Whether you’re a new or seasoned parent, teething can be a hair-graying experience. Crying, whining, drooling and overall crankiness are often a normal part of the process when a baby’s teeth are on the brink of breaking through the gum tissue. Manisha Panchal, M.D., a pediatrician at the Palo Alto Medical Foundation, talks about the signs and symptoms of teething and provides tips on how to soothe baby’s pain and keep those brand new teeth healthy.

When does teething begin, and what changes might I see?

Teething typically starts around 6 months of age, although it could start anytime in a baby’s first year. It’s most common for the two bottom front teeth (called the lower central incisors) to appear first, followed by the two top front teeth (called the upper central incisors).

When babies begin teething they are usually in the oral-discovery phase of development, which means they love to put everything they find into their mouths. Many babies gnaw on their own fingers or toys to relieve gum discomfort around an incoming tooth. Some babies refuse to eat or drink because their mouths are sore.

Drooling may start several weeks before the tooth actually begins to erupt through the gum. If drooling is excessive, it can cause a rash on your baby’s chin, cheeks or upper chest. Drying the baby’s chin with a clean cloth, applying petroleum jelly, such as Vaseline, around the mouth, and making sure the baby sleeps on an absorbent sheet may help with these problems.

Teething symptoms range widely from baby to baby. Some babies exhibit a few of the above symptoms while others keep their parents busy day and night. On the other end of the spectrum are the lucky young souls, not to mention their parents, who breeze through the teething process without showing any symptoms at all.

Babies who do exhibit teething symptoms typically get them a few days before the tooth comes through the gum. The symptoms normally fade after the tooth breaks through.

How can I help my baby be more comfortable?

Mild teething symptoms that improve over a short period of time aren’t a cause for concern, but there are a few tricks to make them more tolerable for babies and their parents. Following are a few recommendations:

• Massage the pain away. Use a clean finger, moistened gauze pad or damp washcloth to rub your baby’s gums. This may help relieve the pain in your baby’s gums. It’s also a good way to jumpstart the habit of running a wet washcloth over baby teeth for dental health.
• Try a teething ring. I generally recommend using rubber instead of liquid-filled teething rings, since the latter may break. Some parents use frozen teething rings, but I don’t recommend this because the extreme cold may cause more pain. You can try putting the ring in the refrigerator instead.
• Bring a bottle. If a bottle helps your baby, be sure to fill it with water. Extended chewing or sucking on a bottle filled with formula, milk or juice may expose your baby to too much sugar, leading to tooth decay.
• Try to chill. It may help to hold a cold washcloth over sore gums. If your baby is eating solids, try offering cool foods like yogurt or applesauce.
• Stop at the store. There are several over-the-counter remedies that may help with the teething process, for example, Hyland’s Baby Teething Tablets offer a homeopathic treatment for teething pain that melts on the baby’s tongue. For babies who are in such discomfort from teething that they cry incessantly, use an over-the-counter acetaminophen-based pain medication such as Infants’ Tylenol.

Should I take my baby to the doctor for teething pain?

If teething symptoms don’t go away after a few days of trying the above tips and medications, or if they grow in severity, parents should take their baby to see the child’s doctor. It’s possible that the pain could be caused by something more serious, such as an infection or other medical condition.

One common myth about teething is that it causes fever and diarrhea, but medical research doesn’t support this belief. Babies exhibiting these symptoms probably have an infection of some type and should be seen by a doctor.

Some babies may experience more pain because their teeth come in later than average, or the teeth break through the gum in an unusual pattern. In many cases these delays or differences are caused by problems such as another tooth getting in the way of an erupting tooth, a small jaw, or the failure of a tooth to break through the gum (impaction). These problems would warrant a visit to the doctor.

It’s also important to see the doctor if a baby loses a primary tooth because of an injury. This may cause the permanent tooth to grow in too early or too late, which could create an impaction or leave too little space for the permanent tooth. A dentist may need to put a spacer in the child’s mouth to keep the space open for the permanent tooth.

Once my baby has teeth, how can I keep them healthy?

Dental health is a lifelong endeavor, and it’s never too early to keep a child’s teeth clean. Parents can use a washcloth or a finger toothbrush (which goes on the top of the parent’s finger) to wipe their baby’s new teeth. Once a child turns 1 year old it’s a good idea to brush his or her teeth with non-fluoridated toothpaste, which makes it safe to swallow.