Mrs. X brought her daughter to see me for a sick visit,thinking she might have an ear infection.

 

I had seen her two weeks ago for her 9 month well-check.She was doing just fine in regard to her growth and development. For the past few days Briana had been fussy, irritable,eating less and rubbing and pulling at her ears. Mom didn’t think that she had any fever. It was a concern that the baby had no teeth yet. At a family gathering all the aunts were worried for Momby saying the nieces and nephews had gotten their teeth by six months.
 

Briana was smiling and engaging during the perfectly normal exam. Her ears were pearly white and couldn’t be any more normal. When I checked her lower gums there was no evidence of teeth erupting other than slight swelling.

 

Mom was relieved that the baby was well, but seemed bothered by what the family members had said. I said to her, “Let’s talk about some facts with teeth and infants.”
 

The average age for the first teeth to erupt is around six months. That is the average age.

 

But some babies can normally get their first teeth at three months, and otherscan normally get their first teeth at 12-13 months.The first teeth to come in are usually the lower central twofollowed by the top two.Then the lateral teeth on the top and bottom. Again, this is the typical order of teeth eruption.But after the first two bottom central teeth erupt the next six teeth can erupt in any order. After the baby has four central teeth on top and four teeth on the bottomthey usually get their first set of pre-molars. This is followed by the four canines occurring between 15-18 months. Lastly, the back set of teeth, the two year molars,can come anywhere from 2-3 years of age.
 

There are a number of myths about teething, but one of the more common misconceptions is that it causes fever.

 

There is no logical explanation why the teeth erupting should cause fever…certainly no fever above 100.4 degrees. Yet, a large number of well-intended family members will emphatically swear that when you were little you always ran a feverwhile you were teething. This is just not so.  

It is common for a teething infant to be fussy, irritable and take little oral intake. It is also common for an infant to pull at the ears and rub themas if they hurt. This is because the facial nerve that serves the face has three branches that extend out from the tempero-mandibular joint (TMJ) in front of the ear. When the infant is teething the discomfort can be referred to the TMJ area through the facial nerve. This can cause the baby to rub and pull at the ear as if he had an infection. I have seen countless patients brought in for an ear infection and upon gathering the history, the baby is crying and rubbing his ear. I would have bet money that he had an ear infection…only to find him perfectly normal, but also having swollen gums.
 

I assured Mrs. X that Briana was healthy and she did NOT have an ear infection.

 

What’smore, the fact that at 9 months she did not have any teeth was no concern and well within the norm. I wouldn’t even give it a second thought if Briana didn’t have any teeth by a year. She seemed pleased with our visit and as I held the door open for her to leave, she stopped, paused and then in a sheepish manner asked, “They really don’t get fever with teething?”