Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Teething gets blamed for most things that happen to a baby between four months and two years, and about half of them are nothing to do with it. That matters, because the "it's just teething" explanation can hide an ear infection or a fever that needs looking at. Here's when teething really starts, what it really does, and what genuinely helps, from a chilled ring to the gels a pharmacist can sell from five months.
When do babies start teething?
Most babies cut their first tooth at around 6 months, but the normal range is wide: some start before 4 months, some not until after their first birthday, and a few are born with a tooth. Gums often look swollen and babies often dribble and chew for weeks before anything appears, so "teething" can seem to go on far longer than the teeth suggest. There's no link between early teeth and development; late teeth run in families and are rarely a problem.
What order do baby teeth come in?
Bottom before top, front before back, in matching pairs. By two and a half to three years most children have all 20 milk teeth.
| Teeth | Usual age |
|---|---|
| Bottom front two (central incisors) | 5 to 7 months |
| Top front two (central incisors) | 6 to 8 months |
| Top lateral incisors, either side of the front two | 9 to 11 months |
| Bottom lateral incisors | 10 to 12 months |
| First molars (back teeth) | 12 to 16 months |
| Canines (the pointed ones) | 16 to 20 months |
| Second molars | 20 to 30 months |
The molars are the ones that upset babies most; they're broad, they take longer to push through, and they arrive when a toddler can tell you about it.
Teething symptoms: what it really causes
A sore, red, swollen gum where the tooth is coming; one flushed cheek; rubbing the ear on that side; more dribbling than usual, and a teething rash (a red, chapped patch on the chin, cheeks and neck where the dribble sits); gnawing on everything within reach; and being fretful, clingy and harder to settle at night for a few days. A mild rise in temperature, under 38°C, is possible.
What isn't a teething symptom
This is the part worth remembering. Teething does not cause a fever of 38°C or more, diarrhoea, vomiting, a cough, a rash on the body, or a baby who won't feed for a whole day. Those are signs of an illness that has happened to coincide with a tooth, and they should be treated as such. A baby under 3 months with a temperature of 38°C or above, or a baby of 3 to 6 months with 39°C or above, needs to be seen the same day.
How long does teething last?
Each tooth tends to cause a few days of grumbling before it breaks through and a day or two after, then things settle until the next one. Across the whole set that's an on-and-off process of about two years, but it's rarely bad for more than a week at a stretch. If your baby has been miserable for longer than that with no tooth to show for it, look for another cause.
What helps: start without medicine
Pressure and cold work on a sore gum, and they have no dose limit. Offer a teething ring chilled in the fridge, never the freezer (frozen rings can bruise gums); a clean cold flannel to chew; and for babies on solids, cool soft foods such as chilled cucumber, banana or a cold spoon of yoghurt, supervised. Gently rubbing the gum with a clean finger is remarkably effective. Wipe dribble often and use a thin layer of a barrier cream at night to prevent the rash. Extra cuddles and distraction do more than parents expect. Skip amber necklaces and bracelets, which are a strangulation and choking risk with no evidence behind them, and note that homeopathic teething powders and granules have not been shown to work.
Teething gels: which ones, from what age
Gels that numb the gum contain lidocaine, a local anaesthetic, and since 2018 they've been pharmacy-only medicines for babies from 5 months. Calgel and Anbesol Teething Gel are the two we stock; both are sugar-free, both are rubbed on with a clean fingertip in a pea-sized amount, and both have a maximum number of applications a day printed on the pack that you should stick to. Don't use them just before a feed, because a numb tongue makes swallowing clumsy. Our pharmacist will ask your baby's age at checkout. For younger babies, Ashton & Parsons Teething Gel is a drug-free soothing gel that can be used from 3 months. Adult mouth-ulcer gels such as Bonjela are not for children under 16, because they contain a salicylate related to aspirin. Everything is in our teething range.
Calpol and Nurofen for teething
If a tooth is clearly making your baby miserable and the drug-free steps aren't enough, a dose of sugar-free infant paracetamol (from 2 months and over 4kg) or infant ibuprofen (from 3 months and over 5kg) is reasonable, at the dose for their age on the pack. Use the syringe, not a spoon, and don't give both routinely "to be safe"; use one, and only for the bad days. Our Calpol dose by age guide has the numbers.
Looking after the new teeth
Start brushing as soon as the first tooth appears: twice a day, a smear of fluoride toothpaste (at least 1,000ppm fluoride), with you doing the brushing. Take your baby to the dentist by their first birthday, which is free on the NHS, so they get used to the chair. Avoid sugary drinks in bottles and don't dip dummies in anything sweet, as the milk teeth hold the space for the adult ones and decay in them is painful and common.
When to call a GP or 111
Call if your baby has a temperature of 38°C or more and is under 3 months, or 39°C or more at 3 to 6 months; is floppy, unusually drowsy or inconsolable; has a rash that doesn't fade when a glass is pressed on it; is having far fewer wet nappies; is pulling at one ear with a fever (likely an ear infection, not a tooth); or has been off their feeds for more than a day. For anything you're unsure about, our pharmacist is a good first call.
Frequently asked questions
Can teething cause a fever?
A slight rise, below 38°C, yes. A true fever of 38°C or above is not teething and needs looking at, especially in a baby under 6 months.
Can I use teething gel and Calpol together?
Yes, they work in different ways, but keep both to the pack limits and don't use a lidocaine gel under 5 months.
What is a teething rash and how do I treat it?
A dribble rash on the chin and neck. Wipe gently, pat dry, and apply a barrier cream; it clears when the dribbling eases.
Do teething powders work?
Homeopathic teething powders and granules have not been shown to work in trials. They are unlikely to do harm, but they are not a treatment; cold, pressure and, from 5 months, a lidocaine gel are what the evidence supports.
Why is my baby pulling their ear?
Gum pain is felt in the ear on the same side, so ear rubbing while teething is common. Ear pulling with a fever, crying when laid flat, or fluid from the ear is more likely an ear infection and should be checked.