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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Teething Care & Anticipatory Guidance

Teething and symptoms attributed to teething are a common concern of parents.

It is important to inform parents that none of these symptoms consistently and accurately predict when teething is about to occur:

  • Congestion or cough
  • Sleep disturbance
  • Decreased appetite for liquids
  • Vomiting
  • Loose or increased stools

The recommended intervention for teething is the use of cold items because the cold acts as an anesthetic for the gums.

Suggested items include:

  • Pacifiers
  • Spoons
  • Clean wet washcloths
  • Frozen bagels or bananas
  • Refrigerated teething rings

Topical teething gels sold over-the-counter (OTC) are often used for teething.

These gels can carry serious risks, including local reactions, seizures with overdose, and methemoglobinemia. Benzocaine containing teething gels should not be used in infants or children under 2 years of age.

Methemoglobinemia: The presence of methemoglobin in the blood due to conversion of part of the hemoglobin to this inactive form .

If necessary, parents should be instructed on proper dosing of OTC analgesic medications, such as acetaminophen or ibuprofen.

Fast Facts
There are no symptoms that consistently and accurately predict teething.
Fever, vomiting, diarrhea, and cough or congestion should not be attributed to teething and may require evaluation.
Teething rings should be refrigerated only to prevent infants from developing fat necrosis.
Parents should be made aware of the potential dangers of over-the-counter topical teething gels.
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