Teeth, Teething, and Drool: A Teething Tutorial for New Parents

Hands in the mouth, chewing on everything, drool everywhere, fussy, and waking up at night? Is it a tooth, or teething?

Is your baby starting to teethe? Hands in the mouth, chewing on everything, and non-stop drool is pretty common in the 4 month old baby set. These are developmental behaviors we commonly call “teething,” but most likely, it will still be three or four more months before the glint of the very first tooth ever pokes through.

After your baby is about ten weeks or so, expect to find his hands or fingers in his mouth more and more. Once your baby can get his fingers or objects to the mouth, he will. Eventually, your baby will try to get his entire hand into his mouth, practice making himself gag, and begin to hold and gnaw away on teethers and toys. This is accompanied by increased saliva production without the skill or social niceties to swallow it down, so you’ll see plenty of drool. The increased saliva production is related to the constant mouthing of fingers and toys, and is also a sign of a maturing digestive tract, the body’s preparation for beginning to eat solid foods.

Is it teething?

Cutting the first tooth. Statistically, the first tooth most commonly erupts, or cuts, during during the seventh month. The two center bottom teeth (central incisors) typically arrive one at a time or as a pair, followed by their neighbor teeth on either side, and then followed by the two center top teeth, and then their neighbors. Although most babies follow this predictable tooth eruption pattern, there’s no reason to worry if your baby cuts teeth “out of order.” All 20 baby teeth are in there, perfectly formed, and will make their way out over the next 18 months.

Best mouthing toys & teethers. The perfect teething toys for young babies are lightweight, small enough for little mouths and satisfying to chew, and are easy to grasp and hold. Clean your baby’s teethers regularly with a little dish soap and warm water, and let them air dry. Fabric toys can usually be washed in a pillowcase or lingerie bag in the laundry. Offer different textured toys (hard, soft, chewy) and fabric toys to see what your baby loves best.

Does that look like a tooth back there? You might notice a whitish dot along your new baby’s gum line or on the roof of the mouth. The first teeth to erupt are usually the bottom central incisors. A hard white bump elsewhere in the mouth may look like the tip of an early tooth, but it’s more likely a temporary cyst common in young babies. Called Bohn’s Nodules or Epstein’s Pearls, depending on the location, they cause no discomfort and will go away without treatment.

Sleep and Teething. Some babies seem to fret at night for weeks before cutting a single tooth, while other babies will surprise you one morning with a brand new tooth poking out of a gummy smile. If you believe your baby is waking up and uncomfortable from teething, it’s okay to try an occasional dose of acetaminophen (Tylenol, Feverall) or ibuprofen (Advil, Motrin, if baby is over six months) using the dosage advised based on your infant’s weight. However, don’t medicate your baby night after night for teething pain. Sleep disruptions are common between 4 and 5 months and are often due to developmental advancements like rolling. Sleep associations become more important to help your baby fall back to sleep after brief awakenings. If several nights of sleep disruption persist with no sign of a tooth emerging, speak with your pediatrician for suggestions.

Safer Infant Sleep and SIDS Risk Reduction

Start oral care even before teeth arrive. Just wipe your baby’s gums with your finger covered in a dampened gauze square or washcloth a couple of times each day. By six months, try to build this into the bedtime routine after the last feeding, so that by the time your baby does have several teeth, the oral care is already a familiar habit. Once your baby has several teeth, you can switch to using a soft toothbrush.

What about fluoride for babies? Fluoride is important to protect the tooth enamel and to help prevent cavities (dental caries). Both the American Academy of Pediatrics and the American Dental Association recommend using fluoridated water for your baby’s drinking water and cooking. If tap water does not contain fluoride, nursery water can be used, or fluoride drops added. The AAP now advises introducing a tiny rice-sized smear of toothpaste with fluoride once the first teeth erupt. Check with your pediatrician for recommendations.

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