pediatrics
Teething
Introduction
Teething is the process in infants of tooth eruption through the gums. Although there is wide variation, a child's first tooth usually erupts by 6 months of age, and a complete set of 20 deciduous teeth usually develops by 2½ years of age. Clinicians often counsel parents that before a tooth erupts, the child may cry, be fussy, and sleep and eat poorly. Also, during Tooth Eruption Times , the child may drool, have red and tender gums, and chew constantly on objects such as toys and crib rails. Teeth Teeth Number Number Age at Eruption* Age at Eruption* Deciduous (20 total) Deciduous (20 total) Lower central incisors 2 5–9 months Upper central incisors 2 8–12 months Upper lateral incisors 2 10–12 months Lower lateral incisors 2 12–15 months 1st molars† 4 10–16 months Canines 4 16–20 months 2nd molars† 4 20–30 months Permanent (32 total) Permanent (32 total) 1st molars† 4 5–7 years Incisors 8 6–8 years Bicuspids 8 9–12 years Canines 4 10–13 years 2nd molars† 4 11–13 years 3rd molars† 4 17–25 years * Varies greatly. † Molars are numbered from the front to the back of the mouth (see figure Identifying the Teeth ). Teething does not cause Fever in Infants and Children . Children who have fever and who are especially fussy should be evaluated for a viral or bacterial infection, because these symptoms are not caused by teething. Teething infants get some relief from chewing on hard (eg, teething biscuits) or cold (eg, firm rubber or gel-containing teething rings) objects. Massaging the child's gums with or without ice also may help. Children may be treated with weight-based doses ofacetaminophenoribuprofen. Teething devices worn around the child's neck should be avoided. Teething gels are not recommended because they are not any more effective than other measures, and some containbenzocaine.Benzocainecan rarely cause methemoglobinemia. 