Teething is the natural process where a baby’s primary teeth push through the gums and emerge into the mouth. Every child is born with all twenty primary teeth already formed beneath the gums. The experience can be uncomfortable for infants, but understanding the visual signs and expected appearance of incoming teeth can provide clarity and reassurance.
Pre-Eruption Visual Signs
The first visual evidence of an incoming tooth appears in the gum tissue. Initially, the area may become noticeably inflamed, displaying a distinct redness and a slight, localized swelling compared to the surrounding pink, smooth tissue.
As the tooth continues its ascent, a raised, firm area, sometimes referred to as a “teething ridge,” becomes visible and can be felt with a clean finger. The gum tissue over the exact point of eruption will often begin to thin, sometimes showing a small, pale area. This visual cue may present as a white or pale yellow bump just beneath the surface, which is the hard enamel of the tooth crown showing through the stretched gum. These localized changes lead to increased drooling and a tendency for the infant to chew or gnaw on objects.
Appearance of the Newly Emerged Tooth
Once the tooth has broken through the gum line, its appearance is distinct from permanent teeth. Primary teeth are smaller in size and appear whiter, sometimes with a blue-white tint, compared to adult teeth. The initial edge of the tooth, particularly the incisors used for biting, may not be perfectly smooth.
Mamelons are scalloped edges on the biting edge of a newly emerged incisor. These are remnants of the three lobes of enamel that fused together during the tooth’s development beneath the gums. Mamelons are a normal part of the tooth structure.
These small projections wear down as the child begins to use their teeth for biting and chewing food. The force of the upper and lower teeth coming into contact against each other during normal function smooths the edge over time.
Common Visual Variations and Concerns
Parents may observe variations related to the eruption process. An eruption cyst is a fluid-filled sac that can appear as a bubble over the site of an incoming tooth. If this fluid-filled sac contains blood, it is called an eruption hematoma and will appear as a bluish, dark red, or purple lump on the gum, resembling a bruise.
Both the cyst and the hematoma are a result of fluid or blood accumulating in the tissue as the tooth pushes toward the surface. The tooth will break through the cyst or hematoma. Any unusual swelling or discoloration should be monitored, and a pediatric dentist can confirm the diagnosis.
A baby may be born with teeth already visible (natal teeth), or have teeth emerge within the first month (neonatal teeth). These teeth are most often the lower central incisors. They may be smaller, cone-shaped, or have a yellowish color due to underdeveloped enamel and root structure. Their mobility or unusual shape may necessitate a dental evaluation to prevent feeding issues or injury.
Teething Timeline and Order of Appearance
The timing of tooth eruption is variable. The lower central incisors are usually the first to emerge, followed shortly thereafter by their counterparts, the upper central incisors.
The full set of twenty primary teeth is usually completed by the child’s third birthday. The order of appearance is:
- Lower central incisors
- Upper central incisors
- Lateral incisors, positioned on either side of the central incisors, completing the front eight teeth
- First molars, emerging toward the back of the mouth, providing the first major chewing surfaces
- Canines, or eye teeth, filling the gaps between the incisors and the first molars
- Second molars, appearing furthest back in the mouth
For instance, a first tooth appearing as early as three months or as late as twelve months is still considered within the normal range of development. Teeth generally emerge in pairs, with the left and right tooth appearing close together, and the lower teeth often slightly preceding the upper teeth in each category.