Teething is a two-year process, not a single event. This guide covers the full eruption timeline, an honest evidence review of every remedy on the market, the important clinical facts about what teething does and does not cause, dental care from the very first tooth, and what to avoid — including a direct warning about amber teething necklaces.
🦷 Open full guide in WiseMama — freeThe 20 primary teeth erupt over roughly two and a half years, starting from around 4–6 months and ending with the second molars at 23–33 months. The process is continuous rather than episodic — at almost any point between 4 months and 3 years, some part of the teething process is active.
Teeth usually erupt in a predictable order, though timing varies considerably between babies:
A first tooth at 4 months and a first tooth at 14 months are both within the normal range. No teeth at 12 months warrants a brief mention to your health visitor. No teeth at 18 months warrants dental assessment. At the other end, some babies are born with natal teeth already present — approximately 1 in 2,000 births — which may need removal if loose or causing feeding difficulties.
Research suggests the most acute discomfort from any individual tooth is concentrated in approximately four days: one day before eruption, the day of eruption, and two days after. This is useful to know — each episode is brief, even if the overall process is long. Most parents find the front teeth manageable and the molars harder, with the second molars at the back often the most difficult of the entire teething journey.
Teething has been blamed for an enormous range of infant symptoms. The evidence narrows this considerably — and some of the most widespread beliefs about teething symptoms are genuinely dangerous misconceptions.
Fever above 38°C. This is the most clinically significant fact about teething. Studies consistently show that teething raises temperature by at most 0.12°C — a trivial elevation. A measured temperature of 38°C or above is caused by illness, not teething. Attributing fever to teething is one of the most common ways that ear infections, urinary tract infections, and other illnesses are delayed in diagnosis. Any feverish baby needs medical assessment — not teething gel and watchful waiting.
Diarrhoea. Teething does not cause diarrhoea. This belief is extremely widespread and unsupported by evidence. A baby with frequent loose stools has a gastrointestinal illness. They need hydration monitoring and possibly medical review.
Runny nose, cough, rash. These are symptoms of viral illness — common in infants at the same age range as teething by coincidence of timing, not causation. Any baby who seems genuinely unwell alongside teething symptoms should be assessed as potentially unwell.
The useful rule: if your baby has any symptom beyond drooling, biting, and mild fussiness, treat it as potential illness rather than teething. The consequences of missing a real illness are significantly worse than those of an unnecessary GP visit.
The teething remedy market is large and mostly driven by parental anxiety rather than evidence. Most products have little or no clinical trial support. Here is an honest assessment of the options.
Teething discomfort is caused by pressure from the erupting tooth pushing through the gum. Applying firm counter-pressure from outside directly addresses this mechanism. It can be delivered by a clean finger rubbed firmly along the gum, a chilled (not frozen) teething ring, a cold damp washcloth, or chilled solid foods in a mesh feeder for babies on solids. Simple, free, and effective at the mechanism that matters.
Chilled — straight from the fridge, not the freezer — teething rings combine counter-pressure with mild cooling, which reduces local inflammation. Natural rubber teething toys (Sophie the Giraffe being the most well-known) work via the same mechanism with the added benefit of textured surfaces that reach different gum areas. These are among the most reliably useful teething tools available.
Lidocaine-based teething gels formulated specifically for infants (Bonjela Baby, Calgel) have modest evidence for short-term relief. They numb the gum surface briefly — the effect lasts minutes as the gel is diluted by saliva — but can provide helpful relief during an acute difficult period. Apply with a clean finger, up to three to four times daily. Important: the original Bonjela (not the baby formulation) contains choline salicylate, which is not recommended for children under 16 due to a link with Reye's syndrome. Only products specifically labelled for babies should be used.
Current NHS guidance does not recommend paracetamol or ibuprofen solely for teething symptoms. They are appropriate when a baby has a clear fever, is in significant pain, or is genuinely unwell. Ibuprofen's anti-inflammatory component makes it particularly relevant for dental discomfort and may be more helpful than paracetamol during molar eruption specifically. If using either, follow age-appropriate dosing carefully and do not use routinely to manage teething as a background condition.
Gentle gum massage with a clean finger provides counter-pressure and physical reassurance simultaneously. It is simple, free, and gives a distressed baby direct contact with a calm parent — which has its own soothing value independent of any gum effect.
Amber teething necklaces are sold with claims that succinic acid released from the amber provides pain relief. There is no clinical evidence for this — no trials, and no plausible mechanism by which a necklace worn around an infant's neck could relieve pain in erupting gum tissue. More importantly, amber teething necklaces are a documented strangulation and choking hazard. The MHRA has issued specific safety warnings. Infant deaths and near-misses have been reported internationally. There is no safe way to use one. Do not use amber teething necklaces.
Products such as Ashton & Parsons teething powders and similar granules are homeopathic — they contain no active ingredient at clinically relevant concentrations and have no evidence of effectiveness beyond placebo. The FDA issued warnings in 2016 and 2017 against homeopathic teething tablets containing belladonna following reports of infant seizures and deaths from inconsistent manufacturing. UK products are separately regulated, but the absence of benefit and the presence of concerns in the category make them an unnecessary choice.
A frozen teething ring is hard enough to damage tender gum tissue. Chilled from the fridge is the correct preparation — not frozen. The same cooling effect without the risk of bruising already-sensitive gums.
Clove oil contains eugenol, which can cause local tissue damage and toxicity in infants at the concentrations in pure oil. Rubbing spirits or wine on gums — a historical practice — can cause hypoglycaemia and alcohol toxicity in young babies. Neither should ever be used.
