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)

Conclusions

The current study found no association between tooth eruption and systemic symptoms such as fever and diarrhea. However, mothers inaccurately reported slight increases in body temperature as fever. Low birth weight children had more teething manifestations than their normal birth weight counterparts. Use of a teething ring, cuddle therapy and rubbing the gums were the most effective methods to reduce symptoms.

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Trial registration
Iranian Registry of Clinical Trials: code IRCT201211127402N3

Acknowledgments
The authors wish to thank the Vice-Chancellory of Research of Shiraz University of Medical Science, Shiraz, Iran, for supporting this research (grant no. 91–6317). The authors also thank Dr. M. Vossoughi of the Dental Research Development Center in Shiraz Dental School for the statistical analysis and K. Shashok (AuthorAID in the Eastern Mediterranean) for help with the English in the manuscript.

Table 1. Demographic information for children in each group
Variable		Group					p value
Variable		1) Cuddle therapy	2) Piece of ice	3) Rubbing gums	4) Teething rings	5) Food for chewing	p value
Child age (months)		16 ± 5.24	17.92 ± 6.37	15.72 ± 5.07	16.08 ± 7.10	18.31 ± 6.11	0.093
Sex	Boy	29 (54.7 %)	25 (50 %)	24 (48 %)	22 (43.1 %)	26 (52 %)	0.813
Sex	Girl	24 (45.3 %)	25 (50 %)	26 (52 %)	29 (56.9 %)	24 (48 %)	0.813
Maternal age (year)		32.08 ± 6.56	29.42 ± 6.15	30.33 ± 6.84	30.51 ± 5.68	29.31 ± 4.57	0.121
Maternal education level	Less than diploma	9 (17 %)	10 (20 %)	12 (24 %)	11 (19.3 %)	8 (16 %)	0.735
	Diploma	26 (49.1 %)	28 (56 %)	28 (56 %)	26 (45.6 %)	25 (50 %)
	University	18 (34 %)	12 (24 %)	10 (20 %)	20 (35.1 %)	17 (34 %)

Quantitative characteristics were reported as the mean ± SD, and qualitative characteristics were reported and the frequency (%)

Table 2. Frequency (percentage) of clinical manifestations of tooth eruption in the study population
Clinical manifestation	Four days before eruption		Day of eruption		Three days after eruption
Number (percentage)	n	%	n	%	n	%
Drooling	234	92.2	160	63	55	21.7
Diarrhea	62	24.4	29	11.4	1	0.4
Fever (Mother's reports)	83	33.1	150	59.1	4	1.6
Lethargy	116	45.7	135	53.1	99	39
Loss of appetite	187	73.6	152	53.1	95	37.4
Lack of sleep	209	82.3	106	41.7	14	5.5
Gum irritation	175	68.9	88	34.6	7	2.8
Chewing objects	180	70.9	132	52	22	8.7
Finger sucking	67	26.4	40	15.7	25	9.8
Irritability	192	75.6	162	63.8	167	66.7
Red and inflamed gums	129	50.8	80	31.5	62	24.4
Gingival pain	103	40.6	86	33.9	36	14.2
Crying	190	74.8	112	44.1	12	4.7
Weight loss	214	84.3	110	43.3	106	41.7
Ear infection	9	3.5	4	1.6	0	0.0
Vomiting and nausea	24	9.4	24	9.4	22	8.7
Drooling + loss of appetite	187	73.6	213	83.9	118	46.5
Drooling + lack of sleep	209	82.3	180	70.9	63	24.8
No symptoms	1	0.4	1	0.4	2	0.8

Table 3. Agreement between fever reported by mothers and recorded by the dentist
	Fever		Kappa coefficient	p value
	Reported by mothers (n)	Recorded by clinician (n)	Kappa coefficient	p value
Days before eruption	83	1	0.008	0.484
Day of eruption	150	3	0.011	0.239
Days after eruption	4	1	0.006	0.898

The kappa coefficient was used to calculate agreement between the two values

Table 4. Number (n) and percentage (%) of children in whom each treatment was effective for different symptoms
Clinical manifestation		Group					p value*
Clinical manifestation		1) Cuddle therapy (n = 53)	2) Piece of ice (n = 50)	3) Rubbing gums (n = 50)	4) Teething rings (n = 51)	5) Food for chewing (n = 50)	p value*
Drooling	n %	47 (95.9)^a	21 (44.7)^b	29 (61.7)^b	47 (94.0)^a	37 (86.0)^a	<0.001
Lethargy	n %	13 (59.1)^a	10 (83.3)^a	17 (70.8)^a	11 (33.3)^b	9 (36.0)^b	0.003
Loss of appetite	n %	21 (52.5)^a	13 (27.7)^b	22 (50.0)^a	17 (89.5)^a	31 (83.8)^a	<0.001
Lack of sleep	n %	41 (97.6)^a	45 (97.8)^a	41 (100)^a	40 (93.0)^a	32 (86.5)^b	0.042
Gum irritation	n %	36 (100)^a	42 (100)^a	36 (94.7)^a	29 (96.7)^a	29 (100)^a	0.27
Chewing objects	n %	29 (100)^a	39 (92.9)^a	39 (97.5)^a	33 (78.6)^a	21 (77.8)^b	0.003
Finger sucking	n %	26 (89.7)^a	40 (95.2)^a	37 (92.5)^a	40 (95.2)^a	23 (85.2)^a	0.525
Irritability	n %	6 (17.1)^a	5 (10.9)^a	6 (15.8)^a	16 (42.1)^b	16 (45.7)^b	<0.001
Red and inflamed gum	n %	11 (64.7)^a	26 (96.3)^b	29 (90.6)^b	21 (72.4)^a	15 (62.5)^a	0.006
Gingival pain	n %	18 (100)^a	29 (96.7)^a	16 (69.6)^b	10 (76.9)^b	14 (73.7)^b	0.012
Crying	n %	41 (97.6)^a	35 (89.7)^a	38 (100)^a	34 (91.9)^a	32 (94.1)^a	0.250

*Chi-squared test
In each row, different letters indicate significant differences between groups (Fisher's exact test)

Table 5. Number and proportion of mothers who were satisfied with different remedies
Group	Completely effective		Moderately effective		Slightly effective		Completely ineffective
Group	n	%	n	%	n	%	n	%
1) Cuddling	22	41.5	16	30.2	15	28.3	0	0.0
2) Pieces of ice	11	22.9	10	20.8	27	56.3	0	0.0
3) Rubbing gums	20	40.8	19	38.8	10	20.4	0	0.0
4) Teething rings	29	56.9	10	19.6	12	23.5	0	0.0
5) Food for chewing	10	20.0	15	30.0	25	50.0	0	0.0