Teething
Consultation guide for UK community pharmacy: clinical features, referral criteria, time frame to resolution and management strategy.
Clinical features
- Pain
- Increased biting, drooling, gum-rubbing, sucking
- Irritability, ear-rubbing or pulling
- Facial redness
- Decreased appetite
- Disturbed sleep
- Mild increase in temperature
Referral criteria
- Some of the clinical features in teething are similar to those seen in other conditions like acute otitis media or a urinary tract infection. Therefore careful questioning is needed to differentiate teething from these (refer if systemic illness is suspected which includes the presence of a high grade fever, or if the child is very distressed, or if the child has prolonged symptoms)
Time frame to resolution
- Symptoms generally start 3-5 days before each tooth eruption and resolves soon after the tooth has erupted
Management strategy
Non-pharmacological advice
- Gentle rubbing/massaging the affected gum with a clean finger may help (and cuddling/comforting the child - teething is a normal process)
- Wipe away excess saliva regularly. Allow the infant to bite on a clean and cool object. Examples include a chilled teething ring or a cold wet flannel. For children who have been weaned, consider the supervised use of chilled fruit or vegetables but avoid objects that could be a choking hazard such as those that can easily be broken into hard pieces. Sugar-free products are preferred since they do not promote tooth decay
- Suggest the parent/carer takes their child to the dentist before their first tooth erupts and makes an appointment for the child following eruption of the first tooth (and also starts cleaning the tooth twice daily with toothpaste). More information on this is provided by dental surgeries and reputable websites such as NHS
Pharmacological advice
- Consider paracetamol or ibuprofen suspension for relieving pain and discomfort (paracetamol has a better safety profile)
- Oral choline salicylate gels are contraindicated due to the risk of Reye's syndrome. Topical anaesthetics and complementary and alternative medicines (such as herbal teething powder) are not recommended as there is no good evidence to support their use; the MHRA advises that non-medicinal measures such as a teething ring or gum massage should be first line. If parents decide to use such products, advise them to follow the manufacturer's dosage recommendations. Be careful about the age limits too. NB: In 2018, the UK Medicines and Healthcare products Regulatory Agency (MHRA) stipulated that oral lidocaine-containing products for infant teething would only be available under the supervision of a pharmacist