The emergence of a baby’s first teeth, known as teething, is a normal developmental event. This milestone involves the movement of the tooth crown through the jawbone and the overlying gum tissue to become visible. The physical and behavioral changes that accompany this process can cause discomfort for the child. Understanding the signs that precede a tooth breaking through the surface helps parents anticipate this change.
The Typical Timeline of Tooth Eruption
The eruption of the first primary teeth typically begins when an infant is between four and seven months old. This timing varies significantly, with some children starting earlier or later. The usual sequence begins with the mandibular central incisors, the two bottom front teeth. Following these, the maxillary central incisors, or the top two front teeth, generally appear next. By the age of two and a half to three years, a child usually has all 20 of their baby teeth.
Visual Signs of Impending Eruption
The gums undergo several distinct changes just before a tooth cuts through the surface. The most common visual sign is localized swelling and redness of the gum tissue directly over the impending tooth. This inflammation occurs as the tooth crown pushes against the mucosal barrier, making the area appear visibly distended and tender. Parents may also observe an eruption cyst, a small, soft, fluid-filled blister on the gum line. If this cyst contains blood, it is called an eruption hematoma and appears as a bluish, purple, or dark-red lump; these are benign and usually rupture on their own.
Common Accompanying Symptoms
Beyond the visual changes in the mouth, the physical discomfort of the erupting tooth causes several behavioral and systemic symptoms. One noticeable sign is excessive drooling, which begins when pressure on the gums stimulates the salivary glands. This increased saliva often leads the child to gnaw or bite excessively on objects to counteract the deep pressure sensation in the gums. The discomfort can also lead to heightened irritability and fussiness, disrupting sleep patterns. While a slight elevation in body temperature is possible due to localized inflammation, this is typically not a true fever above 100.4°F (38°C).
When to Seek Medical Guidance
While teething is a normal process, certain symptoms should prompt a consultation with a pediatrician or pediatric dentist. A temperature that exceeds 100.4°F (38°C) is not considered a normal result of teething and suggests the presence of an unrelated infection or illness. Similarly, severe diarrhea, persistent vomiting, or a body rash that extends beyond the face should not be attributed solely to an erupting tooth. These signs indicate a possible concurrent illness, and a healthcare provider should evaluate them promptly. If a child has not developed any teeth by 12 to 18 months of age, this is considered a delayed eruption and warrants a dental examination.