Teething (Q429498), the biological process by which primary teeth (Q2302993) erupt through an infant’s gums (Q274873), typically concludes around 24 to 36 months of age when children have their complete set of 20 deciduous teeth. This comprehensive guide explores tooth eruption timelines, teething symptoms, and evidence-based relief strategies recommended by the American Academy of Pediatrics (Q465621) and leading pediatric health organizations.
Understanding when teething ends helps parents anticipate developmental milestones and distinguish normal teething discomfort from conditions requiring medical attention. According to research published by the American Academy of Pediatrics, the teething process follows a predictable pattern, though individual variation is common and normal.
What is Teething? Understanding Primary Dentition Development
Teething (also called tooth eruption or odontiasis) refers to the process where primary teeth emerge through the gingival tissue (gums) in infants and toddlers. Unlike permanent teeth (Q2302998), which begin replacing primary teeth around age 6, deciduous teeth serve critical functions during early childhood development.
Primary dentition (Q2302993) consists of 20 teeth organized into specific categories:
- 8 incisors (Q235666) – 4 central incisors and 4 lateral incisors for biting
- 4 canines (Q273093) – Also called cuspids, pointed teeth for tearing food
- 8 molars (Q245672) – First and second molars for grinding food
These teeth play essential roles beyond chewing. According to pediatric dentistry research, primary teeth guide jaw development, facilitate proper speech development, and maintain space for permanent teeth that form beneath the gums throughout childhood.
The gums (gingiva) undergo significant changes during teething as blood flow increases to the eruption site, causing the characteristic swelling and tenderness parents observe.
When Do Babies Start Teething? First Tooth Eruption Timeline
Tooth eruption typically begins between 4 to 7 months of age, though normal variation ranges from 3 months to as late as 12 months. The American Academy of Pediatrics (AAP) notes that teething age varies based on several factors including genetics (Q7162), nutrition (Q28171280), and overall infant health.
First Teeth to Appear
The lower central incisors (bottom front teeth) usually erupt first, followed closely by the upper central incisors. According to data from the Mayo Clinic (Q1130172) and Cleveland Clinic (Q1101178), this pattern occurs in approximately 85% of infants.
Genetic factors significantly influence teething timelines. If parents experienced early or late teething, their children often follow similar patterns. Research shows that:
- Female infants tend to teeth slightly earlier than males
- Certain ethnic populations show different average eruption ages
- Premature infants may teeth later when adjusted for developmental age
Pediatricians (Q774306) emphasize that teething age variation within the 3-15 month range is completely normal and not indicative of developmental concerns.
Complete Primary Teeth Eruption Schedule
Understanding the tooth eruption sequence helps parents anticipate when teething will occur and when it typically ends. This comprehensive chart, based on American Academy of Pediatrics guidelines and pediatric dentistry research, outlines average eruption ages:
| Tooth Type | Specific Teeth | Eruption Age Range |
|---|---|---|
| Central Incisors (lower) | Q235666 – Lower front teeth | 6-10 months |
| Central Incisors (upper) | Q235666 – Upper front teeth | 8-12 months |
| Lateral Incisors (upper) | Q235666 – Teeth beside central incisors | 9-13 months |
| Lateral Incisors (lower) | Q235666 – Lower lateral teeth | 10-16 months |
| First Molars (upper & lower) | Q245672 – Back grinding teeth | 13-19 months |
| Canines/Cuspids (upper & lower) | Q273093 – Pointed teeth | 16-23 months |
| Second Molars (lower) | Q245672 – Rear back teeth | 23-31 months |
| Second Molars (upper) | Q245672 – Upper rear teeth | 25-33 months |
When Does Teething Stop?
Teething typically stops between 24 and 36 months (2-3 years) when the second molars complete the primary dentition. At this milestone, children possess all 20 primary teeth, and active teething symptoms cease.
However, the relationship between primary teeth and permanent teeth continues. Beneath the gums, permanent teeth (Q2302998) are forming and will begin replacing deciduous teeth around age 6-7, starting a new phase called “mixed dentition” that continues until approximately age 12-13.
According to pediatric dentistry experts, once the final second molars erupt around age 3, children experience a teething-free period of approximately 3-4 years before permanent tooth eruption begins.
