Teething: a mum’s story

My 5 month old must be teething. She is chewing on everything from fingers (her own and other people’s) to toys and she drools so much she can run herself a bath almost anywhere.  And I consider myself lucky, some mothers in my mum’s group are at the end of their wits with sooki, irritable babies, their weird bowel movements and red faces. Teething seems to be the first of the many painful human conditions to attack our babies.

Recently, a friend from mum’s group asked about a certain teething gel and if we (other mum’s) would recommend it.  Being a dentist, even though I haven’t seen a child younger than 15 in my dental chair for many years, I immediately felt the need to reply to her Facebook post. Without doing any research on it, I pulled all my misguided and gossip-based pieces of information from my baby-brain depleted memory. I gave the woman all the wrong information about it and basically scared her into thinking this thing was poison in a tube. I later consulted good old Dr Google and found I was totally off the mark with the type of poison I presented it to be, but maybe not too far from the truth saying it was not very healthy for her baby.

The “Bonjela incident” as I like to call it, made me kick myself for offering advice without doing my homework (as a mum you tend to do that a lot, actually, especially a second-time mum dishing out wisdom to those naïve first time-mums) and also inspired me to go down the rabbit hole of teething relief products and see what I can find out. Is teething even a real ‘condition’? Are these medicaments, supplements, chewables and pieces of jewelry, which are so cleverly marketed to mums, really any good?

The first thing I discovered was that teething is an old wives tale about 5000 years old and it still seems to stick! Hippocrates, the father of medicine himself (back in 400 or so BC) believed teething to be a serious illness and teething was even considered a deadly condition up to the 19^th century. In 1839 England, 12% of all deaths of children younger than 4 were blamed on teething. During autopsies, doctors noted unerrupted teeth in the children’s jaws and this supposedly confirmed their diagnoses. It didn’t help that as nasty as teething was believed to be, even nastier were the ‘remedies’ supposed to relieve the teething complaints. They varied from putting hare brains on the baby’s gums and drinking dog’s milk to administering lead and mercury concoctions (?!), so no doubt a high percentage of the ‘teething deaths’ would have been directly caused by the remedies themselves.

The second thing I discovered is that “teething produces nothing but teeth”. This phrase was coined by an English pediatrician in 1975 and holds true today, backed by a decent body of evidence in various studies. One such study followed 125 healthy children from their 4 month check up to their first birthday.  It found that the only symptoms that correlated with the eruption of teeth seemed to appear in the 8 day window of 4 days before the tooth erupts, the day it emerges and the 3 days after it.

Most studies agree that the signs and symptoms actually associated with teething are mild and include:

• gum rubbing,
• thumb sucking,
• ear rubbing,
• drooling,
• increased irritability,
• daytime wakefulness,
• rash around the mouth,
• mild increase in temperature and
• decreased appetite for solids.

Signs and symptoms NOT associated with teething are:

• diarrhea,
• vomiting,
• stool looseness,
• fever,
• rashes other than a facial rash,
• sleep disturbance or
• decreased appetite for liquids.

It is really important to see a doctor if a baby suffers from these more severe symptoms as teething is a ‘bucket diagnosis’ and can delay the real diagnosis and appropriate treatment.

The third thing I discovered in my effort to redeem myself for bad teething advice to my friend was that parents, nurses, pharmacists, GPs and dentists are actually quite misguided in their understanding of teething and its associated signs and symptoms. Parents especially are being suckered into buying medicaments, supplements, French toys, pretty but ineffective and potentially dangerous jewelry, all in hope we will somehow protect our babies from the inevitable localized pain, no matter how mild or how temporary it may be.

Pediatricians seem to believe that real reasons behind what we observe to be painful and unusual changes in our babies around the time their teeth start to erupt (between 6 and 30 months of age) may be that the maternal (passive) immunity is no longer protecting the baby as it comes into contact with common illnesses and the baby begins developing their own immune response. One such proposition is that a first-time Herpes Simplex Virus infection (cold sore virus) may be responsible for some of the more severe symptoms and signs previously put down to teething.

The fourth and final lesson for me was: if they weren’t born with a silver spoon, just give them one to chew on. Apparently, one possible root of the ‘born with a silver spoon’ expression is that children of wealthy parents used to chew on spoons to relieve their painful gums, mostly by applying pressure. So, wealthy or not, a spoon is readily available and seems to be just as effective as anything else on the market.

Here are some of the popular remedies and aides and what they do or do not do:

• Spoons, cold and wet flannels, toys or teething rings– great for applying pressure to the inflamed area, can be cooled in the fridge (watch out for gel filled teethers and make sure to follow manufacturer’s care instructions as they can leak if damaged and grow bacteria). Most toys made after 1999 do not contain it, but check labels for presence of potentially harmful phthalates in the plastic toys. If in doubt, a simple spoon will do the trick and a silver one is even better.

• Bread rusks, chilled vegetable or fruit sticks– while they also apply pressure and cool the inflamed gum area, I am a bit weary of keeping food in my children’s mouths for too long. The sugar (even complex sugars) presence in the foods can contribute to a higher risk of tooth decay.

• French rubber toys– apparently more ‘Sophie the giraffe’ toys were sold in 2010 than babies were born, interesting and telling statistic on purchasing habits of parents.  While the toy is cute, how do parents make sure their 6 month old baby chews exclusively on the giraffe and not on the other, less fashionable pieces of rubber?

• Chamomile based food supplements and powders– chamomile is supposed to be soothing to an irritable child, but there is no scientific evidence that it offers any pain relief.

• Amber bead necklaces– these cute pieces of jewelry are supposed to leach out oil, which penetrates the child’s skin and relieves discomfort. The beads are not supposed to be chewed or sucked and present a chocking hazard for young children.

• Over the counter medication:

1. Choline salicylate gels (Bonjela)– this topical analgesic is similar to aspirin, but also with anti-inflammatory properties, which reduces swelling. If used overzealously it can cause chemical burns on the gums. It must be used sparingly as young children swallow most of it.
2. Topical anesthetic gels – these are not recommended for young children due to risks of allergic reaction, alcohol content and if they contain Benzocaine (Orajel,Orabase), they can cause methemoglobinemia (reduced ability to carry oxygen in the bloodstream).
3. Paracetamol and Ibuprofen (Panadol, Nurofen)– these should only be administered under the advice of your GP and in the correct dose and frequency for your child’s age and weight.

So, here I am, at midnight, at the end of my discovery about teething. Well, it feels good to know that I was not the only mis-informed dentist and mum in the world and even better to have finally understood the facts and fiction about this very tumultuous period in my baby’s life. Now off to get some sleep before the little drool machine edges even closer to that dreaded 8 day window of real teething trouble!

This post is dedicated to the mums of my mum’s group, they know who they are. I am sorry for leading you down the wrong path and I hope my ‘research’ into teething helps you all. It has definitely helped me. Goodnight and sweet uninterrupted dreams to you all!