Teething: Facts and Fiction
Teething is the process by which an infant's teeth sequentially appear by breaking through the gums. Though the process of teething is sometimes referred to as "cutting teeth", when teeth emerge through the gums they do not cut through the flesh. Instead, special chemicals are released within the body that causes some cells in the gums to die and separate, allowing the teeth to come through. Teething has long been regarded as an unpleasant experience for infants and their parents. Many parents, child carers and health professionals still believe that teething signs and symptoms and in particular, teething pain, should be managed.
Teething was known as "dentition difficilis," Latin for pathologic dentition or difficult dentition.
Even though teething is a normal part of infant development, surprisingly little is known about the causes and management of teething signs and symptoms. It is widely believed that pain and other discomfort associate with tooth eruption in infants should and can be managed by pharmacological and non-pharmacological means. Teething pain is the commonest symptom associated with the eruption of the primary dentition. Pain may result from elevation of inflammatory mediators in the crevicular fluid and in tissues surrounding the erupting tooth, which stimulate nociceptive receptors. Local pain maybe further exacerbated by rubbing or scratching the gingival tissues, by biting into hard objects, or by the presence of pathology such as eruption cysts. The eruption of primary teeth usually begins around 4-8 months of age with the eruption of the lower incisors, and is complete at around 30-36 months of age when second primary molars erupt. The timing of tooth eruption varies by as much as six months.
Signs and symptoms commonly attributed to teething:
For many people, teething is perceived to cause significant discomfort to infants and substantial distress to the parents. Disturbances are transient but may recur repeatedly during 4 to 36 months of age. Teething is associated with increased drooling, sucking of digits and rubbing of gingiva. Nevertheless, more recent prospective studies reveal that most systemic teething signs and symptoms (fever, vomiting, facial rashes, sleep disturbances, stool looseness, decreased appetite for liquids, and cough) are due to other causes. It is important to remember that during this same time period of an infant's life, passive immunity due to maternal antibodies wanes and exposure to a wide variety of childhood illnesses occurs. Due to this temporal relationship, teething often is blamed for symptoms such as changes in sleep and eating patterns, rhinorrhea, drooling, rash, fussiness, and diarrhea. Many of the historical misconceptions about teething and the related dangerous remedies persist. Because diarrhea with dehydration continues to be the leading cause of childhood mortality in developing countries, there is belief that teething causes diarrhea remains commonplace.
Management
The management of teething pain is most frequently sought teething advice today. Many teething remedies are implemented without the advice of a dental professional, but rather based on input from community nurses, friends, other mothers, self-help books, doctors and pharmacists. Pharmacological and non-pharmacological strategies are usually used in combination.
Pharmacological strategies for teething generally aim to achieve analgesia, anaesthesia, sedation or a combination of these. Â The conservative use of acetaminophen and ibuprofen can aid in the discomfort caused by teething. Â Benzocaine at a concentration of 20% gives temporary relief of pain on mucosal tissues. Â These local anaesthetics agents are found commonly in teething preparations.
Common non-pharmacological strategies against teething pain
1) Cooling
- Chewing of chilled teething rings, cold wet towels, chilled fruits and vegetables e.g. cucumber, Â Â Â carrot, apple
- Cooling of the gingival with cold compress, frozen peas, ice
- Wiping gingiva with alcohol
2)Rubbing
- Gingival massage using firm finger pressure
- Chewing of teething rusks, dry toasts, pacifiers
It is clear that parents find the symptoms of their children experience distressing. It is important to provide parents with information and simple management techniques, taking into an account the views of parents and the common belief in the existence of ‘teething' as an entity. It is equally important to inform parents that some symptoms should not be attributed to teething as they may have a more serious underlying cause, and to provide parents with information about normal developmental phases of early childhood.
Teething was known as "dentition difficilis," Latin for pathologic dentition or difficult dentition.
Even though teething is a normal part of infant development, surprisingly little is known about the causes and management of teething signs and symptoms. It is widely believed that pain and other discomfort associate with tooth eruption in infants should and can be managed by pharmacological and non-pharmacological means. Teething pain is the commonest symptom associated with the eruption of the primary dentition. Pain may result from elevation of inflammatory mediators in the crevicular fluid and in tissues surrounding the erupting tooth, which stimulate nociceptive receptors. Local pain maybe further exacerbated by rubbing or scratching the gingival tissues, by biting into hard objects, or by the presence of pathology such as eruption cysts. The eruption of primary teeth usually begins around 4-8 months of age with the eruption of the lower incisors, and is complete at around 30-36 months of age when second primary molars erupt. The timing of tooth eruption varies by as much as six months.
Signs and symptoms commonly attributed to teething:
- Agitation
- Bowel upset including diarrhoea,
- Constipation, loose stool
- Colic
- Convulsion
- Cough
- Croup
- Ear rubbing / pulling
- Excessive saliva and drooling
- Facial flushing
- Fever
- Inflamed / irritated gingiva
- Loss of appetite
- Malaise
- Malodorous urine
- Otitis media
- Painful gingiva / mouth
- Perioral rash
- Primary herpetic gingivostomatitis
- Respiratory problems including runny nose,
- Congestion, throat infection
- Restlessness
- Severe crying
- Skin rash
- Sleep disturbance
- Vomiting
- Wakefulness
- Weight loss
For many people, teething is perceived to cause significant discomfort to infants and substantial distress to the parents. Disturbances are transient but may recur repeatedly during 4 to 36 months of age. Teething is associated with increased drooling, sucking of digits and rubbing of gingiva. Nevertheless, more recent prospective studies reveal that most systemic teething signs and symptoms (fever, vomiting, facial rashes, sleep disturbances, stool looseness, decreased appetite for liquids, and cough) are due to other causes. It is important to remember that during this same time period of an infant's life, passive immunity due to maternal antibodies wanes and exposure to a wide variety of childhood illnesses occurs. Due to this temporal relationship, teething often is blamed for symptoms such as changes in sleep and eating patterns, rhinorrhea, drooling, rash, fussiness, and diarrhea. Many of the historical misconceptions about teething and the related dangerous remedies persist. Because diarrhea with dehydration continues to be the leading cause of childhood mortality in developing countries, there is belief that teething causes diarrhea remains commonplace.
Management
The management of teething pain is most frequently sought teething advice today. Many teething remedies are implemented without the advice of a dental professional, but rather based on input from community nurses, friends, other mothers, self-help books, doctors and pharmacists. Pharmacological and non-pharmacological strategies are usually used in combination.
Pharmacological strategies for teething generally aim to achieve analgesia, anaesthesia, sedation or a combination of these. Â The conservative use of acetaminophen and ibuprofen can aid in the discomfort caused by teething. Â Benzocaine at a concentration of 20% gives temporary relief of pain on mucosal tissues. Â These local anaesthetics agents are found commonly in teething preparations.
Common non-pharmacological strategies against teething pain
1) Cooling
- Chewing of chilled teething rings, cold wet towels, chilled fruits and vegetables e.g. cucumber, Â Â Â carrot, apple
- Cooling of the gingival with cold compress, frozen peas, ice
- Wiping gingiva with alcohol
2)Rubbing
- Gingival massage using firm finger pressure
- Chewing of teething rusks, dry toasts, pacifiers
It is clear that parents find the symptoms of their children experience distressing. It is important to provide parents with information and simple management techniques, taking into an account the views of parents and the common belief in the existence of ‘teething' as an entity. It is equally important to inform parents that some symptoms should not be attributed to teething as they may have a more serious underlying cause, and to provide parents with information about normal developmental phases of early childhood.
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