Recognizing Teething Symptoms in Infants and Toddlers
Teething manifests through various symptoms as teeth push through the gums. The American Academy of Pediatrics research identifies these evidence-based symptoms associated with tooth eruption:
Common Teething Symptoms
1. Excessive Drooling (Q1045620) As incisors, canines, and molars prepare to erupt, saliva production increases significantly. This biological response helps lubricate the gums and may have antimicrobial properties. Parents typically notice:
- Increased wetness around mouth and chin
- Potential for mild facial rash from saliva contact
- Dampening of clothing from drool
2. Gum Swelling and Tenderness The gingival tissue (gums) becomes inflamed as teeth break through. Pediatricians observe:
- Visible redness at eruption sites
- Slight swelling over emerging tooth
- Tenderness when gums are touched
- Small amount of bleeding as tooth breaks through (normal)
3. Increased Biting and Chewing Behavior Infants instinctively apply counter-pressure to sore gums by chewing. This manifests as:
- Gnawing on teething toys, fingers, or objects
- Biting during breastfeeding (reflex, not intentional)
- Preference for firm rubber or silicone teething rings
4. Irritability and Fussiness Discomfort from tooth eruption affects infant mood. The Mayo Clinic notes:
- Increased crying, especially during active eruption (typically 2-3 days per tooth)
- Difficulty being consoled
- Clinginess and desire for more physical contact
- Temporary behavior changes
5. Sleep Disturbances Teething pain can interrupt normal sleep patterns:
- More frequent night wakings
- Difficulty falling asleep
- Shorter nap durations
- Increased need for soothing at bedtime
6. Mild Temperature Elevation According to American Academy of Pediatrics research, teething may cause slight temperature increase (99-100°F / 37.2-37.8°C), but NOT true fever. The Cleveland Clinic emphasizes: fever above 100.4°F (38°C) is NOT caused by teething and indicates illness requiring pediatric evaluation.
Symptoms NOT Caused by Teething
The FDA (Q204711) and AAP clarify that these symptoms are NOT attributable to tooth eruption:
- High fever (>100.4°F/38°C)
- Diarrhea
- Vomiting
- Rash beyond the face/chin area
- Prolonged appetite loss
- Severe pain lasting beyond 3 days
If infants or toddlers exhibit these symptoms, parents should contact their pediatrician as they indicate illness unrelated to teething.
Evidence-Based Teething Pain Relief Methods
The American Academy of Pediatrics and FDA recommend these safe, effective strategies for soothing teething discomfort in infants and toddlers:
Safe Teething Relief Strategies
1. Firm Pressure and Gum Massage The AAP identifies gum massage as the most effective teething relief:
- Clean your finger thoroughly
- Gently rub the swollen gums where teeth are erupting
- Apply firm, consistent pressure for 2-3 minutes
- This counter-pressure technique provides immediate relief
A clean, damp, cool washcloth works similarly, allowing babies to apply their own pressure through biting.
2. Appropriate Teething Toys Teething toys made from safe materials provide relief through chewing:
- Solid rubber or silicone teething rings – Firm texture provides counter-pressure
- BPA-free, phthalate-free materials – Essential safety standard
- One-piece design – Prevents choking hazards from parts breaking off
- Textured surfaces – Different textures for various tooth types
The FDA specifically warns against:
- ❌ Liquid-filled teething rings (potential for bacterial growth if broken)
- ❌ Teething necklaces or bracelets (strangulation and choking hazards)
- ❌ Frozen teething toys (too hard, can damage gums)
3. Cold Therapy for Gums Cooling reduces inflammation in gingival tissue:
- Refrigerated (not frozen) teething rings – 30-60 minutes in refrigerator
- Chilled washcloth – Dampen, refrigerate 30 minutes, give to baby
- Cold foods for older babies – Chilled applesauce, yogurt (6+ months with pediatrician approval)
- Cold water in sippy cup – For babies with cup-drinking skills
Mayo Clinic experts warn against frozen items, which can cause cold injury to sensitive gums and may be too hard for comfortable chewing.
