Teething in infants: a structured review of symptomatology, parental misconceptions, and evidence-based management

Teething is a common developmental milestone in infants, typically occurring between six and thirty months of age. Although generally associated with localized discomfort, current literature indicates that teething is frequently misattributed as a cause of systemic symptoms such as fever and diarrhea. This review synthesizes findings from existing literature on teething symptomatology, clarifies commonly held misconceptions and highlights the risks associated with inappropriate management strategies. A structured literature review was conducted using predefined criteria to identify relevant publications, including systematic reviews, meta-analyses, cohort studies, observational studies and professional health guidelines published between 1990 and 2024. The review focused on teething-related symptoms, caregiver beliefs and intervention outcomes. Current evidence supports a consistent association between teething and mild, localized symptoms including irritability, drooling and gum inflammation. Inflammatory cytokines such as interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α), found in gingival crevicular fluid, suggest a localized immune response. There is no credible evidence linking teething to high fever or gastrointestinal disturbances. Misconceptions—rooted in both historical practice and persistent caregiver beliefs—have contributed to the use of potentially harmful remedies, such as topical anesthetics and teething necklaces. According to current literature, teething is a benign, self-limited process that warrants conservative management. Caregiver education remains critical to reducing the use of unsafe remedies and avoiding delays in the diagnosis of unrelated illnesses. Pediatric dental providers are uniquely positioned to correct misinformation and promote safe, evidence-based approaches to teething.

Teething; Syndrome; Pediatric; Dentistry; Management; Symptoms; Misconceptions; Inflammation; Infant

[1] American Academy of Pediatric Dentistry. Perinatal and infant oral health care. The Reference Manual of Pediatric Dentistry (pp. 318–322). American Academy of Pediatric Dentistry: Chicago, Ill. 2024.

[2] Massignan C, Cardoso M, Porporatti AL, Aydinoz S, Canto Gde L, Mezzomo LA, et al. Signs and symptoms of primary tooth eruption: a meta-analysis. Pediatrics. 2016; 137: e20153501.

[3] A Nemezio M, Mh De Oliveira K, C Romualdo P, M Queiroz A, Wg Paula-E-Silva F, Ab Silva R, et al. Association between fever and primary tooth eruption: a systematic review and meta-analysis. International Journal of Clinical Pediatric Dentistry. 2017; 10: 293–298.

[4] Wake M, Hesketh K. Teething symptoms: cross sectional survey of five groups of child health professionals. The BMJ. 2002; 325: 814.

[5] King DL, Steinhauer W, García-Godoy F, Elkins CJ. Herpetic gingivostomatitis and teething difficulty in infants. Pediatric Dentistry. 1992; 14: 82–85.

[6] Jaber L, Cohen IJ, Mor A. Fever associated with teething. Archives of Disease in Childhood. 1992; 67: 233–234.

[7] Noor-Mohammed R, Basha S. Teething disturbances; prevalence of objective manifestations in children under age 4 months to 36 months. Medicina Oral, Patologia Oral, Cirugia Bucal. 201; 17: e491–e494.

[8] Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics. 2000; 105: 747–752.

[9] Sood S, Sood M. Teething: myths and facts. Journal of Clinical Pediatric Dentistry. 2010; 35: 9–13.

[10] Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: a cohort study. Pediatrics. 2000; 106: 1374–1379.

[11] Memarpour M, Soltanimehr E, Eskandarian T. Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies. BMC Oral Health. 2015; 15: 88.

[12] Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Paiva SM. Prospective longitudinal study of signs and symptoms associated with primary tooth eruption. Pediatrics. 2011; 128: 471–476.

[13] Cunha RF, Pugliesi DM, Garcia LD, Murata SS. Systemic and local teething disturbances: prevalence in a clinic for infants. Journal of Dentistry for Children. 2004; 71: 24–26.

[14] Un Lam C, Hsu CS, Yee R, Koh D, Lee YS, Chong MF, et al. Early-life factors affect risk of pain and fever in infants during teething periods. Clinical Oral Investigations. 2016; 20: 1861–1870.

[15] Pereira TS, da Silva CA, Quirino ECS, Xavier Junior GF, Takeshita EM, Oliveira LB, et al. Parental beliefs in and attitudes toward teething signs and symptoms: a systematic review. International Journal of Paediatric Dentistry. 2023; 33: 577–584.

