Teething!.....or maybe not....?

I frequently saw patients at work who told me at the 2 month well child check up about how their kiddo is already teething.  Sometimes this would come as excitement (ooh something new!), but most commonly parents seemed very distraught at the idea of having to deal with teething so soon.  And at the 4 month visit, it's one of the topics on everyone's mind.  One thing was for sure though, if a parent decided their child was teething, they were 100% absolutely sure that this was fact.  Attempting to disagree with teething progress hurt my relationship with the families I saw as they felt I didn't trust them or were trying to undermine them.  With time I learned to develop a different approach to addressing early teething and educate about the unlikely reality that teeth would be appearing any time soon because so many other exciting (well not to me, but maybe to you) changes are happening in the mouth first!

Above is my favorite guide to teething that I provide to parents.  By no means do teeth follow rules.  Some babies indeed will pop a tooth at 3 months, while others reach their birthday with gummy smiles still.  And some babies erupt teeth in the oddest of patterns with little regard for symmetry or the "correct" order.  But, this image does help give a concrete visual to parents as they try to observe what is happening in their own baby or toddler's mouth.  

But before the teeth.... drool!  And hands in the mouth!  And fussiness!  Some healthcare providers refer to this as "pre-teething".  I suspect this term was made up to appease the parents who came to appointments informing their provider that their child was teething, when in fact they were not.  At birth, only about half of the saliva glands are active, so while your baby's mouth should be moist or wet, they very rarely are slobbering all over you in the newborn stage (if they are, bring it up to your provider as in rare occasions that can indicate a smaller airway for a variety of reasons, making swallowing difficult).  The other half (ok, it's not really a 50/50 thing here, but for an easy to follow generalization I hope that you're all ok with this basic explanation) are turned on like a light switch around 3 months old.  So boom, drool.  Lots of it.  And with drool comes new sensations, so they put their hands in their mouth.  And then, oh my gosh what is this fantastic toy at the end of my arm that is in my mouth!  Chewing on fingers, putting EVERYTHING in the mouth, and some fussiness starts.  Why fussiness?  Because not all new sensations are pleasant.  

What about the white specks or lines you sort of see in their gums?  Well, when those saliva glands become active the gums naturally thin out a bit and sometimes the ridge of the gum's connective tissue can be seen.  This is a sign to look for to help gauge of the process of teething might be starting, but this is still at the early end of the spectrum.  When the teeth are actually coming, those gums will get very swollen, red, and tender to the touch.  Most kids don't readily open wide for you to take a look, so catch a glimpse when they are laughing, or crying (silver lining?), or better yet stick a clean finger in their and feel around.

When teeth cut through, you may see blood.  For some reason this note doesn't make it into most resources on teething, and a lot of healthcare providers forget to mention it too.  Some kids might spot a bit of blood, others (like mine) may bleed a lot, and still others might never bleed at all.  Often times I didn't know Ben was getting a tooth until we brushed his teeth and we had a bloody toothbrush to show for it.  Gross, I know, but being squeamish and being a parent don't go hand in hand so well, so I'm assuming you can all take that imagery.  

So when your kid starts drooling, you've reached the first step - saliva glands are activated!

When your kid starts sticking hands in the mouth - woohoo, I have hands!  They taste good and feel interesting in my mouth!

When you think the gums look funny and might have white underneath them - the saliva glands aren't blocked (hooray) and less fluid is stored in the mucosa tissue.

When you think the gums look swollen and red - teeth are finally coming!  But they could be here in days or weeks...be patient.

When a tooth cuts through - you may see blood, but your baby has near instant pain relief and life will soon be easier.

The whole process DOES last about 3-4 months from first drool to first tooth in most cases.  I don't care one bit if you refer to the whole process as teething, but if your doctor (hopefully gently) tries to correct you, at least now you know why.

And please, if your baby is in pain from teething, provide them relief!  You're not imagining anything, teething pain is worse at night.  This one has a pretty simple explanation behind it, there are no distractions in the middle of the night, so all of the focus goes to the pain.  I am a big fan of Motrin (over 6 months old) and Tylenol myself, but I know not all parents want to go that route initially.  My professional advice on amber teething necklaces is that there is not enough scientific evidence to support use.  But....my kid wears one, and anecdotal stories from parents are worth something to me too.  He drools less and is happier while he wears it, so placebo or not we stick with it.  Orajel scares me both personally and professionally - please don't use it.  The concept behind the product is to numb the area.  Well how can you guarantee that the saliva doesn't carry this to the back of the throat and numb the throat?  Huge choking hazard, and I have treated little ones who aspirated their own saliva and didn't have a cough reflex causing pneumonia.  Teething tablets...they contain a similar ingredient to the Orajel actually, so I'm not a huge supporter, but they don't seem to have as big of a risk.  My kiddo never took a pacifier, but I have heard from moms that they have had great success with making milk popsicles for their children using an ice cube tray and a pacifier.  Frozen waffles are favorites over here, as well as chewing/sucking on frozen washcloths.  If you have any other remedies for teething pain, please leave them in the comments.  I always ask parents what works for their family, and love to pass off that information to others who are struggling with the more common routes of treatment.  

Happy teething to you all!

Happy and wearing his amber necklace on the day tooth number 12 showed up