Teething Disease

DESCRIPTION

Teething is the eruption of the deciduous teeth which most children experience without difficulty. It is a natural, gradual and predictable process but the timetable varies from baby to baby.

Deciduous teeth
- Most deciduous teeth begin to erupt at 5–7 months of age and teething is completed by 2–3 years
- The mandibular central incisors erupt first, then the two or four maxillary incisors followed by the lower lateral incisors
- After a few months, the four molars appear (lower ones at 12 months, the upper ones at 14 months)
- After the cuspid teeth appear at 16–18 months of age the second molars erupt at 25–33 months
- About 25% of normal babies may have delayed eruption of teeth until 4 or 6 teeth simultaneously appear after their first birthday
- Premature babies erupt teeth according to their gestational age rather than chronological age. If teething seems particularly delayed, refer patient to a pediatric dentist.
Teeth in neonates
- One in 2000 neonates are born with a tooth (appears to be familial)
- These neonatal teeth may be loose but most are the normal deciduous lower central incisors and can persist
- Mild ulceration in the sublingual area has been reported in 18% of these babies
- Because of the potential for aspiration there is some controversy about elective removal of the loose teeth (most pediatric dentists would remove these teeth if they are loose)
System(s) affected: Gastrointestinal
Genetics: N/A
Incidence/Prevalence in USA: N/A
Predominant age: Birth to 2 1/2 years
Predominant sex: N/A

SIGNS AND SYMPTOMS

A large percent of babies have no signs or symptoms of teething
Excessive drooling and chewing on fingers begins at 3–4 months of age. This is also the time that normal hand-mouth stimulation increases salivation.
A small red or white spot may appear over the swollen gum just prior to tooth eruption
Local inflammation, swelling, and occasional hemorrhage can be found on the involved gums
Discomfort may be noted more with the eruption of the first tooth, the molars, and/or with the simultaneous eruption of multiple teeth
Restlessness, irritability, disturbed sleep, changes in feeding patterns, nasal discharge, mild cough, chin rash, fever, diarrhea, pulling of ear, and rubbing of the cheeks have been reported by parents. It is impossible to document that these are caused by teething, so parents and health providers should consider other possible etiologies so as not to miss or delay diagnosing an illness.

CAUSES

N/A

RISK FACTORS

N/A

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Treatment for teething includes reassurance for the parents and symptomatic relief, if needed
Provide the infant with a safe, one-piece teething ring, clean cloth, or pacifier for gumming
Rub the involved swollen gums if the baby appears to be comforted
Cool fluids may be offered but avoid frozen foods or objects, as these could cause thermal damage to the tissues
Toast, cookies, bagels, and crackers are offered by some parents for teething, but parents must observe carefully to prevent choking
Avoid over-the-counter preparations for teething such as lidocaine (Xylocaine) 2%, Baby Ora-Gel, Num-zit Gel, Num-zit Liquid, and Ambesol. Misuse, overuse, and sensitivity have been reported.
Avoid the use of alcohol
For infants with low-grade fever, irritability, and/or inflamed gums (when other comforting measures have not been helpful), acetaminophen in proper doses (10–15 mg/kg/dose every 4 hours as needed) can be used intermittently
Gum hematomas that erupt appear as a blue cyst. Most do not require medical intervention. Ensure there are no other signs of a bleeding disorder.
Breastfeeding babies may attempt to chew on the nipple at the end of sucking while teething but can be taught not to bite. Breastfeeding can continue after teeth are present.
Advise parents to avoid: sugared pacifiers, painted furniture which may contain lead, tying a teething ring with a cord around the infant's neck, and imported fluid-filled teething rings

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No special diet

PATIENT EDUCATION

Parents should be cautioned not to misinterpret teething as the cause of any systemic manifestation. A health provider should be consulted for any systemic complaints.
The ABC's of Teething, American Academy of Pediatric Dentistry, Public Relations Manual

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

N/A

EXPECTED COURSE AND PROGNOSIS

Normal progression through the teething process without illness

ASSOCIATED CONDITIONS

N/A

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.