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Ask Our Experts: Teething

What are some of the common problems that arise when children begin teething? How can parents help to ease teething discomfort and what would paediatricians recommend?

Dr. Khoo Boon Aik, Consultant Paediatrician and Neonatologist from Sunway Medical Centre says:

Your baby usually starts teething anytime between 3 months and 12 months of age. By the time your child is about 3 years old, he or she will have all 20 primary teeth. The lower front teeth usually come in first. Upper front teeth usually come in 1 to 2 months after the lower front teeth.

Generally about one third of infants show no symptom during teething, another one third may experience mild symptoms such as increase drooling, which may lead to rashes on the face or chin area, ear rubbing or tendency of putting hands into their mouth. The remaining one third will experience more severe problems such as soreness of the gum or jaw causing restlessness or fussiness with temporary refusal to feed with disturbed sleep. However, teething will not cause fever especially high-grade fever, diarrhoea, cough, runny nose, and generalized rashes or prolong excessive fussiness.

Most infants need no further treatment, as the teething symptoms are mostly mild and self-limiting. However, for those infants who experience excessive fussiness and discomfort that interfere with their feeding and sleep pattern, parents may try some home remedies to ease those symptoms such as applying teething gel with your clean finger around your baby’s gum or a silicon-based teething ring or teat, or introduce cold soft foods such as banana, fruit puree and cool yogurt for infants who are already on weaning diet.

There are many teething gel available over the counter, which mainly contain anaesthetic and antiseptic ingredients. These gels are relatively safe and helpful to some extent to soothe the painful gum. However, please read the label carefully as some gel may contain aspirin that is not safe for infants. Pain relief medication such as paracetamol or ibuprofen syrup can be given to those infants with painful and swollen gum who refuse feeding especially when the molar tooth is pushing through. Fortunately, most infants will be able to tolerate the teething period without much problem and they don’t need medication.

Apart from teething, common gum problems can happen also in infants or toddlers as they grow up:

  • Infection of the gum called gingivitis or infection of the lips and angles of mouth called gingiva-stomatitis. It is commonly caused by a virus, and generally self-limiting but some cold sores may be due to herpes simplex virus which may need to be treated with antivirus.
  • Viral infection that is confined to the oral cavity, called herpangina, is presented with multiple ulcers of the oral mucous membrane, tongue and gum. Those involving the hands and foot with red spots and blisters are called hand-foot-mouth disease. They are generally self-limiting but some children may need intravenous drip for rehydration due to poor oral intake.
  • Fungal infection of the oral cavity including the gums is called oral thrush. It is easily treated with antifungal oral gel. Rinsing the mouth with water after milk feeding will help to prevent this problem.
  • Some infants may develop mucoceles, which is a harmless fluid-filled cyst of the gum, inside the lower lips or under the tongue due to blocked or damaged salivary ducts leading to mucous seeping out, pools of mucous becoming walled off, which causes a cyst-like swelling. They are generally harmless and will often go away without treatment. Sometimes, the cyst may grow larger but don’t try to open or rupture it yourselves.

If these symptoms arise, please consult your paediatrician or dentist for further expert opinion and management.

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