Is Teething Painful? Why It Hurts and How to Help

Teething is painful for many babies, though not all of them and not to the same degree. In one large study, roughly a third of infants showed signs of pain during tooth eruption, which means the majority got through it with only mild fussiness or none at all. The discomfort is real, rooted in physical changes happening inside the gum tissue, but the experience varies far more than most parenting advice suggests. What parents attribute to teething and what the evidence actually supports are often two different things, and the gap matters when deciding how to help.

Why Teething Hurts

A baby’s primary teeth begin forming in the jaw well before birth. When it comes time for a tooth to emerge, it moves upward (or downward, for upper teeth) through the bone and then through the soft gum tissue covering it. This process involves the release of inflammatory chemicals in the gum as cells break down to create a path for the tooth. The tissue becomes swollen, red, and tender in the days surrounding eruption. Babies respond to this the way they respond to any localized irritation: by drooling more, chewing on things, and sometimes crying or refusing to eat.

The pain tends to be most noticeable right around the day the tooth breaks through the surface. A clinical trial that tracked body temperature and symptoms day by day found that measurable changes peaked on the day of eruption itself, with the day before and after showing significantly less disturbance.

Not every tooth causes the same level of trouble. Broader, flatter teeth like molars have to push through more tissue than narrow incisors, and many parents report that molar eruption is harder on their baby than the front teeth. But individual variation is enormous. Some babies cut multiple teeth at once with barely a whimper, while others seem distressed by a single incisor.

Which Teeth Come In First

Most babies get their first tooth between about six and ten months of age, though the range extends in both directions. The lower central incisors (the two bottom front teeth) almost always arrive first, followed by the upper central incisors. After that, the lateral incisors fill in on either side, then the first molars, canines, and finally the second molars, with the full set of twenty primary teeth usually in place by age two and a half to three.¹

This sequence matters because different phases of eruption seem to cause different levels of disruption. The early incisors are small and sharp, so they tend to cut through quickly. The first molars, arriving around twelve to sixteen months, have a wider surface and can cause more prolonged gum swelling. Canines, with their deep roots, are another commonly difficult stage. Parents who survived the first few teeth without much drama sometimes get blindsided when molars start coming in.

Separating Real Symptoms from Myths

This is where teething gets genuinely controversial. Parents and even some healthcare providers have long attributed a wide range of symptoms to teething: high fever, diarrhea, runny nose, rashes, ear pulling, and more. The evidence, however, supports a much shorter list.

Symptoms that studies consistently link to teething include gum irritation and swelling, increased drooling, a desire to chew or bite on things, mild fussiness, and disrupted sleep. A slight rise in body temperature on the day of eruption has been documented in clinical research, with one study measuring an average of about 36.7°C on eruption day, a small but statistically significant bump compared to surrounding days.² That same study found no correlation between fever as reported by mothers and actual temperature readings taken by investigators, suggesting parents tend to overestimate how warm their teething baby really is.

High fever, though, is a different story. A systematic review pooling data from multiple studies found no overall association between fever and primary tooth eruption.³ A slight temperature increase is not the same as a fever. Teething does not cause temperatures above 38°C (100.4°F), and a baby with a genuine fever, especially one who looks unwell, should be evaluated by a doctor rather than assumed to be “just teething.”⁴

Diarrhea is another commonly blamed symptom that lacks solid evidence. The timing coincidence is understandable: babies around six months are starting solid foods, putting everything in their mouths, and losing the passive immunity from maternal antibodies all at once. Infections are more common during this window regardless of whether teeth are coming in. Blaming diarrhea or a high fever on teething can delay recognition of a real illness, which is the practical reason this distinction matters.

What Makes Teething Worse for Some Babies

Research has identified a few factors that seem to increase how much pain and fever a baby experiences during teething. A study of early-life risk factors found that infants whose mothers were exposed to secondhand tobacco smoke during pregnancy had about a 35% higher rate of teething pain. When mothers both smoked actively and were exposed to secondhand smoke, the risk of teething pain in their children nearly doubled. Delivery by cesarean section was also associated with a higher risk of teething pain, with about a 27% increase.⁵

Infant temperament plays a role too. A survey of Australian parents found that parents who described their baby’s overall temperament as more “difficult” reported more distress during teething, and longer symptom duration per tooth correlated with higher parental distress as well.⁶ It is hard to untangle cause and effect here. A baby who is generally more reactive may respond more intensely to gum discomfort, or a parent who is already stressed may perceive more distress in their baby. Either way, the experience of teething is not purely biological. It is filtered through the baby’s disposition and the parent’s interpretation.

How to Soothe a Teething Baby Without Medication

The first line of relief should always be non-drug approaches, and the good news is that some of them work well. A systematic review of teething treatments found that among non-pharmacological methods, teething rings were the most effective option studied. In one trial, teething rings helped with drooling, sleep disruption, gum irritation, and crying in the majority of babies who used them.⁷

Chilling the teething ring in the refrigerator (not the freezer, which can make it hard enough to bruise gums) adds a mild numbing effect. Cold washcloths work on the same principle: the baby chews on the cloth, and the cold reduces inflammation at the gum surface. Some parents use a clean finger to gently massage the swollen area, which provides counter-pressure that many babies find soothing.

Solid teething foods for older babies, like chilled cucumber sticks or frozen fruit in a mesh feeder, give them something safe to gnaw on while also providing sensory distraction. The key with any chewable object is supervising use and choosing items that cannot break into small pieces.

When Pain Medication Makes Sense

For babies who are clearly uncomfortable despite non-drug measures, infant acetaminophen (paracetamol) or ibuprofen are the standard options. Ibuprofen is generally suitable from about six months of age, while acetaminophen can be used earlier. Both are effective at reducing mild to moderate pain and any slight temperature rise associated with eruption.

