2. D E E P T H I P . R .
P U S H P A G I R I C O L L E G E O F D E N T A L S C I E N C E S
TEETHING

3. CONTENTS
 INTRODUCTION
 DEFINITION
 CLINICAL FEATURES
 MANAGEMENT
 STUDY REPORTS
 ASSOCIATION WITH HERPES SIMPLEX
INFECTION
 CONCLUSION
 BIBLIOGRAPHY

4. INTRODUCTION
 Teething - ‘eruption of primary teeth’.
 Abnormal or difficult eruption
 Eruption of primary teeth - fifth or sixth month.
 Eagerly awaited and important MILESTONE
 No distress
 Sometimes local irritation- minor or severe enough
to interfere with the child’s sleep
 Relatively large molars
 Diseases – 6 to 26 months –19th century teething

5.  Teething is the physiologic process of the eruption of
primary teeth through the gums.

6. CLINICAL FEATURES
LOCAL SIGNS
 Hyperemia or swelling of the mucosa overlying the
erupting teeth
 Patches of erythema on the cheeks
 Flushing of the skin of the adjacent cheek
 Hand and fingers always put in the mouth

7. CLINICAL FEATURES
SYSTEMIC SIGNS
 General irritability and crying
 Increased salivation and drooling
 Loss of appetite
 Insanity
 Sleeplessness and restlessness
 Meningitis
 Increased thirst
 Circumoral rash
 Cough

8. ASSOCIATED PROBLEMS
SYSTEMIC
 Fever
 Convulsions
 Diarrhea
 Vomiting
 Bronchitis
 Cholera
 Tetanus
 Infantile paralysis

9. ASSOCIATED PROBLEMS
LOCAL
 Eruption hematoma
 Eruption sequestrum
 Ectopic eruption
 Transmigration
 Transposition

10. POSSIBLE EXPLANATION FOR THE
SYMPTOMS
 Eruption- local inflammatory process
 Irritability- child puts whatever object found into
mouth- relief
 Unclean objects- infection and inflammation in the
already inflamed gums
 If not relieved- restless,
wakeful, fretful, fearful and
refuses nourishment

11. POSSIBLE EXPLANATION FOR THE
SYMPTOMS
 Alimentary canal active-diarrhea, nausea, vomiting,
convulsions
 Association with diarrhea, fever, convulsions-
coincidental
 Mouthing of contaminated toys or teethers used to
rub the gums

12. MANAGEMENT
PREVENTIVE MEASURES
 Mention teething in prenatal counselling- the first
postnatal oral issue confronted
 Educate members of the family
 Good oral and body hygiene;
gums healthy and fresh
 Gums wiped after each meal with cotton soaked in
weak antiseptic- 1:100 KMnO4
 Adequate vitamins, minerals, proteins

13. LOCAL MANAGEMENT
Gentle massage- clean finger or saline soaked gauze
piece & increased fluid consumption
TEETHING OBJECTS
 Satisfy the natural desire of the infant to chew on
hard objects
 Stimulates the gumpads for the smooth and painless
eruption

14. LOCAL MANAGEMENT
Teething foods
-Hard non sweetened firm rusks
-Toasted bread
-Biscuit preparations
- Hard fruits and vegetables
apple,guava,carrot

15. LOCAL MANAGEMENT
Teething toys
 Specifically manufactured teething rings, keys,
blowers, rattles
 Relief from soreness by the pressure
 Liquid containing ones – avoided
 Caution against cheap toys with lead

16. LOCAL MANAGEMENT
 Pacifiers releasing preventive agents- sodium
fluoride, xylitol
 Teething necklaces
 Clove oil, licorice sticks,
vanilla extract
 Frozen items

17. LOCAL MANAGEMENT
 Topical Medicaments
- glycerin
-lignocaine hydrchloride(tds/qid)
Caution : Rapid systemic absorption- toxic doses if
misused
-benzyl alcohol
-mild purgatives (phenolphthalein, castor oil,
calomel, milk of magnesia)

18. INGREDIENTS IN PREPARATIONS
NAME LOCAL
ANALGESIC
ANTISEPTIC ANALGESIC/
ANTI-INFLAMMATORY
AGENT
Bonjela none 0.01% cetalkonium
chloride
4.6% glycerin
8.7% choline salicylate
0.05% menthol
Dentinox 0.3% lignocaine
hydrochloride
0.1%
cetylpyridinium
chloride
0.3%
polyethoxdodecane
3% alcohol
0.06% menthol
0.08% myrrh tincture
Pyralvex none 5% anthraquinone
glycosides
1% salicylic acid
Teejel none 0.01% cetalkonium
chloride
8.7% choline salicylate

