Understanding Children's Teething Problems with Dr. Kanchankumar Bhagyawant

Both medical professionals and the general public use term "teething" as an incorrect diagnosis for a wide range of symptoms, including fever, pain, irritability, sleep issues, mouthing/biting, drooling, red cheeks, decreased oral intake, gum inflammation, runny nose, and diarrhoea. Such parental beliefs are consistent worldwide, across all education levels, and for both first-time and experienced parents.

This article looks at the symptoms and indicators that are often linked to teething as well as potential other causes. The management of teething from a modern perspective is covered, along with supportive interventions.

·         Understand normal anatomy and physiology of tooth eruption as well as causes of delayed eruption.

·         Be aware of the historic beliefs about the effects of teething and therapies that have been used in the past.

·         Describe the effects of teething and the signs and symptoms that are unrelated to teething, which necessitate referral to a physician.

·         The features that are currently accepted to be associated with teething.

·         Advice to parents about current methods of teething pain relief, including conventional pharmacological and 'alternative' holistic methods.

 ·         Understand normal anatomy and physiology of tooth eruption as well as causes of delayed eruption:

Tooth eruption or teething is the process by which a tooth moves from the pre-eruptive position in the alveolar bone through the mucosa into the oral cavity. As the tooth moves upward in the jaw, this area of fused epithelium breaks down, and the tooth erupts. Prior to this, the gingiva may appear bluish and swollen as a result of a transient hematoma. The dental follicle is a source of eicosanoids, cytokines, and growth factors and, thus, may contribute to some of the localized symptoms seen with teething.

Primary teeth, also known as deciduous teeth or milk teeth, comprise 8 incisors, 4 canines, and 8 molars for a total of 20 teeth as shown in the picture:.

The timing of tooth eruption varies widely, although most children get their first deciduous tooth around 6 months of age and their last between 24 and 30 months of age. . The lower central incisors usually erupt first and the molars last. Teeth tend to emerge in pairs, and girls often get their teeth earlier than do boys. The average number of teeth a child should have is roughly his or her age in months minus 6 until 24 months of age. Preterm infants acquire their teeth at a later chronological age but the same post conceptual age as term infants.

A number of pathologic conditions are associated with a delay in tooth eruption:

·         Impacted Teeth

·         Down Syndrome

·         Impedance of tooth eruption by adjacent or overlying tooth or bone.

·         Cleidocranial Dysplasia

·         Congenital Hypothyroidism

·         Gaucher Disease

·         Osteopetrosis

·         Rickets

Historical Teething Remedies no longer used now:

Reality:

“Teething produces nothing but teeth.” is a straightforward summation of the actual process of teething.

Symptoms:

The period associated with the eruption of the deciduous teeth in infants can be difficult and distressing for both the child and their respective parents. The eruption of the deciduous teeth is accompanied by a number of relatively minor symptoms

•     Pain

•     Inflammation of the mucous membrane overlying the tooth (possibly with small hemorrhages)

•     General irritability/malaise

•     Disturbed sleep/wakefulness

•     Drooling/sialorrhea

•     Gum rubbing/biting/sucking

•     Bowel upset (ranging from constipation to loose stools and diarrhea)

•     Loss of appetite/alteration in volume of fluid intake

•     Ear rubbing on the same side as the erupting tooth

Studies could not identify systemic manifestations such as decreased appetite for liquids, congestion, sleep disturbances, daytime restlessness, loose stools, vomiting, cough, body rash, fever greater than 38.90C, an increase in finger sucking, and gum rubbing to be associated with teething in children.

Textured or cold teething rings to bite on to relieve discomfort. The cold temperature of the object causes localized vasoconstriction, which decreases the inflammation, and biting on the object gives further relief by applying pressure to the gums.

Management of teething:

•           Teething rings (chilled)

•           Hard sugar-free teething rusks/bread-sticks/ oven-hardened bread

•           Cucumber (peeled)

•           Frozen items (anything from ice cubes to frozen bagels, frozen banana, sliced fruit)

 •          Pacifier (even frozen)

•           Rub gums with clean finger, cool spoon, and wet gauze

•           Reassurance

•           Analgesic/antipyretics

•           Topical anesthetic agents

•           Alternative holistic medicine

General advice regarding medication:

Only sugar-free objects and medication should be prescribed during teething. Use correct dosages to prevent overdose of the child when dispensing medicaments. Teething remedies should be kept well out of reach of all children, as even ‘childproof’ containers can be opened by small children, and because of added flavorings, children can unwittingly overdose themselves. Medicines, including teething remedies, should never be added to food or feeding bottles, as parents cannot accurately control the dosage ingested. In addition, the active ingredient of the medication may adversely interact with foodstuffs and the possibility exists for other children to share potentially harmful medication in this way.

The infant should be promptly referred to a pediatrician for an accurate diagnosis and appropriate treatment of severe systemic upsets occur.