The first tooth is one of those milestones that gets blamed for almost every miserable few days in the second half of the first year. Most of the time, the baby is fine and the discomfort is real but mild; sometimes the fussiness has nothing to do with the teeth at all. This is what teething actually does, what it doesn't do, and what's worth doing about it. For the wider picture see our complete guide to child health.
The Timeline
Baby teeth (primary teeth) start forming in the womb but don't appear above the gum until somewhere in the second half of the first year. The usual sequence:
- Lower central incisors (bottom front two): 6–10 months
- Upper central incisors (top front two): 8–12 months
- Upper lateral incisors: 9–13 months
- Lower lateral incisors: 10–16 months
- First molars (big back ones): 13–19 months
- Canines (the pointy ones either side of the front): 16–22 months
- Second molars (the very back ones): 23–31 months
By 2.5–3 years all 20 baby teeth should be in.
The first tooth can arrive as early as 4 months or as late as 14–18 months. Both ends of that range are normal. A baby who turns one without a tooth in sight isn't behind on anything that matters — there's no association with later development. If no tooth has appeared by 18 months, a dental review is reasonable, partly to confirm normal anatomy and partly to discuss timing.
A few babies are born with a tooth or two already present (natal teeth). These look strange but usually don't matter; they need removing only if they're loose enough to risk being inhaled, or if they're cutting the underside of the tongue or sore for breastfeeding.
What It Actually Feels Like
For a few days before a tooth comes through, the gum over the eruption site is swollen and tender. The baby chews on everything in reach (the counter-pressure genuinely takes the edge off), drools heavily, and is more grumpy than usual. The drooling is partly because saliva production goes up, and partly because babies this age haven't yet got the hang of swallowing it.
The discomfort is real, but mild to moderate. Teething doesn't produce screaming, hours of inconsolability, or a baby who looks unwell. If that's what you're seeing, the explanation isn't the teeth.
What Teething Does Not Cause
The evidence here is now reasonably settled — controlled studies that have actually filmed gums and tracked daily symptoms in real time consistently find no link between tooth eruption and any of the following:
- A temperature above 38°C. A trivial blip of a few tenths of a degree is sometimes recorded; a true fever isn't. A feverish baby who is also teething has a fever from another cause.
- Diarrhoea. Almost universally believed; not supported by the data. Gastroenteritis is extremely common at this age and frequently coincides.
- Vomiting, persistent cough, runny nose, or any kind of generalised rash. Not teething.
- Crying for hours, or a baby who looks unwell or floppy. Not teething either.
The reason this matters is the trap of timing — 6 to 12 months is also the window in which babies meet their first round of viruses and ear infections. The symptoms overlap. "It's just teething" gets used as the default, and that's the single most common reason a real illness gets seen too late. If something doesn't fit the gentle, local picture above, treat it as something else.
Easing the Discomfort
A chilled teething ring. Keep one or two in the fridge — not the freezer. Frozen rings are too hard and can bruise or damage the gum. The cold and the firm pressure together are the most effective home measure for a really sore gum.
Cold foods if they're on solids. Refrigerated cucumber sticks, slices of cool melon, an oversized cold (not frozen) banana, plain Greek yoghurt straight from the fridge. A mesh feeder with frozen breastmilk or fruit inside is also useful for babies who are still mostly milk-fed.
Gum massage. A clean finger, pressed firmly along the gum ridge over the sore spot, for a minute or so. It looks crude and works well. Some babies will let you do it; others bat the hand away.
Paracetamol or ibuprofen at night if sleep is genuinely disturbed. Weight-appropriate dose, not "just in case." Ibuprofen is not for babies under 3 months or under 5 kg, and not for any baby with reduced fluid intake or vomiting (it's harder on the kidneys when fluid balance is off).
Distraction. Sometimes the most effective thing is changing what's in front of the baby — going outside, getting in the bath, switching from sitting on the floor to being carried. The gum is still sore, but the brain is on something else.
What to Avoid
- Teething gels with lidocaine or benzocaine. No longer recommended in the UK or US. The evidence of benefit is weak and the risks of overdose in babies are real (cases of serious blood disorders and deaths have been reported with benzocaine in particular).
- Amber teething necklaces. No biological mechanism by which they could work; documented cases of strangulation and choking. Don't use them.
- Frozen teething rings. Cold is good. Frozen-solid is too hard.
- Rubbing whisky on the gums (genuinely still circulates as folk advice). Alcohol on a baby's mucous membranes is harmful and absorbed straight in. Don't.
Care from the First Tooth
Brushing starts the day the first tooth comes through. Twice a day, including the last thing before bed. A smear (rice grain size) of fluoride toothpaste at 1000 ppm or above on a soft baby toothbrush, or wrapped around a finger if a brush is unmanageable. Public Health England's guidance is unambiguous: skip the "training" toothpastes that don't contain fluoride — they don't reduce decay.
A first dentist appointment is recommended at around 12 months, or whenever the first tooth comes if that's later. NHS dental care for under-18s is free; the appointment is mostly to introduce the child to the chair and give parents a chance to ask about diet and brushing.
When to Speak to Someone
Most teething needs nothing beyond the home measures above. Talk to a GP or dentist if:
- A baby looks systemically unwell during a teething episode (fever, persistent crying, refusing feeds, fewer wet nappies)
- You can't get on top of pain with paracetamol and ibuprofen at the right doses
- A tooth is coming through in an unusual position, or a baby reaches 18 months without any teeth
- The mouth has lots of white patches that don't wipe off (oral thrush is common in teething age and worth confirming)
The general principle is the same as with most things in early infancy: if it fits the calm, brief, local picture, it's teething. If it doesn't, it's something else.
Key Takeaways
The first tooth usually arrives between 6 and 10 months — a lower central incisor. Anywhere between 4 and 18 months is within normal range. The full set of 20 baby teeth is in by around 2.5–3 years. Teething itself produces gum discomfort, drooling, and a day or two of mild fussiness around eruption — nothing more. Controlled studies are clear: it does not cause fever above 38°C, diarrhoea, or significant illness. What helps: a chilled (not frozen) teething ring, a clean finger pressed along the gum, weight-appropriate paracetamol or ibuprofen at night if sleep is disturbed. What to avoid: lidocaine/benzocaine gels (no longer recommended), and amber necklaces (strangulation and choking risk). Brushing starts the day the first tooth shows — twice a day, smear of fluoride toothpaste, including the last thing before bed.