[16] World Health Organization. Oral health. WHO Fact Sheets. 2022. Available at: https://www.who.int/news-room/fact-sheets/detail/oral-health (Accessed: 19 March 2025).

[17] Shapira J, Holan G, Dishon T, Kupietzky A. Inflammatory cytokine levels in gingival crevicular fluid during eruption of primary teeth. Pediatric Dentistry. 2003; 25: 441–445.

[18] Abdulsatar FF, Amin M, Khalaf M, Al-Batayneh OB. Use of unsafe teething remedies in infants: a cross-sectional study. Journal of the Canadian Dental Association. 2022; 88: m7.

[19] National Health Service (NHS). Baby teething symptoms. 2022. Available at: https://www.nhs.uk/conditions/baby/babys-development/teething/baby-teething-symptoms/ (Accessed: 19 March 2025).

[20] Australian Dental Association (ADA). Terrible teething: soothing your teething tot. 2016. Available at: https://selfservice.ada.org.au/getattachment/Your-Dental-Health/Resources-for-Professionals/Resources-for-Children-0-11/Terrible-teething-soothing-your-teething-tot/Terrible-teething,-soothing-your-teething-tot.pdf.aspx (Accessed: 19 March 2025).

[21] Royal Australian College of General Practitioners (RACGP). Oral health. Guidelines for preventive activities in general practice. 2025. Available at: https://www.racgp.org.au/clinical-resources/clinical-guidelines/view-all-racgp-guidelines/preventive-activities-in-general-practice/miscellaneous/oral-health (Accessed: 19 March 2025).

[22] Canadian Paediatric Society (CPS). Healthy teeth for children. Caring for kids. 2021. Available at: https://caringforkids.cps.ca/handouts/healthy-living/healthy_teeth_for_children (Accessed: 19 March 2025).

[23] World Health Organization (WHO). International classification of primary care, Second edition (ICPC-2). 2003. Available at: https://www.who.int/standards/classifications/other-classifications/international-classification-of-primary-care (Accessed: 19 March 2025).

[24] Centers for Medicare & Medicaid Services (CMS). ICD-10-CM Diagnosis Code K00.7: teething syndrome. 2025. Available at: https://www.icd10data.com/ICD10CM/Codes/K00-K95/K00-K14/K00-/K00.7 (Accessed: 19 March 2025).

[25] Lunt RC, Law DB. A review of the chronology of eruption of deciduous teeth. The Journal of the American Dental Association. 1974; 89: 872–879.

[26] Tintinalli J. Emergency medicine: a comprehensive study guide. 6th edn. McGraw-Hill Professional: New York. 2004.

[27] Owais AI, Zawaideh F, Al-Batayneh OB. Challenging parental myths regarding their children’s teething. International Journal of Dental Hygiene. 2010; 8: 28–34.

[28] Drugs.com. Primary herpetic gingivostomatitis in children. 2025. Available at: https://www.drugs.com/cg/gingivostomatitis-in-children.html (Accessed: 23 March 2025).

[29] Zerr DM, Meier AS, Selke SS, Frenkel LM, Huang ML, Wald A, et al. A population-based study of primary human herpesvirus 6 infection. New England Journal of Medicine. 2005; 352: 768–776.

[30] McIntyre GT, McIntyre GM. Teething troubles? British Dental Journal. 2002; 192: 251–255.

[31] Markman L. Teething: facts and fiction. Pediatrics in Review. 2009; 30: e59–e64.

[32] Seward MH. General disturbances attributed to eruption of the human primary dentition. Journal of Dentistry for Children. 1972; 39: 178–183.

[33] Wilson PH, Mason C. The trouble with teething—misdiagnosis and misuse of a topical medicament. International Journal of Paediatric Dentistry. 2002; 12: 215–218.

[34] Ashley MP. It’s only teething… a report of the myths and modern approaches to teething. British Dental Journal. 2001; 191: 4–8.

[35] Kaur B. Awareness of parents towards teething. Bangladesh Journal of Medical Science. 2012; 11: 40–43.

[36] Arnos K. The complete teething guide: from birth to adolescence. 1st edn. Spirit Dance Publishing: California. 2003.

[37] Kute Keiki. Can teething cause fever? 2025. Available at: https://www.kutekeiki.com/teething/can-teething-cause-fever/ (Accessed: 23 March 2025).