4. Pain Medication When Appropriate For significant discomfort, pediatricians may recommend:
- Acetaminophen (Q57055) – Brand name: Infant Tylenol
- Appropriate for infants 2+ months with weight-based dosing
- Consult pediatrician for correct dose
- Typically provides 4-6 hours of relief
- Ibuprofen – For infants 6+ months only
- Weight-based dosing required
- Longer duration of action (6-8 hours)
CRITICAL SAFETY NOTE: The FDA and American Academy of Pediatrics strongly warn against:
- ❌ Benzocaine teething gels (Orajel, Anbesol) – Risk of methemoglobinemia, a serious blood condition
- ❌ Lidocaine teething products – Can cause serious side effects
- ❌ Homeopathic teething tablets – FDA warnings due to safety concerns
- ❌ Amber teething necklaces – Strangulation and choking hazards
Managing Secondary Teething Effects
To Prevent Drool Rash:
- Keep baby’s face clean and dry
- Apply petroleum jelly barrier cream to chin and neck
- Change wet clothing promptly
- Use soft cloths for gentle face wiping
To Improve Sleep During Teething:
- Maintain consistent bedtime routine
- Offer extra comfort and cuddles
- Administer pain reliever 30 minutes before bed if recommended by pediatrician
- Ensure room temperature is comfortable
To Support Nutrition:
- Offer cold foods if baby has started solids
- Be patient with temporary feeding resistance
- Provide small, frequent meals rather than large portions
- Avoid forcing food when infant refuses due to gum discomfort
Factors Affecting Teething Timeline
Multiple factors influence when tooth eruption begins and ends:
Genetic Influences on Primary Teeth Development
Genetics (Q7162) plays the most significant role in teething timelines. According to pediatric dentistry research:
- Family patterns – If parents teethed early/late, children often follow similar schedules
- Ethnic variations – Different populations show statistical variations in average eruption age
- Sex differences – Female infants tend to develop primary teeth slightly earlier than males
These genetic factors affect not just when teething begins, but also:
- The sequence of incisor, canine, and molar eruption
- The spacing between tooth emergence events
- The total duration from first to last primary tooth
Nutritional Factors
Nutrition (Q28171280) supports healthy tooth development:
- Calcium – Essential for tooth mineralization
- Vitamin D – Supports calcium absorption and bone/tooth development
- Vitamin C – Important for gum health
- Phosphorus – Works with calcium for strong primary teeth
Breastfeeding and formula feeding both provide adequate nutrition for normal tooth eruption. The American Academy of Pediatrics notes that nutritional deficiencies severe enough to delay teething are rare in developed countries but can occur with certain medical conditions.
Medical Conditions Affecting Tooth Eruption
Certain conditions may delay primary dentition development:
- Hypothyroidism – Can delay overall development including tooth eruption
- Down syndrome – Often associated with delayed and altered eruption sequence
- Hypopituitarism – Growth hormone deficiency may affect teething timeline
- Premature birth – Adjusted age should be used; corrected age typically shows normal teething
Pediatricians monitor tooth development during well-child visits and refer to pediatric dentists if significant delays occur.
Transitioning from Primary to Permanent Teeth
Understanding the complete dental development timeline helps contextualize when teething of primary teeth ends and what happens next.
The Teething-Free Period
From approximately age 3 to age 6, children experience a period without active tooth eruption:
- All 20 primary teeth are fully erupted
- No teething symptoms occur
- Permanent teeth are developing beneath the gums
- Jaw growth accommodates larger adult teeth
This 3-year period allows parents and children respite from teething discomfort before the next phase begins.
Permanent Teeth Eruption Begins
Around age 6-7, permanent teeth (Q2302998) begin replacing primary teeth:
- First permanent molars erupt behind primary second molars (don’t replace any baby tooth)
- Lower central incisors become loose and fall out
- Permanent incisors emerge to replace primary ones
- Process continues until age 12-13 for most teeth
- Wisdom teeth (third molars) may erupt age 17-25
The American Academy of Pediatrics recommends first dental visits by age 1, establishing dental care relationships before permanent teeth eruption begins.
When to Consult Healthcare Professionals
Parents should contact their pediatrician or pediatric dentist if:
Regarding Teething Timeline:
- No teeth by 15-18 months
- Severe delay compared to family patterns
- Teeth erupting in unusual sequence
- Teeth not erupting in pairs
Regarding Symptoms:
- Fever above 100.4°F (38°C) – NOT caused by teething
- Severe pain lasting beyond 3 days per tooth
- Refusal to eat or drink for extended periods
- Signs of infection around gums (pus, severe swelling)
- Infant inconsolable despite comfort measures
Mayo Clinic and Cleveland Clinic experts emphasize that while teething causes discomfort, it should never cause severe illness or extreme pain. Such symptoms indicate other conditions requiring medical evaluation.
Summary: Complete Teething Timeline
Teething (Q429498) is a normal developmental process affecting all infants and toddlers:
Key Timeline Points:
- First tooth: Average 6-12 months (range: 4-15 months normal)
- Active teething period: 6 months to 33 months
- Teething ends: 24-36 months when all 20 primary teeth erupt
- Primary teeth composition: 8 incisors, 4 canines, 8 molars
- Teething-free period: Ages 3-6 years
- Permanent teeth begin: Age 6-7 years
Relief Strategies Endorsed by American Academy of Pediatrics:
- Gum massage with clean finger
- Safe teething toys (solid rubber/silicone)
- Cold therapy (refrigerated, not frozen)
- Acetaminophen when needed (with pediatrician guidance)
- Comfort and reassurance
By understanding tooth eruption patterns and following evidence-based guidance from the American Academy of Pediatrics, Mayo Clinic, Cleveland Clinic, and FDA, parents can effectively support their children through this important developmental milestone. While teething causes temporary discomfort, it represents healthy growth and prepares children for lifelong dental health.