Baby Teething: Signs, Soothing Tips and Safe Teethers

Drool on every bib, a fist that never leaves the mouth, and a baby who suddenly wakes at 2am for no clear reason. For many parents, these are the first clues that a tooth is on its way. Teething is a normal stage of development, but it can be hard on the whole family, especially when it overlaps with broken sleep, weaning and the flu season. In Oman, where babies spend much of the day in air-conditioned rooms and the weather stays warm well into autumn, a few practical habits make the process easier.

This guide from Avicen Online explains when teeth usually appear, the signs to look for, safe ways to soothe sore gums, which products are worth having at home, and the symptoms that are not teething and need a doctor.

When Do Babies Start Teething?

Most babies start teething at around 6 months, according to the NHS, although some start before 4 months, some after 12 months, and a few are even born with a tooth. The American Academy of Pediatrics (AAP) notes that the first tooth usually appears between 6 and 10 months, and discomfort can begin a little earlier.

Teeth tend to arrive in a familiar order, although every baby is different:

• Front teeth (central incisors): usually first, at around 6 months, with the bottom ones often before the top
• Teeth either side of the front teeth (lateral incisors): around 8 months
• First back teeth (first molars): around 12 months
• Pointed teeth (canines): around 18 months
• Second molars: around 24 months

Most children have all 20 milk teeth by the age of 2 to 3. If your baby is a little early or late, that is usually nothing to worry about, but mention it at your next check-up if you are unsure.

Common Signs of Teething

Some babies cut teeth with no fuss at all, while others are unsettled for a few days before each tooth breaks through. The NHS and AAP list these common signs:

• A sore, red or swollen gum where the tooth is coming through
• More dribbling than usual, sometimes with a rash around the mouth or chin
• Chewing or gnawing on fingers, toys and anything within reach
• One flushed cheek, or rubbing the ear on the same side
• Being more fretful or clingy, and sleeping less well
• A slightly raised temperature, but below 38°C

What teething does not cause

It is easy to blame every symptom on teeth, but this can mean an illness is missed. The AAP states that teething does not cause fever or diarrhoea, and the NHS says there is no evidence that it causes diarrhoea. If your baby has a temperature of 38°C or more, loose stools, vomiting, a cough or a runny nose, treat these as signs of illness rather than teething. Having a reliable digital thermometer from our thermometers range at home helps you check quickly rather than guess.

Safe Ways to Soothe Sore Gums

Simple comfort measures are the first step, and they are what both the NHS and AAP recommend before any medicine:

• Gum massage: wash your hands, then gently rub your baby's gum with a clean finger for a minute or two. The pressure often brings quick relief.
• A teething ring or teether: firm but soft rubber or silicone gives your baby something safe to bite on.
• Cool, not frozen: chilling a teether in the fridge can soothe hot, swollen gums. The NHS advises never putting a teething ring in the freezer, as very cold, hard objects can damage tender gums.
• A cool, damp washcloth: let your baby chew on a clean, damp cloth that has been chilled in the fridge.
• Cool foods once weaning: from about 6 months, soft fruit such as chilled melon or cucumber sticks can help. Always stay with your baby while they eat.
• Comfort and distraction: cuddles, play and a calm bedtime routine all help an uncomfortable baby settle.

Avoid sugary rusks and biscuits, which can start tooth decay even when only a few teeth are through. Hard, small pieces of food are also a choking risk; our guide to foods that can be dangerous for children under 5 explains what to avoid.

Choosing a Safe Teether

There are many shapes and styles of teether, and the best choice is the one your baby can grip easily and likes to chew. When choosing, look for:

• The right age range: check the pack, as many teethers are labelled 0+, 3+, 4+ or 6+ months.
• Soft, solid silicone or rubber: a one-piece teether such as the Philips Avent Natural Teether 6M+ is made from soft, flexible silicone and can be chilled in the fridge.
• Easy-grip handles: small hands need something light with a wide handle.
• Easy to clean: wash teethers after each use and sterilise them as the pack instructs.

A note on water-filled cooling teethers

Cooling teethers filled with sterile water, such as the Pigeon Cooling Teether Duck, are popular because they hold the cold for longer. The AAP, however, advises against liquid-filled teethers because they can split or leak. If you use one, chill it in the fridge only, check it carefully before every use, and throw it away at the first sign of a crack, bite mark or leak. Never let your baby chew on a teether while unsupervised.

