Quick Answer
Teething typically begins between 4 and 7 months, though the range of normal extends from as early as 3 months to as late as 12 months for the first tooth. Most babies have a full set of 20 primary teeth by around age 3. Teething causes genuine discomfort, and the most effective soothing strategies involve counter-pressure, cold, and distraction rather than medication. High fever, diarrhoea, and significant illness are not caused by teething and should be assessed by a healthcare provider rather than attributed to tooth eruption. This guide covers the teething timeline, signs to expect, what is and is not caused by teething, and evidence-supported soothing strategies.
The Teething Timeline
Primary teeth (also called baby teeth or milk teeth) typically erupt in a broadly predictable sequence, though the timing varies between individual children. The general sequence is:
- Lower central incisors (bottom front two teeth): 6 to 10 months, usually the first to appear
- Upper central incisors (top front two teeth): 8 to 12 months
- Upper lateral incisors (teeth either side of the top front two): 9 to 13 months
- Lower lateral incisors: 10 to 16 months
- First molars (upper and lower): 13 to 19 months
- Canines (upper and lower): 16 to 22 months
- Second molars (upper and lower): 25 to 33 months
The full set of 20 primary teeth is typically complete by around age 3. The molars and canines tend to cause more discomfort than the incisors due to their larger surface area breaking through the gum tissue. Significant individual variation is normal; a baby who cuts their first tooth at 4 months and one who cuts it at 12 months are both within the normal range.
Signs of Teething
Symptoms that are well supported by evidence as teething-related include:
- Increased drooling: Often begins 2 to 3 months before the first tooth appears and is one of the earliest and most consistent teething signs
- Gum swelling and sensitivity: The gum over the erupting tooth becomes visibly swollen, redder than surrounding tissue, and sensitive to touch
- Increased chewing and mouthing: Babies instinctively apply counter-pressure to the gum by chewing on fingers, toys, or anything within reach
- Irritability and unsettled behaviour: Pain and discomfort make babies harder to settle and more easily frustrated, particularly in the days immediately before and after a tooth breaks through
- Slightly disrupted sleep: The discomfort of active tooth eruption can cause more frequent night waking for a few days around the time a tooth is cutting through
- Mild temperature elevation: A very slight increase in body temperature (below 38 degrees Celsius) in the immediate days around tooth eruption has some evidence support, though it is modest
- Facial rash: Drool rash, a mild redness and chapping around the chin, cheeks, and neck caused by constant skin contact with saliva, is a common secondary effect of the increased drooling that accompanies teething
What Teething Does Not Cause
Research consistently shows that teething does not cause the following, despite them being commonly attributed to teething in popular belief:
- High fever (above 38 degrees Celsius or 100.4 degrees Fahrenheit): A significant fever is not a teething symptom. If your baby has a fever above this threshold, it should be assessed by a healthcare provider for another cause
- Diarrhoea or loose stools: While many parents observe loose stools during teething periods, controlled research has not established a causal relationship. Loose stools during teething are more likely related to increased hand-to-mouth behaviour that introduces pathogens, or to coincidental viral illness at a time of heightened immune development
- Significant respiratory symptoms: Runny nose and cough are not teething symptoms. They indicate a respiratory illness and should be assessed accordingly
- Vomiting
- Ear pulling accompanied by other illness signs: While babies do sometimes touch their ears when in jaw or gum pain, significant ear pulling with fever or other symptoms warrants assessment for ear infection rather than teething attribution
The risk of attributing these symptoms to teething is that other, treatable causes are missed or delayed. If your baby is unwell beyond mild irritability and drooling, consult your healthcare provider rather than assuming teething is the cause.
How to Soothe Teething Discomfort
Counter-Pressure
Applying firm, gentle pressure to the gum surface provides direct relief by counteracting the internal pressure of the erupting tooth. Options include:
- A clean finger rubbed firmly along the gum line, which gives immediate relief and is always available
- A chilled (not frozen) teething ring: the cold provides additional numbing and the firm surface delivers counter-pressure. Freeze-solid teething rings can be too hard and cold for sensitive gum tissue; refrigerate rather than freeze
- A chilled damp muslin or face cloth, which is particularly effective for younger babies who can grip and mouth fabric easily
Teething Toys
Silicone teething toys in a range of textures give babies something safe to chew on that satisfies the instinct to apply pressure to the gum. Look for teething toys that are large enough not to pose a choking risk, free from BPA and phthalates, easy to clean, and without small parts that could detach. Avoid amber teething necklaces, which carry a documented strangulation and choking risk and have no credible evidence of efficacy.
Distraction
On high-discomfort teething days, increased engagement through play, going out, or additional physical contact and carrying can distract the baby from gum discomfort effectively. The discomfort of teething is real but episodic; distraction is a legitimate and effective management strategy for the periods between more direct soothing interventions.
Pain Relief Medication
For significant teething discomfort, infant-appropriate pain relief (paracetamol or ibuprofen for babies over 3 months and 5kg, dosed according to weight) is safe and effective when used as directed. Pain relief is appropriate for the days of greatest discomfort around active tooth eruption and does not need to be reserved as a last resort. Consult your healthcare provider or pharmacist for appropriate dosing guidance for your baby's weight and age.
Topical teething gels containing lidocaine or benzocaine are not recommended for babies. The FDA and equivalent regulatory bodies in multiple countries have warned against their use in children under 2 due to risks of methemoglobinemia (a condition that reduces the blood's ability to carry oxygen) and other adverse effects. Homeopathic teething tablets and gels have also attracted regulatory warnings and are not recommended.
Breastfeeding and Bottle Feeding During Teething
Many babies seek more frequent feeds during teething periods, as the sucking action and closeness of feeding are both comforting. This is entirely normal and can be accommodated. Some breastfed babies bite during feeds as they seek gum counter-pressure; a firm, calm response (unlatching immediately and saying no, then relatching) is the standard approach. Most babies learn quickly that biting ends the feed.
For bottle-fed babies, the familiar sucking pattern of feeding is comforting during teething. The Emulait Classic Bottle is designed with a breast-shaped nipple that supports a natural, comfortable suck, which is particularly reassuring for a baby who is already experiencing gum discomfort.
Dental Care During Teething
Begin dental hygiene as soon as the first tooth appears. Use a soft-bristled infant toothbrush or a clean damp cloth to wipe the tooth surface twice daily. A rice-grain-sized amount of fluoride toothpaste is recommended from the first tooth by the American Academy of Pediatric Dentistry. The first dental visit is recommended by 12 months or within 6 months of the first tooth appearing, whichever comes first.
Key Takeaway
Teething typically begins between 4 and 7 months, starting with the lower central incisors, and is complete by around age 3. Genuine teething symptoms include drooling, gum swelling, increased chewing, irritability, and mild sleep disruption. High fever, diarrhoea, and significant illness are not caused by teething and require medical assessment. Soothe with chilled teething rings (refrigerated, not frozen), counter-pressure from a clean finger, silicone teething toys, and distraction. Use infant paracetamol or ibuprofen for significant discomfort. Avoid topical teething gels with lidocaine or benzocaine, homeopathic teething products, and amber teething necklaces. Begin tooth brushing as soon as the first tooth appears.
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This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your pediatrician or healthcare provider if your baby has a high fever, significant illness, or symptoms you are concerned about during teething.