The first tooth is the start of dental care — not a milestone to admire before dental hygiene begins. Starting from the first tooth establishes the habit early, protects enamel during formation, and makes every subsequent dental appointment easier.
Begin twice-daily brushing as soon as the first tooth erupts — after breakfast and last thing before sleep. Use a soft-bristled baby toothbrush or a rubber finger brush, and spend about a minute per session covering all visible tooth surfaces. Babies and toddlers resist toothbrushing with varying degrees of enthusiasm. Distraction, songs, making it a game, and consistent routine all help — but even an imperfect brush is better than none.
Fluoride is incorporated into forming enamel and makes teeth significantly more resistant to decay. It is the single most effective preventive measure for childhood dental caries.
Low-fluoride "baby" toothpastes do not provide adequate protection. Standard children's fluoride toothpaste at the correct dose is what is needed. After brushing, spit or wipe out but do not rinse — the fluoride residue remaining on the teeth continues to protect.
Falling asleep with milk pooling around the teeth — whether from breast or bottle — is associated with early childhood tooth decay. This is not a reason to stop breastfeeding, but it is worth being aware of. Wiping or brushing teeth before a night feed, or at minimum before the last sleep of the night, reduces risk. Bottles of juice, sweetened drinks, or formula at night carry significantly higher decay risk than breast milk.
Register with a dentist as soon as teeth appear, or by 12 months at the latest. NHS dental care for children is free — no referral needed. The first appointment is brief and informal: the dentist assesses the teeth, identifies any early concerns, and begins building a relationship with the child before any dental anxiety can develop. Starting early makes every subsequent visit easier.
Teething and sleep disruption share the same period of infancy, and the relationship between them is more complicated than it first appears.
Almost every significant teething window coincides with a major sleep regression. The first teeth (6–10 months) coincide with the 6-month developmental regression. The incisors and first molars (8–19 months) coincide with the 8–10 month and 12-month regressions — already the most disruptive for many families. The second molars (2–3 years) arrive during the period of significant toddler sleep challenges.
This means that teething receives credit for sleep disruption that developmental regressions would have caused anyway, and developmental sleep changes get attributed to teething and "waited out" when they actually need addressing.
Teething-related sleep disruption is real but concentrated in the 3–5 day window around active eruption. If a baby who has been sleeping reasonably well suddenly wakes more frequently for a few days and then settles, this is consistent with teething. If disruption continues for weeks, the developmental regression is the more likely primary driver — and waiting for the tooth to clear it won't work.
During the acute eruption window, brief additional comfort is appropriate. A dose of ibuprofen before bed — with its anti-inflammatory action — may be helpful during particularly difficult nights when there is clear gum discomfort. This is a short-term measure for an acute situation, not a routine approach.
I spent months convinced our daughter's terrible sleep was teething. She was also going through the 8-month regression and learning to crawl. Once I understood those were separate things, I stopped waiting for a tooth to come through before addressing the sleep — and things finally improved. The tooth had come in weeks before.
The most important clinical point about teething is the risk of attributing real illness to it — and therefore not seeking appropriate care when care is needed.
Infants begin teething at exactly the age when they also begin losing maternal passive immunity and becoming vulnerable to ear infections, urinary tract infections, and viral illness. The peak teething window (6–18 months) is also the peak period for these common infant illnesses. When a baby who is "teething" develops a fever, it is easy — and wrong — to put it down to the teeth.
Temperature of 38°C or above. In a baby under 3 months, any fever is a medical emergency. In a baby under 12 months, a temperature of 38°C or above warrants same-day GP contact. It is not a teething fever. It is a fever.
Diarrhoea or vomiting. Not caused by teething. A gastroenteritis or other illness. Needs hydration monitoring and, if severe or prolonged, medical review.
Visible rash. Not caused by teething, other than drool rash immediately around the mouth and chin. Any rash with fever or in unusual locations needs assessment.
Ear pulling with fever. Ear pulling alone sometimes accompanies teething. Combined with fever it suggests otitis media — needs GP assessment and likely antibiotics.
A baby who seems genuinely unwell. Parents know when something is different. A baby who is unusually floppy, not feeding, has a different-sounding cry, or seems to be deteriorating is not having a difficult teething day. Trust that instinct.
The second molars arrive last — around 23 to 33 months — and are consistently reported as the most uncomfortable primary teeth. They are the largest, erupt through the thickest gum tissue at the back of the mouth, and their approach is often signalled weeks in advance by changes in behaviour, sleep, and appetite.
Parents often notice increased clinginess, sleep disruption, food refusal (particularly harder foods), and a toddler who can't quite explain what's wrong in the weeks before second molars break through. The gum may appear swollen and slightly blue-tinged — an eruption cyst, entirely normal, that typically resolves as the tooth breaks through. Children at this age are better able to communicate discomfort but lack the vocabulary to describe where and why it hurts, which can make the period frustrating for everyone.
The back-of-mouth location makes counter-pressure harder to apply than with front teeth — a knuckle pressed to the gum, or a teething toy that reaches the back of the mouth, tends to be more effective than front-of-mouth chewing. Ibuprofen is particularly worth considering for second molar pain given its anti-inflammatory action. If a toddler is having significant sleep disruption with clear signs of gum discomfort, appropriate doses of children's ibuprofen before bed are a reasonable short-term measure.
The second molars are the last of the 20 primary teeth. Once they are through — by around age 3 — the teething process that has been running since those first uncertain months is complete. The permanent teeth begin appearing from around age 6, but the primary teething phase that has caused disruption since infancy is done. That is a definite endpoint worth knowing about.