Teething Symptoms: What's Normal and What Isn't
In short: teething symptoms are usually mild: sore, swollen gums, extra drooling, chewing on everything, a little fussiness and perhaps a slightly raised temperature under 38°C. Teething does not cause a high fever, diarrhoea, a runny nose or a baby who is clearly unwell. If your baby has any of these, look for another cause rather than putting it down to teeth.
Key takeaways
Most babies cut their first tooth around six months, but anywhere from before four months to after twelve months can be normal.
The two bottom front teeth usually come first, and most children have all 20 milk teeth by two to three years.
Teething can cause a slight rise in temperature, but a fever of 38°C or higher is not caused by teething.
Teething does not cause diarrhoea, vomiting, a cough or a runny nose, even though these often happen at the same age.
Amber teething necklaces and numbing gels containing benzocaine or lidocaine are not safe for babies and should be avoided.
When do babies start teething?
Most babies get their first tooth at around six months, though the normal range is wide, from before four months to just after the first birthday.
Gum discomfort can start a few weeks before a tooth breaks through, and some babies seem to "teethe" on and off for months. A few babies are even born with a tooth. Timing often runs in families, so ask your own parents when you got your first teeth.
In what order do baby teeth come through?
The order is fairly predictable, although every baby has their own timetable. As a rough guide:
Front teeth (central incisors): around 6 months.
Teeth either side of the front teeth (lateral incisors): around 8 months.
First back teeth (first molars): around 12 months.
Pointed teeth (canines): around 18 months.
Second back teeth (second molars): around 24 months.
Bottom teeth usually appear before the matching top ones. By two to three years, most children have a full set of 20 milk teeth.
My baby is 12 months and has no teeth. Should I worry?
Usually not. A baby who is otherwise growing, feeding and developing well and has no teeth at a year is most often just a late teether. If there are still no teeth by around 18 months, or your child has other concerns such as slow growth, mention it to your paediatrician or dentist.
What are the real signs of teething?
The signs that teething genuinely causes are local to the mouth: red, swollen gums, drooling, chewing, rubbing the face and some extra crankiness for a few days around each tooth.
Common teething signs
Red, swollen or tender gums, sometimes with a small bluish bump where a tooth is coming.
More drooling than usual, sometimes with a rash on the chin or cheeks from the wet skin.
Gnawing on fingers, toys and anything within reach.
One flushed cheek, or rubbing the ear on the same side as the sore gum.
Fussiness and lighter, more broken sleep for a few nights.
A slightly raised temperature, staying below 38°C.
How long do teething symptoms last for each tooth?
For most teeth, the uncomfortable phase lasts only a few days, around the time the tooth cuts through the gum. Molars are bigger and can take a little longer. If your baby has been miserable for more than a week, or the crying is out of character, it is worth looking for another cause.
Does teething cause fever, diarrhoea or a runny nose?
No. Studies show teething can cause at most a small rise in temperature, and it does not cause a true fever of 38°C or more, diarrhoea, vomiting, a cough or a runny nose.
This is one of the most important things I share with parents. Teething happens at the same age that babies start crawling, putting everything in their mouths and, for many Malaysian families, starting at a taska or nursery. Babies of this age catch a lot of viral infections, and it is easy to blame the new tooth. The risk is that a real illness, such as an ear infection, a urine infection or dengue, is missed because everyone assumed it was "just teeth".
What about loose stools while teething?
Some parents notice slightly looser stools during teething, often linked to swallowing a lot of drool or to changes in eating. True diarrhoea, meaning frequent watery stools, has another cause, most often a tummy bug. Watch for signs of dehydration such as fewer wet nappies, a dry mouth or unusual sleepiness.
Does teething cause a rash?
Teething can cause a drool rash around the mouth, chin and neck, because the skin is constantly wet. It does not cause a rash elsewhere on the body or a nappy rash. A spreading rash, especially with fever, needs a doctor to look at it.
When to see a doctor, and when not to worry
Judge your baby by how unwell they seem, not by the teeth: a cheerful, feeding baby with sore gums is fine, while fever, poor feeding or unusual drowsiness needs checking.
Usually fine
Sore gums, drooling and chewing with a baby who is still feeding and playing.
A temperature slightly raised but under 38°C.
A few unsettled nights around a new tooth.
A drool rash on the chin or cheeks.
No teeth yet at 12 months in a baby who is otherwise well.
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No teeth at all by around 18 months.
A tooth that looks discoloured, chipped, or has white or brown patches.
A swelling on the gum that is filled with fluid or keeps getting bigger.
Crying or poor sleep lasting more than a week.
Loose stools lasting more than a day.
See a doctor the same day
A temperature of 38°C or higher in a baby under three months.