Never tie anything around the neck

Do not tie a teether, dummy or ring around your baby's neck. The AAP warns that teething necklaces and bracelets, including amber, wood, marble and silicone beads, carry a risk of choking and strangulation, and there is no good evidence that they work.

Dummies, Bibs and Dribble Rash

Some babies find extra comfort in sucking during teething. If you use one of the pacifiers and soothers we stock, choose the right size for your baby's age, replace it when the teat looks worn, and never dip it in honey, sugar or juice. Honey should not be given to babies under 1 year old.

All that dribbling can make the skin on the chin, neck and chest sore, and the warm, humid weather in Oman can make it worse. Gently pat the face dry through the day, change damp clothes, and use a soft bib such as the Baby Plus silicone bib to keep clothes drier. For more on gentle cleansers and barrier creams, see our guide to baby skin care in hot weather.

Teething Gels and Pain Relief

Teething gels

There is little evidence that teething gels work, and the NHS recommends trying teething rings or painkillers first. Gels containing local anaesthetics need particular care. In 2018 the US Food and Drug Administration (FDA) warned that over-the-counter benzocaine teething products should not be used in children under 2, because of the risk of a rare but serious blood condition called methemoglobinemia. The AAP also warns against lidocaine gels, homeopathic teething tablets and any product containing alcohol.

If you would like to try a gel, choose one made specifically for babies and ask our pharmacist first. Some options, such as Gengigel Teething Gel, are based on hyaluronic acid rather than a numbing agent; always check the pack and follow the leaflet.

Paracetamol and ibuprofen

If your baby is clearly in pain and comfort measures are not enough, the NHS says sugar-free paracetamol can be given from 2 months and ibuprofen from 3 months. Choose a product made for babies, such as Panadol Baby & Infant Suspension, use the syringe or spoon supplied, and follow the leaflet or ask your pharmacist for the right amount for your baby's age and weight. Never give aspirin to children under 16.

Caring for Those First Teeth

Tooth care starts as soon as the first tooth appears. The NHS advises brushing twice a day, including last thing at night, using a smear of children's fluoride toothpaste for under-3s and a pea-sized amount from 3 to 6 years. Check the pack for the fluoride level, which should be at least 1,000ppm.

A soft, small brush makes this easier. A silicone brush such as the Optimal Baby Silicone Toothbrush 0m+ is gentle on sore gums and can double as a gum massager. Book your child's first dental visit when the first teeth appear, or before their first birthday, and avoid putting your baby to bed with a bottle of milk or juice.

When to See a Doctor

Teething can make babies grumpy, but it should not make them unwell. Contact your doctor or health centre if your baby:

• Has a temperature of 38°C or higher (for babies under 3 months, seek advice straight away)
• Has diarrhoea, vomiting, or is feeding much less than usual
• Has fewer wet nappies, a dry mouth or seems unusually sleepy, which can be signs of dehydration
• Cries in a way that is different from usual, or cannot be comforted
• Has a rash that does not fade when pressed, a stiff neck or breathing difficulty (go to emergency care)
• Has a swollen, bleeding or infected-looking gum

You know your baby best. If something does not feel right, it is always fine to get it checked.

Frequently Asked Questions

How long does teething pain last?
Discomfort usually comes and goes for a few days around each tooth, rather than for months at a time. Many babies have no symptoms at all for some teeth.

Does teething cause fever?
Teething may cause a slightly raised temperature, but the NHS says this stays below 38°C. A temperature of 38°C or more usually points to an infection, so speak to your doctor.

Can I put a teether in the freezer?
No. The NHS and FDA advise chilling teethers in the fridge only. Frozen teethers can become hard enough to hurt tender gums.

Are amber teething necklaces safe?
No. The AAP warns that teething necklaces of any material pose a risk of choking and strangulation.

When should I start brushing my baby's teeth?
As soon as the first tooth appears. Use a soft baby toothbrush and a smear of fluoride toothpaste twice a day.

The Takeaway

Teething is a normal milestone, and most babies get through it with simple comfort: a clean finger on the gum, a fridge-cooled teether, cuddles and a little patience. Keep teethers clean and checked, skip necklaces and numbing gels, and use baby pain relief only when needed and as directed. Above all, remember that fever, diarrhoea and a baby who seems unwell are not normal teething, and need a doctor's opinion.

You can find a wide choice of baby teethers and everyday baby care essentials at Avicen Online, with free delivery across Oman on orders above OMR 10. Our pharmacists are happy to help you choose.

This article is for general information and does not replace advice from your doctor or pharmacist.