The two medications have different side-effect profiles. An analysis of adverse events reported to the FDA found that acetaminophen was associated with a higher rate of liver-related problems and nervous system effects compared to ibuprofen, while ibuprofen carried a higher rate of kidney-related issues and general administration-site reactions.⁸ At the low doses used for teething and the short duration most parents need them, serious adverse events from either drug are rare. The practical takeaway is to use the correct dose for the baby’s weight, avoid combining the two without medical advice, and not to rely on medication as the default for every fussy evening.

Acetaminophen remains by far the most commonly used teething remedy. In the Australian survey mentioned earlier, about 60% of parents reported using paracetamol for teething, while 55% used topical gels.⁶ Those topical gels, however, deserve a closer look.

Products That Are Not Worth the Risk

Several widely marketed teething products carry risks that outweigh any potential benefit. Parents should know which ones to avoid.

• Benzocaine gels: Over-the-counter oral numbing gels containing benzocaine (sold under brand names like Orajel for babies) can cause a serious condition called methemoglobinemia, where the blood loses its ability to carry oxygen effectively. Cases reported to poison control have included infants with dangerously elevated methemoglobin levels requiring emergency treatment with IV methylene blue and supplemental oxygen.⁹ The FDA has warned against using benzocaine in children under two.
• Homeopathic teething tablets: FDA laboratory testing found that some homeopathic teething tablets contained inconsistent and sometimes dangerously high amounts of belladonna, a toxic plant extract. The agency has warned consumers not to use these products on infants and children.¹⁰
• Amber teething necklaces: These are marketed with the claim that succinic acid from Baltic amber absorbs through the skin and provides anti-inflammatory relief. There is no peer-reviewed evidence supporting this mechanism or any clinical benefit. Meanwhile, the necklaces pose real risks of strangulation, choking if beads break off, and skin or oral infections.¹¹ Health Canada has issued explicit warnings about both strangulation and aspiration hazards.¹²

The pattern across all three is the same: a product with no credible evidence of effectiveness and a documented capacity to cause harm. Sticking with teething rings, cold cloths, and weight-appropriate doses of acetaminophen or ibuprofen when needed is both safer and better supported by research.

A Long History of Getting Teething Wrong

The modern warnings about benzocaine and belladonna are just the latest chapter in a centuries-long story of dangerous teething treatments. Hippocrates wrote about teething symptoms in ancient Greece. The Romans considered being born with teeth a sign of greatness. Soranus of Ephesus recommended rubbing the gums with olive oil and hare’s brain. In 1575, the French surgeon Ambroise Paré popularized lancing the gums with a blade to “help” teeth break through, a practice that persisted for centuries.¹³

By the 17th and 18th centuries, teething was actually listed as a cause of death in mortality records. This was not because teeth killed anyone; it was because serious infections happening to coincide with tooth eruption were misattributed to the teething process itself. The same confusion that leads modern parents to blame a 39°C fever on teething led historical physicians to blame fatal illnesses on it.

The 19th century brought teething syrups containing morphine and other opiates. Mrs. Winslow’s Soothing Syrup, one of the most popular, was marketed directly to mothers and caused overdose deaths in infants. It was not until the Pure Food and Drug Act of 1906 that these products began to be regulated in the United States.¹³ The arc from hare’s brain to morphine syrup to belladonna tablets is a reminder that the desire to soothe a crying baby has always outpaced the evidence for how to do it safely.

How Teething Reshapes the Mouth’s Ecosystem

One underappreciated consequence of teething has nothing to do with pain. The arrival of teeth fundamentally changes the microbial landscape inside a baby’s mouth. Before any teeth erupt, the oral microbiome is relatively simple, dominated by a single group of bacteria. A longitudinal study tracking infants from the pre-dentate stage through full eruption of the primary teeth found that Streptococcus made up over 60% of the oral bacteria before any teeth appeared but dropped sharply to about 26% once the first teeth arrived.¹⁴

Teeth create new surfaces and new niches. Hard enamel, gum crevices around the tooth base, and the small gaps between teeth all provide habitat for bacterial species that cannot colonize smooth gum tissue alone. The study found that microbial diversity changed dramatically during the eruption of the front eight incisors but stabilized after that. By the time all eight incisors were in, the basic structure of the baby’s oral microbiome was established and persisted through the rest of primary tooth eruption.¹⁴

This is relevant for parents in a practical way: the bacteria that colonize those early tooth surfaces include the species responsible for dental decay. Wiping a baby’s new teeth with a soft cloth or starting gentle brushing once teeth appear is not just about cleanliness. It is about shaping which bacteria get established in a mouth that is being colonized for the first time. The window during and just after the eruption of the incisors appears to be a particularly formative period for the oral microbiome, making early dental hygiene habits more consequential than many parents realize.

When to Call the Doctor

Most teething discomfort resolves on its own within a few days per tooth and does not require medical attention. But there are clear signals that something other than teething is going on. A rectal temperature above 38°C (100.4°F) is not caused by teething and warrants a call to the pediatrician. The same goes for persistent diarrhea, a rash that spreads beyond the chin area (drool rash around the mouth is common and harmless), lethargy, refusal to drink fluids, or symptoms that last more than a few days without any visible tooth emerging.

The biggest risk with teething is not the teething itself. It is the tendency to use teething as a catch-all explanation for symptoms that deserve investigation. A baby who is inconsolable, feverish, and off their feeds may well have an ear infection, a urinary tract infection, or a virus. Attributing all of that to teeth can cost time. When in doubt, it is always safer to have a baby evaluated and be told it is just teething than to wait it out and miss something treatable.