para>Over-the-counter preparations for teething, such as lidocaine (Xylocaine 2%), or benzocaine (Baby Ora-Gel, Num-Zit Gel, Num-Zit Liquid, Baby Anbesol) should be AVOIDED. Misuse, overuse, toxicity, and sensitivity have been reported. ‚
- These are of questionable benefit because they are washed off quickly by saliva, and the benefit may be due in part to the pressure placed on the gingivae when applied.
- FDA issued a warning about possible serious harm, to include death (15)[A].
ISSUES FOR REFERRAL
- Parents should establish a dental home for infants by 12 months of age. Dental caries remain the most prevalent infectious disease in children in the United States. Preventative care and anticipatory guidance offered in a dental home help prevent early childhood caries (16)[A].
- Other medical problems may delay tooth eruption. It is reasonable to refer a child who has not erupted a tooth by 18 months of age to a dentist, if he or she is not seeing one already (5)[C].
ADDITIONAL THERAPIES
Infants who bite or chew while breastfeeding can be trained not to bite by withdrawing the child from the breast for a moment, and then resume. Resist urge to startle the infant. ‚
COMPLEMENTARY & ALTERNATIVE MEDICINE
Homeopathy is used to treat teething. Chamomilla is one reported treatment, but no efficacy or safety studies have been published (17)[C]. ‚
INPATIENT CONSIDERATIONS
Admission Criteria/Initial Stabilization
Outpatient ‚
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
No restrictions ‚
DIET
Breastfeeding can continue during and after teething. Otherwise, no special diet required. ‚
PATIENT EDUCATION
- Parents should be cautioned not to misinterpret teething as the cause of any systemic manifestation. The health provider should be consulted for any systemic complaints.
- American Dental Association, Mouth Healthy Web site: http://www.mouthhealthy.org/en/babies-and-kids/
- Teething Tots: http://kidshealth.org/parent/pregnancy_newborn/common/teething.html
PROGNOSIS
Normal progression through the teething process without illness ‚
COMPLICATIONS
Dental caries are a common childhood illness and can be prevented with fluoride use. Current guidelines recommend the following: ‚
- Use of fluoridated toothpaste for all children beginning with first tooth eruption.
- Use of fluoride varnish every 3 to 6 months after first tooth eruption.
- Dietary fluoride supplements if fluoride is not present in the drinking water (18)[A]
REFERENCES
11 Aktoren ‚ O, Tuna ‚ EB, Guven ‚ Y, et al. A study on neonatal factors and eruption time of primary teeth. Community Dent Health. 2010;27(1):52 " “56.22 Cunha ‚ RF, Boer ‚ FA, Torriani ‚ DD, et al. Natal and neonatal teeth: review of the literature. Pediatr Dent. 2001;23(2):158 " “162.33 Kobayashi ‚ TY, Gomide ‚ MR, Carrara ‚ CF. Timing and sequence of primary tooth eruption in children with cleft lip and palate. J Appl Oral Sci. 2010;18(3):220 " “224.44 Sajjadian ‚ N, Shajari ‚ H, Jahadi ‚ R, et al. Relationship between birth weight and time of first deciduous tooth eruption in 143 consecutively born infants. Pediatr Neonatol. 2010;51(4):235 " “237.55 Stellzig-Eisenhauer ‚ A, Decker ‚ E, Meyer-Marcotty ‚ P, et al. Primary failure of eruption (PFE) " ”clinical and molecular genetics analysis [in English, German]. J Orofac Orthop. 2010;71(1):6 " “16.66 Noor-Mohammed ‚ R, Basha ‚ S. Teething disturbances: prevalence of objective manifestations in children under age 4 months to 36 months. Med Oral Patol Oral Cir Bucal. 2012;17(3):e491 " “e494.77 Tighe ‚ M, Roe ‚ MF. Does a teething child need serious illness excluding? Arch Dis Child. 2007;92(3):266 " “268.88 Feldens ‚ CA, Faraco ‚ IM, Ottoni ‚ AB, et al. Teething symptoms in the first year of life and associated factors: a cohort study. J Clin Pediatr Dent. 2010;34(3):201 " “206.99 Macknin ‚ ML, Piedmonte ‚ M, Jacobs ‚ J, et al. Symptoms associated with infant teething: a prospective study. Pediatrics. 2000;105(4, Pt 1):747 " “752.1010 Wake ‚ M, Hesketh ‚ K, Lucas ‚ J. Teething and tooth eruption in infants: a cohort study. Pediatrics. 2000;106(6):1374 " “1379.1111 Kiran ‚ K, Swati ‚ T, Kamala ‚ BK, et al. Prevalence of systemic and local disturbances in infants during primary teeth eruption: a clinical study. Eur J Paediatr Dent. 2011;12(4):249 " “252.1212 Plutzer ‚ K, Spencer ‚ AJ, Keirse ‚ MJ. How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial. Child Care Health Dev. 2012;38(2):292 " “299.1313 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 " “95.1414 McIntyre ‚ GT, McIntyre ‚ GM. Teething troubles? Br Dent J. 2002;192(5):251 " “255.1515 U.S. Food and Drug Administration. FDA Drug Safety Communication: FDA recommends not using lidocaine to treat teething pain and requires new Boxed Warning. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm. Published June 26, 2014. Updated October 9, 2014.1616 American Academy of Pediatric Dentistry. Clinical Affairs Committee " ”Infant Oral Health Subcommittee. Guideline on infant oral health care. Pediatr Dent. 2012;34(5):148 " “152.1717 Thompson ‚ EA, Bishop ‚ JL, Northstone ‚ K. The use of homeopathic products in childhood: data generated over 8.5 years from the Avon Longitudinal Study of Parents and Children (ALSPAC). J Altern Complement Med. 2010;16(1):69 " “79.1818 Clark ‚ MB, Slayton ‚ RL, Segura ‚ A, et al. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014;134(3):626 " “633.
ADDITIONAL READING
- American Academy of Pediatrics. Children 's Oral Health Web site: http://www2.aap.org/commpeds/dochs/oralhealth/index.html.
- American Academy of Pediatrics Oral health initiative. Protecting all children 's teeth (PACT): a pediatric oral health training program: http://www2.aap.org/oralhealth/pact/pact-home.cfm.
- Williams ‚ GD, Kirk ‚ EP, Wilson ‚ CJ, et al. Salicylate intoxication from teething gel in infancy. Med J Aust. 2011;194(3):146 " “148.
CODES
ICD10
K00.7 Teething syndrome ‚
ICD9
520.7 Teething syndrome ‚
SNOMED
- 8004003 teething syndrome (disorder)
- 247349000 painful teething (finding)
CLINICAL PEARLS
- Parents and caregivers should follow the American Academy of Pediatrics ' recommendations for treating teething pain.
- Use a teething ring chilled in the refrigerator (not frozen).
- Gently rub or massage the child 's gums with your finger to relieve the symptoms.
- Topical pain relievers and medications that are rubbed on the gums are not necessary or even useful because they wash out of the baby 's mouth within minutes, and they can be harmful.
- Teething may cause discomfort but does not cause significant fevers.
- Teething babies can still breastfeed. Babies can be taught not to bite, and breastfeeding may continue past 12 months of age without difficulty.