19. SYSTEMIC TREATMENT
Only if local treatment has been ineffective
ANALGESICS
 Sugar free Paracetamol preparations(5ml=120mg)
Dosage: upto 1year- 5ml at bedtime
1-5 years - 10ml at bedtime
 Soluble acetyl salicylic acid tablets
 Chamomilla- homeopathic medicine

20. SYSTEMIC TREATMENT
HYPNOTICS & SEDATIVES
 To restore normal sleep rhythm after a succession of
sleepless nights
 Combined with analgesics

21. SYSTEMIC TREATMENT
 Chloral Elixir Paediatric BPC
(5ml=200mg of chloral hydrate)
Dosage: Upto 1year- 2.5ml bd
1-5 years- 2.5-5ml tds
 Dichloralphenazone Elixir BPC (Welldorm Elixir)
(5ml= 225mg dichloralphenazone)
Dosage: Upto 1 year- 2.5-5ml hs
1-5 years- 5-10ml hs

22. CAUTION
If symptoms persist for more than 24 hours,
physician should be consulted to rule out
URTI and other diseases of infancy

23. SELECTION OF TREATMENT
COMPLAINT TREATMENT
Irritation at the site of tooth eruption Topical application
Daytime irritability and fretfulness Topical application & systemic analgesics
Disturbed sleep Topical application, systemic analgesics
&hypnotic

24. SURGICAL
TREATMENT
Pain relief from an eruption cyst or hematoma
TECHNIQUE:
 Two semilunar incisions are made over the crown of
the tooth which meet at their extremities
 The intervening portion of the tissue which lies over
the occlusal portion of the unerupted tooth , is then
removed with a pair of tissue forceps

25. STUDY REPORTS
 King & Dally reported 5016 deaths in England &
Wales – teething (1839)
 Illingworth – failed to produce evidence of
teething causing fever, convulsions, bronchitis or
diarrhea
 Supported by Tasanen’s study observing 192
eruptions in 126 infants & 107 controls, which
concluded that
 teething does not increase the incidence of infection
 does not cause any rise in temperature, ESR, WBC
count
 does not cause diarrhea, cough, sleep disturbance
or rubbing of the ear or cheek

26. STUDY REPORTS
It does cause:
 Day time restlessness
 Increase in finger sucking
 Increase in drooling
 Loss of appetite
Change in the colour of the mucosa in the area of the
erupting tooth:
 No change in 1/3rd of the children
 Slight change in another 1/3rd
 Pronounced change with small haemorrhages in 1/3rd

27. STUDY REPORTS
 Study on 46 healthy infants - Jaber, Cohn & Mor
a small increase in body temperature
- 43%
-the day of emergence of their first tooth
 Macknin et al confirmed these results
 Leung reported- serious systemic disturbances
were overlooked by ascribing symptoms to teething
 Swann identified an organic cause of illness in 48
patients out of 50 hospitalised due to symptoms-
teething

28. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
 Few scientific data to implicate teething as the
etiology of fever, diarrhea
 Children with teething symptoms- culture positive
for HSV Type1
On examination:
Generalized erythematous gingiva
Several ulcerated areas in
the mucosa
Coated white tongue
Several partially erupted teeth

29. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
Diagnosis
Subjective symptoms
Prodrome of itchiness or mild tingling sensation
before the development of the lesions
Mild flulike symptoms
Objective symptoms
2-4 mm diameter size vesicles
Rupture & crust over in
36-48 hours
Heals in 7 days

30. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
Investigations
Viral titre peak in 48 hours - then falls
Tzanck preparation of the vesicles-
multinucleated giant cells(Tzanck cells) &
inclusion bodies(Lipschutz bodies)

31. ASSOCIATION WITH HERPES SIMPLEX
INFECTION
Therapy
Keep the lesions well lubricated with an emollient to
promote healing
Isolate the patient from persons at risk for primary
herpes infection
Prophylactic oral acyclovir reduce the frequency

32. CONCLUSION
Since the time of Hippocrates (460-377BC) it has been
observed that teething infants often suffer from several
systemic conditions including fever, diarrhea,
convulsions.
This discussion concludes with the note that, from the
review of the available literature on teething there is no
conclusive evidence to attribute teething as the sole
factor leading to the conditions associated with it.
This is an area that requires still lot of investigation for
explanation.

33. BIBLIOGRAPHY
 Dentistry for the Child and Adolescent- McDonald, Avery,
Dean(8th edition)
 Pediatric Dentistry- Infancy through Adolescence-
Pinkham(3rd edition)
 A manual of paediatric dentistry- R.J.Andlaw & W.P.Rock(4th
edition)
 Textbook of Pedodontics- Shobha Tandon
(2nd edition)
 Textbook of Pediatric Dentistry- S.G.Damle
(3rd edition)
 Principles & Practice of Pedodontics- Arathi Rao
(2nd edition)
 Jablonki’s Dictionary of Dentistry
 www.infantteethingtoys.com

34. THANK
YOU