Teething, or baby tooth eruption, is the common developmental process where a child’s primary teeth push through the gums and become visible in the mouth. All infants experience this stage as they transition from a liquid diet to solid foods. The process begins long before the first tooth appears, with the foundations of the teeth forming beneath the gums during the second trimester of pregnancy. Observing the timeline and physical changes helps parents understand and support their child through this natural, yet sometimes uncomfortable, stage.
The Typical Timeline and Order of Eruption
Eruption of the twenty primary teeth typically begins around six months of age, though timing is highly variable. The entire process is gradual and usually completes by the time a child is about three years old. While individual timelines differ, the sequence of tooth emergence generally follows a predictable pattern.
The lower central incisors—the two bottom front teeth—are usually the first to appear, typically between five and seven months. These are quickly followed by the upper central incisors, which emerge next, usually between six and eight months. The lateral incisors, located on either side of the central teeth, then follow, leading to the eruption of the first molars, the canines, and finally the second molars toward the back of the mouth.
Physical Appearance of the Gums During Teething
As a tooth prepares to break through, the gum tissue in that localized area will often appear visibly swollen and red. This inflammation is caused by the pressure of the tooth crown moving closer to the surface.
Parents may notice the gum line looking stretched or tender, sometimes revealing a small, white, or translucent bulge just beneath the surface, which is the cusp of the emerging tooth. Occasionally, a small, soft, bluish-purple swelling, known as an eruption hematoma or eruption cyst, appears on the gum. This is essentially a minor bruise caused by fluid or blood accumulating in the soft tissue as the tooth moves, and it typically resolves naturally as the tooth erupts.
Accompanying Behavioral and Systemic Signs
Tooth eruption is accompanied by a range of behavioral and physical symptoms. Increased drooling is one of the most common signs, as the pressure on the gums stimulates saliva production. This excessive moisture can sometimes lead to localized skin irritation, resulting in a mild rash on the chin, cheeks, or neck.
The discomfort often causes infants to seek relief by chewing or gnawing on objects, hands, or toys, as this counter-pressure helps soothe the tenderness. Babies may also exhibit increased irritability and difficulty sleeping due to the persistent discomfort. Some children may rub their cheeks or pull at their ears on the side where a tooth is erupting, as the nerve pathways can cause pain to radiate to those areas. A slight elevation in body temperature below 100.4°F (38°C) may occur, but true fevers above this threshold are not caused by teething and usually indicate a concurrent illness.
When to Consult a Pediatrician or Dentist
While teething is a normal process, certain symptoms warrant a professional medical consultation to rule out other issues. A fever higher than 101°F (38.3°C) is not considered a typical teething symptom and should prompt a call to the pediatrician. Similarly, symptoms such as severe diarrhea, vomiting, or a widespread rash that extends beyond the face are rarely attributable to tooth eruption and may indicate an infection.
Parents should also seek advice if a child is unable to be soothed or if they refuse to drink liquids, as this can lead to dehydration. If no teeth have emerged by the time a child reaches eighteen months of age, it is appropriate to consult a pediatric dentist to ensure that development is progressing as expected. The first dental visit should ideally occur within six months of the first tooth appearing, or no later than the child’s first birthday.