Signs and Symptoms Associated With Primary Tooth Eruption: A Clinical Trial of Nonpharmacological Remedies

Mahtab Memarpour; Elham Soltanimehr; Taherh Eskandarian


BMC Oral Health. 2015;15(88) 

In This Article


Teething is a normal physiologic process consisting of intraosseous tooth movement in the jaw until the tooth emerges in the oral cavity.[1,2] Tooth eruption takes place during an 8-day window that includes 4 days before tooth eruption, the day of eruption and the 3 subsequent days.[3] Systemic and local signs and symptoms ascribed to primary tooth eruption include general irritability, sleep disturbances, crying, fussiness, rhinorrhea, facial flushing, fever, diarrhea, loss of appetite, drooling, ear rubbing on the side of the erupting tooth, inflammation of the gingiva overlying the tooth, gum irritation, and increased biting.[3–8] Epidemiological studies have reported different prevalences of disturbances during primary tooth eruption, ranging from 95 % according to Cunha et al.[9] to 68 % according to Noor-Mohammed and Basha.[10]

Although teething may cause problems for children, there is controversy regarding the direct relationship between tooth eruption and systemic symptoms. Some studies have failed to find any causal relationship between teething and symptoms such as fever, diarrhea, rashes or infections.[1,3,4] However, other research reported that parents and health care personnel do perceive some associations.[8,11,12]

Over the years several methods based on popular and traditional beliefs and folk practices have been used to relieve teething symptoms. In some cultures aggressive, potentially harmful methods have been used such as local blistering, cautery[7] or gum lancing[13] for erupting teeth. Although some methods have been assumed to be safe and easy to use, such as teething necklaces or quack remedies, they increase the risk of strangulation or aspiration of small beads.[14] Other approaches involve the use of opiates, poisons such as lead acetate, mercury and bromide,[7] or cooling baths to treat fever.[15]

Some dentists may recommend using teething gels that may contain benzocaine or choline salicylate to reduce pain. These chemical products should be used carefully due to the risk of methemoglobinemia, interference with the gag reflex (and subsequent choking)[3,16] and intoxication.[17] In other words, pharmacological products such as topical analgesics or systemic medications may lead to complications or have side effects.[6,12,18] Some parents prefer to use safer nonpharmacological methods as remedies for teething problems, such as homeopathic and natural remedies,[3] behavioral therapy, chewing clean, cool objects such as a chilled teething ring or rattle, chilled hard vegetables or gingival massage with a cold, wet washcloth [12,19–21]

Because of the controversy regarding the seriousness of some disturbances during tooth eruption, this study was designed to evaluate teething signs and symptoms in children younger than 3 years of age. An additional aim was to compare the clinical effectiveness of five nonpharmacological methods used as remedies to relieve teething disturbances. To our knowledge no clinical studies to date have been designed to compare the effectiveness of these methods in very young children.