The first tooth is a milestone, but the weeks before it arrives can be trying for both baby and parent. Teething discomfort is real, and the desire to do something about it is entirely understandable. The problem is that the market for teething products is large, poorly regulated in places, and includes some options that are ineffective, some that are unnecessary, and a few that are actively unsafe.
This guide covers what is known about teething pain, which interventions have the best evidence, and which products to avoid. The goal is to help parents make informed choices rather than reaching for whatever is in the pharmacy display.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers infant health across all stages of early childhood.
What Is Actually Happening During Teething
Teeth form in the jaw during foetal development and erupt through the gum tissue from around 4 months onwards, though the timing varies considerably between individual babies. The first teeth are usually the lower central incisors, followed by the upper central incisors. The full set of 20 primary teeth is usually in place by around 2.5 to 3 years.
As a tooth approaches the surface, it causes inflammation of the gum tissue – the surrounding area becomes red, swollen, and tender. This gum inflammation is the main source of teething discomfort. The process of eruption through the gum is generally brief, with the worst discomfort occurring in the days immediately before and after the tooth breaks through.
Research on teething symptoms has been more rigorous than might be expected for what can appear a minor topic. Michael Macknin at the Cleveland Clinic published a prospective study in Pediatrics (2000) tracking symptoms in 125 infants through 475 tooth eruptions. The study confirmed that drooling, finger sucking, gum rubbing, and irritability are genuinely associated with teething. Mild temperature elevation (up to 37.9°C) was also found to be associated with teething, but high fever was not. The finding that has become most important for clinical practice: fever above 38°C during teething should prompt a clinical assessment, not automatic attribution to the teeth.
What Works
Chilled teething rings. A teething ring or clean, damp cloth cooled in the refrigerator (not the freezer) provides pressure and mild cold that reduces gum inflammation. The cold has a mild anaesthetic effect; the counter-pressure also seems to provide relief. This is among the most evidence-consistent recommendations. The key caution is that frozen rings can be hard enough to damage gum tissue and are not recommended.
Gum massage. Gentle counter-pressure on the gum from a clean adult finger is effective for many babies. The same pressure mechanism applies – the baby pushing against resistance appears to relieve discomfort. This also provides physical closeness, which has independent soothing effects.
Chilled foods. For babies who have started solid foods, chilled (not frozen) fruit purees, yoghurt, or pieces of chilled cucumber (with supervision to prevent choking) can provide relief through the same cold-and-pressure mechanism.
Paracetamol or ibuprofen. When teething discomfort is genuinely disrupting a baby's sleep or feeding, age-appropriate paracetamol or ibuprofen (ibuprofen from 3 months/5kg for licenced paediatric preparations) are safe and effective. Dosing should follow the weight-based guidelines on the packaging. These should not be used preventively or routinely but are appropriate when a baby is clearly in pain.
What to Avoid
Teething gels containing lidocaine or benzocaine. The Medicines and Healthcare products Regulatory Agency (MHRA) and the US Food and Drug Administration (FDA) have both issued warnings about teething gels containing local anaesthetics. Benzocaine is associated with methaemoglobinaemia – a condition in which haemoglobin loses its ability to carry oxygen – in infants. Lidocaine in teething preparations has caused seizures and cardiac events, primarily when absorbed in excessive amounts. The MHRA's position is that lidocaine-containing teething gels should not be used in children under 2.
Amber teething necklaces. These products are widely sold with the claim that amber releases succinic acid when warmed by body heat, which acts as a natural painkiller. There is no credible evidence that this mechanism operates at concentrations relevant to pain relief. More importantly, the American Academy of Pediatrics, NHS England, and the Lullaby Trust have all issued warnings that amber necklaces and teething jewellery pose strangulation and choking hazards. These products should not be used.
Teething rusks. Many commercial teething rusks are high in sugar, which is problematic for the teeth that are erupting. Dental guidelines recommend avoiding sugary foods before the first teeth appear. A plain, unsweetened teething ring provides the same physical benefit without the sugar exposure.
Homeopathic teething remedies. Homeopathic teething powders and granules (including products like Nelsons Teetha) do not have clinical evidence of efficacy beyond placebo. In the United States, the FDA recalled some homeopathic teething products containing belladonna alkaloids due to toxicity concerns. NICE and NHS guidance does not recommend homeopathic preparations for any childhood condition.
Teething and Fever: The Distinction That Matters
The association between teething and mild temperature elevation is real, but the association between teething and proper fever is not well supported. The Macknin study and subsequent research suggest that teething may cause a temperature of up to 37.9°C but does not cause fever above 38°C. This distinction matters because attributing a significant fever to teething can delay the assessment of a genuine illness – ear infection, urinary tract infection, viral illness – that requires treatment.
The practical guideline: if a baby has a temperature above 38°C, or any fever and the baby appears unwell, a clinical assessment is appropriate regardless of whether teeth are about to emerge.
Key Takeaways
Teething typically begins between 4 and 7 months and continues until around age 3. The most reliably effective relief comes from chilled (not frozen) teething rings, gentle gum massage with a clean finger, and standard paracetamol or ibuprofen if pain is significant. Teething gels containing lidocaine or benzocaine are not recommended for infants due to safety concerns. Teething does cause discomfort but should not cause high fever, and any fever above 38°C warrants clinical assessment rather than being attributed to teething alone.
