Physiological Process, Associated Symptoms, and Evidence-Based Management



Infant teething is a normal developmental process characterized by the eruption of primary teeth through the oral mucosa, typically occurring between 6 and 30 months of age. Although teething is frequently associated with various local and systemic symptoms by caregivers, scientific evidence suggests that most manifestations are mild and localized. This review examines the physiological basis of teething, evaluates commonly reported symptoms, addresses prevalent parental misconceptions, and summarizes evidence-based management strategies. Current literature indicates that teething is not causally associated with significant systemic illness, and misattribution of serious symptoms to teething may delay appropriate medical evaluation.


Teething refers to the eruption of primary teeth into the oral cavity and represents a key milestone in early childhood development. Despite its physiological nature, teething has historically been linked to a wide range of symptoms, including fever, diarrhea, and systemic illness. Such associations have persisted across cultures and generations, often leading caregivers to attribute unrelated medical conditions to the teething process. Contemporary pediatric research, however, challenges many of these beliefs and emphasizes the importance of distinguishing normal teething-related discomfort from pathological conditions requiring clinical attention.

Physiological Basis of Tooth Eruption​

Primary tooth development begins during intrauterine life, with calcification initiating as early as the second trimester. Tooth eruption is a complex biological process involving alveolar bone remodeling, periodontal ligament activity, and localized inflammatory responses. The eruption pathway through the gingival tissue may induce mild inflammation, resulting in localized discomfort. Importantly, this inflammatory response is generally limited in scope and duration and does not reflect a systemic inflammatory state.

Clinical Manifestations​

Local Symptoms​

Multiple prospective and observational studies have identified a consistent pattern of mild, localized symptoms temporally associated with tooth eruption. These include:

• Increased salivation (drooling)
• Gingival swelling and tenderness
• Irritability or fussiness
• Biting or chewing behaviors
• Mild sleep disturbances

Macknin et al. (2000) demonstrated that while such symptoms may coincide with tooth eruption, no single symptom occurs in the majority of infants, and symptom severity is generally low.

Systemic Symptoms and Misattribution​

Caregivers frequently report systemic symptoms such as fever, diarrhea, rhinorrhea, and reduced appetite during teething. However, high-quality evidence does not support a causal relationship between teething and significant systemic manifestations. Studies have shown that measured body temperature elevations during teething are minimal and remain within normal physiological ranges. Similarly, gastrointestinal symptoms are more likely attributable to concurrent infections or dietary changes rather than tooth eruption itself.


The misattribution of systemic symptoms to teething poses a clinical risk, as it may delay diagnosis and treatment of underlying illnesses.

Parental Beliefs and Cultural Perspectives​

Parental perceptions of teething symptoms are strongly influenced by cultural beliefs and anecdotal experiences. Surveys consistently reveal that a majority of parents believe teething causes fever and illness. Healthcare providers play a critical role in correcting misconceptions through anticipatory guidance and evidence-based education. Improved parental understanding has been shown to reduce unnecessary medication use and inappropriate home remedies.

Evidence-Based Management​

Management of teething should focus on symptom relief for mild local discomfort while avoiding potentially harmful interventions. Recommended strategies include:

• Use of chilled (not frozen) teething rings
• Gentle gingival massage with a clean finger
• Age-appropriate systemic analgesics when clinically indicated and prescribed

The use of topical anesthetics, particularly those containing benzocaine or lidocaine, is discouraged due to the risk of toxicity and limited evidence of benefit. Any presentation involving high fever, persistent diarrhea, lethargy, or signs of systemic illness warrants medical evaluation independent of teething status.

Discussion​

The persistence of teething-related myths highlights a gap between scientific evidence and public perception. While teething may cause transient local discomfort, the attribution of serious symptoms to this process is not supported by empirical data. Clinicians must emphasize careful symptom assessment and discourage the normalization of potentially serious clinical signs under the guise of teething.

Conclusion​

Infant teething is a benign, physiological process accompanied primarily by mild local symptoms. Current evidence does not support a causal link between teething and significant systemic illness. Accurate caregiver education and evidence-based management are essential to prevent misdiagnosis, unnecessary interventions, and delayed treatment of unrelated medical conditions.

References ​

Macknin, M. L., Piedmonte, M., Jacobs, J., & Skibinski, C. (2000). Symptoms associated with infant teething: A prospective study. Pediatrics, 105(4), 747–752.
Wake, M., Hesketh, K., & Lucas, J. (2000). Teething and tooth eruption in infants: A cohort study. Pediatrics, 106(6), 1374–1379.
McIntyre, G. T., & McIntyre, G. M. (2002). Teething troubles? British Dental Journal, 192(5), 251–255.
Seward, M. H. (1972). General disturbances attributed to eruption of the human primary dentition. Journal of Dentistry for Children, 39, 178–183.
King, D. L., Steinhauer, W., & Garcia-Godoy, F. (2018). Teething symptoms: A review of the evidence. Pediatric Dentistry, 40(5), 357–361.