[38] U.S. Food and Drug Administration. FDA drug safety communication: reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth. 2011. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-reports-rare-serious-and-potentially-fatal-adverse-effect-use-over (Accessed: 23 March 2025).

[39] Dally A. The lancet and the gum-lancet: 400 years of teething babies. The Lancet. 1996; 348: 1710–1711.

[40] Mersch J, Jacob D, Stöppler MC. Teething. 2024. Available at: https://www.medicinenet.com/teething/article.htm#medications (Accessed: 23 March 2025).

[41] Tsang AKL. Teething, teething pain and teething remedies. International Dentistry South Africa. 2010; 5: 48–61.

[42] Karri SK, Saper RB, Kales SN. Lead encephalopathy due to traditional medicines. Current Drug Safety. 2008; 3: 54–59.

[43] Dally A. The rise and fall of pink disease. Social History of Medicine. 1997; 10: 291–304.

[44] Elbur AI, Yousif MA, Albarraq AA, Abdallah MA. Parental knowledge and practices on infant teething, Taif, Saudi Arabia. BMC Research Notes. 2015; 8: 699.

[45] Kumar S, Tadakamadla J, Idris A, Busaily IA, AlIbrahim AY. Knowledge of teething and prevalence of teething myths in mothers of Saudi Arabia. Journal of Clinical Pediatric Dentistry. 2016; 40: 44–48.

[46] Kakatkar G, Nagarajappa R, Bhat N, Prasad V, Sharda A, Asawa K. Parental beliefs about children’s teething in Udaipur, India: a preliminary study. Brazilian Oral Research. 2012; 26: 151–157.

[47] El-Gilany AH, Abusaad FES. Mothers’ teething beliefs and treatment practices in Mansoura, Egypt. Saudi Dental Journal. 2017; 29: 144–148.

[48] Cranswick N. Over-the-counter medication in children: friends of foe? Australian Prescriber. 2001; 24: 149–151.

[49] Ige OO, Olubukola PB. Teething myths among nursing mothers in a Nigerian community. Nigerian Medical Journal. 2013; 54: 107–110.

[50] Alkhozaim DA, Al-Haj Ali SN, Farah RI. Levels and correlates of knowledge of teething among Saudi Arabian families. PeerJ. 2022; 10: e13948.

[51] HajiAhmadi M, Akhlaghi N, Aghajani F, Moshgelgosha H, Soltanian M. Comparison of information provided by pediatricians regarding tooth eruption and the information available on the internet. Dental Research Journal. 2021; 18: 6.

[52] Haznedaroglu E, Mentes A. The Internet versus pediatricians as a source of infant teething information for parents in Turkey. Clinics. 2016; 71: 430–434.

[53] Calcagno E, Barattini DF, Servetto R. Therapeutic approach to pediatric oral disorders. Minerva Pediatrics. 2018; 70: 175–181.

[54] Plutzer K, Spencer AJ, Keirse MJ. How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial. Child: Care, Health and Development. 2012; 38: 292–299.

[55] Baykan Z, Sahin F, Beyazova U, Ozçakar B, Baykan A. Experience of Turkish parents about their infants’ teething. Child: Care, Health and Development. 2004; 30: 331–336.

[56] Bankole OO, Lawal FB. Teething. International Quarterly of Community Health Education. 2017; 37: 99–106.

[57] Getaneh A, Derseh F, Abreha M, Yirtaw T. Misconceptions and traditional practices towards infant teething symptoms among mothers in Southwest Ethiopia. BMC Oral Health. 2018; 18: 159.

[58] Muthu MS, Vandana S, Akila G, Anusha M, Kandaswamy D, Aswath Narayanan MB. Global variations in eruption chronology of primary teeth: a systematic review and meta-analysis. Archives of Oral Biology. 2024; 158: 105857.

[59] DI Pierro F, Bertuccioli A, Donato G, Spada C. Retrospective analysis of the effects of a hyaluronic-based gum gel to counteract signs and symptoms of teething in infants. Minerva Pediatrics. 2022; 74: 101–106.

[60] Rosu S, Barattini DF, Murina F, Gafencu M. New medical device coating mouth gel for temporary relief of teething symptoms: a pilot randomized, open-label, controlled study. Minerva Pediatrics. 2023; 75: 514–527.

[61] Cochrane AL. Effectiveness and efficiency: random reflections on health services. Nuffield Provincial Hospitals Trust: London. 1972.