II. Physiology: Eruption of primary teeth

  1. One tooth erupts monthly between 6 months to 2 years
  2. Onset of Teething symptoms: 3-4 days before eruption
  3. End of Teething symptoms: 2-3 days after Tooth Eruption

III. Symptoms

  1. Irritability or restlessness
  2. Discomfort
  3. Increased night-time awakening
  4. Appetite decreased
  5. Chewing on toys or fingers
  6. Increased Drooling
    1. May be associated with rash on chin and neck
  7. Cough
  8. Low grade Temperature rise (e.g. 99.5 F) may occur
  9. Teething does not cause:
    1. High fever
    2. Rhinorrhea
    3. Diarrhea
    4. Diffuse rash

IV. Signs: Local gum inflammation at site of Tooth Eruption

  1. Sore, tender, swollen gum tissue
  2. Gum discoloration (blue or purple)

V. Management

  1. Distract with comforting (rocking or cuddling)
  2. Massage child's gums with a clean finger
  3. Ice Rings
  4. Clean frozen wash cloth
  5. Consider systemic Analgesic
    1. Tylenol
    2. Motrin
  6. Avoid fluid-filled Teething rings after Tooth Eruption
  7. Avoid Teething on potential Choke Hazards
    1. Frozen bananas
    2. Frozen Popsicles
  8. Avoid Orojel (topical anesthetic)
    1. Methemoglobinemia may occur with Overdose

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