscuits or crackers in young infants because of choking risk and added sugar. The AAP HealthyChildren guidance summarizes the safe options.

Caring for the First Teeth

Once the first tooth erupts, dental care begins. The American Academy of Pediatric Dentistry and the 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 sugary 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 left on already-erupted teeth) should be wiped or brushed off.

When Teething Isn’t the Real Issue

The most common and consequential parenting mistake is attributing infection symptoms to teething and delaying care. Ear infections, urinary tract infections, viral illnesses, and occasionally 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 — treat them as something other than teething and check in with your pediatrician.

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 the same day or seek emergency care if your infant has a rectal temperature of 100.4°F (38°C) or higher and is under 3 months old, a temperature above 102°F at any age, persistent vomiting, signs of dehydration (dry mouth, fewer than 4–6 wet diapers in 24 hours, a sunken soft spot), unusual lethargy or difficulty waking, trouble breathing, or a seizure. Do not assume these are teething symptoms — they are not.

Frequently Asked Questions

Can teething cause a fever?

Teething can cause a mild temperature elevation — rarely above 100.4°F (38°C). A true fever (100.4°F rectal or higher in a young infant, or 102°F or higher in older children) suggests illness, not teething, and should be evaluated. A fever in a baby under 3 months always warrants prompt medical attention.

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 usually resolves with gentle wiping and a bland barrier ointment such as petroleum jelly.

How long does teething pain last for each tooth?

Studies suggest roughly 4 days of mild discomfort per tooth — typically about 2 days before eruption, the day of, and a day after. Pain that lasts noticeably longer or is severe usually has another cause and is worth discussing with your pediatrician.

Are teething necklaces safe?

No. The FDA has warned against amber, wood, marble, and silicone teething necklaces because of strangulation and choking risks, and there is no credible evidence they relieve pain. Do not use them, including “wear-only” amber necklaces.

Is benzocaine gel (like Orajel) safe for my baby’s gums?

No. The FDA advises against benzocaine teething products in children under 2 because of the risk of methemoglobinemia, a rare but serious blood disorder. Use cold, pressure, and gum massage instead, and ask your pediatrician about weight-based acetaminophen or ibuprofen if needed.

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 or beaded necklaces — they are unsafe, unproven, or both. If your baby seems sicker than fussy — high fever, vomiting, diarrhea, lethargy, or trouble breathing — call your pediatrician rather than blame the gums. And book that first dental visit by the first birthday.

Sources

• American Academy of Pediatrics — HealthyChildren.org teething and tooth-care guidance
• U.S. FDA — safety communications on benzocaine teething products (risk of methemoglobinemia in children under 2) and on homeopathic teething tablets and gels
• AAP News and AAFP — coverage of the FDA benzocaine teething warning
• Pediatrics (2016) — systematic review of signs and symptoms associated with primary tooth eruption
• American Academy of Pediatric Dentistry — first dental visit by age 1 recommendation