A fever of 38°C or higher at any age that lasts more than a day, or with a rash, vomiting or drowsiness.
Refusing feeds, or fewer than four wet nappies in 24 hours.
Unusual sleepiness, floppiness or a cry that sounds different from normal.
Fast or difficult breathing.
Fever with bleeding gums, a new rash or repeated vomiting, especially during a dengue outbreak in your area.
What you can do at home
Simple, cold and safe things work best for teething: something firm to chew, a clean finger to rub the gums and lots of cuddles.
Babies under six months
Gently rub the gums with a clean finger for a minute or two.
Offer a solid rubber or silicone teething ring, chilled in the fridge rather than the freezer.
Wipe drool from the face often and pat dry to prevent a rash. A thin layer of barrier cream can help.
Keep feeding as usual. Some babies want to feed more for comfort, others feed for shorter periods.
Babies six to twelve months
Offer a clean, damp, chilled washcloth to chew on.
If your baby has started solids, cold soft foods such as chilled yoghurt or mashed fruit can soothe the gums. Stay close during eating.
Offer sips of cool water from an open or sippy cup.
Start brushing as soon as the first tooth appears, twice a day, with a smear of fluoride toothpaste the size of a grain of rice.
Toddlers getting molars
Offer firm, chilled teething toys designed for back teeth.
Keep bedtime routines steady, even if sleep is disrupted for a few nights.
If your child is very uncomfortable, ask your doctor or pharmacist whether a simple pain reliever is suitable, and follow the dose on the label for your child's age and weight.
Plan a first dental check by around the first birthday, then regularly as advised by your dentist.
What not to do
Do not use amber, wooden or bead teething necklaces or bracelets. They carry a risk of choking and strangulation.
Do not use numbing gels or tablets containing benzocaine or lidocaine for babies.
Do not rub alcohol, minyak angin or traditional oils on the gums.
Do not give hard frozen objects or liquid-filled teethers that can split.
Do not put your baby to bed with a bottle of milk or juice, as this raises the risk of tooth decay.
Do not assume a fever or diarrhoea is "just teething".
From Dr Nisa's clinic: Teething is one of the most common reasons parents give for a baby being unwell, and it is understandable, because the timing fits so well. In clinic, I gently remind families that teeth cause sore gums and grumpiness, not a high temperature or a tummy upset. When a baby has a real fever, I look for the usual causes first, such as the ears, throat, chest and urine. The teeth can wait; an infection sometimes cannot.
Worried about your baby's teething?
I am Dr Nisa Khalil, a consultant paediatrician with more than 18 years of experience looking after babies and children, and I see families at ParkCity Medical Centre in Desa ParkCity, Kuala Lumpur. If your baby has a fever, is not feeding well, or you are not sure whether it is teeth or something else, I am happy to see them.
Book an appointment or start an online eConsult.
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Frequently asked questions
Can teething cause a fever?
Teething can cause a slight rise in temperature, but it stays below 38°C. A true fever of 38°C or more is not caused by teething and usually means an infection. Look for other signs such as a runny nose, cough, ear pulling, vomiting or a rash, and see a doctor if your baby is under three months, the fever lasts more than a day, or your baby seems unwell.
How long does teething last?
Each tooth usually causes a few days of discomfort around the time it breaks through the gum. Because there are 20 milk teeth arriving between about six months and three years, teething happens in short bursts over two to three years, not as one long phase. Most babies have long settled spells between teeth.
Does teething cause diarrhoea?
No. There is no good evidence that teething causes diarrhoea. Some babies have slightly looser stools from swallowing extra drool, but frequent watery stools have another cause, most often a viral tummy bug. Keep up feeds, watch for fewer wet nappies or a dry mouth, and see a doctor if loose stools last more than a day.
Are teething gels safe for babies?
Numbing gels containing benzocaine or lidocaine are not recommended for babies and young children. Benzocaine has been linked to a rare but serious blood problem, and the gel is quickly washed away by drool anyway. A chilled teething ring, gentle gum rubbing and a cold washcloth are safer and often just as effective.
Are amber teething necklaces safe?
No. Amber, wooden, marble and silicone teething necklaces and bracelets can cause choking or strangulation, and there is no reliable evidence that they reduce teething pain. Health authorities, including the American Academy of Pediatrics and the US Food and Drug Administration, advise parents not to use them.
Why is my teething baby waking at night?
Gum soreness can feel worse when your baby is lying down and has fewer distractions, so a few broken nights around a new tooth are common. Keep the bedtime routine calm and consistent. If night waking lasts more than a week, or comes with fever or crying that is unusual for your baby, look for another cause such as an ear infection.
Medically reviewed by Dr Nisa Khalil on 15 October 2026. This article is general information and does not replace a consultation with your own doctor.
References
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