Teething and tooth eruption in infants: A cohort study

Teething - filling in the gaps…

Dentists and dental care professionals may be faced with concerns from parents and carers regarding teething in infants and young children. Teething is a normal physiological and self-limiting process; however, the diverse signs and symptoms that have, over time, been attributed to teething, can make diagnosis challenging. Appropriate diagnosis is crucial in preventing the potentially life-threatening sequalae of dismissing symptoms as teething and delaying appropriate treatment of a systemically unwell child. Management of teething can be approached in a five-step process based on the National Institute for Health and Care Excellence clinical knowledge summary on teething. These include: 1) history-taking, clinical examination, diagnosis and referral of systemically unwell or severely distressed children for urgent medical review; 2) providing parental/carer reassurance, information and preventative advice; 3) simple, non-pharmacological management strategies; 4) pharmacological intervention; 5) safety-netting advice in case the child becomes systemically unwell, has prolonged symptoms, or is in severe distress. The purpose of this article is to bridge knowledge gaps regarding teething to enable appropriate diagnosis and encourage dissemination of preliminary information and ensure appropriate referral by frontline dental professionals.

Clinical manifestations of tooth eruption in the first year of life and related risk factors in three regions of Brazil: multicenter birth cohort study

PURPOSE

Estimate the incidence of teething symptoms and investigate risk factors at three centers in different regions of Brazil.

METHODS

A prospective cohort study enrolled children at birth in the cities of Manaus (northern region), Porto Alegre (southern region) and Salvador (northeast region). Sociodemographic and anthropometric variables were collected at baseline and 6 months. At 12 months, data were collected on the child's health through structured interviews and dental examinations, including the primary outcome: occurrence of signs and symptoms of tooth eruption reported by parents. Statistical analysis involved Poisson regression with robust variance, with calculation of relative risks (RR).

RESULTS

The incidence of teething symptoms was 82.4% (238/289). The multivariate analysis revealed a higher occurrence of the outcome in the city of Salvador (RR = 1.39; 95% CI 1.23-1.58), when mother's education was more than 11 years (RR = 1.31; 95% CI 1.04-1.65), when a larger number of individuals resided in the home (RR = 1.15; 95% CI 1.02-1.29), when a smoker resided in the home (RR = 1.16; 95% CI 1.03-1.31) and when the child presented flu or cold in the first year of life (RR = 1.23; 95% CI 1.09-1.38). The most reported symptoms were fever (50.5%), irritability (42.6%), itching (40.8%) and diarrhea (35.3%). Most parents (82%) took some action to alleviate symptoms, including unprescribed systemic medication, such as analgesic, anti-inflammatory and anti-diarrheic agents.

CONCLUSION

Reports of teething symptoms were associated with the city investigated, socioeconomic factors of the families and characteristics of the child's health. A high rate of administering unprescribed medication was also found.

Efficacy of treatments used to relieve signs and symptoms associated with teething: a systematic review

The purpose of this review was to systematically evaluate all the existing literature on the efficacy of treatments used to relieve the signs and symptoms associated with teething. A systematic search up to February 2021, without restrictions on language or date of publication, was carried out in MEDLINE/PubMed, SCOPUS, Web of Science, The Cochrane Library, EMBASE, LILACS, BBO, OpenGrey, Google Scholar, Portal de Periódicos da CAPES, clinicaltrials.gov, and the references of the included studies. Clinical studies that evaluated the effect of any intervention to alleviate the signs and symptoms associated with teething in babies and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. The characteristics and results of the individual studies were extracted and synthesized narratively. The GRADE approach was followed to rate the certainty of the evidence. Three randomized and two non-randomized clinical trials were included. The outcomes of these five articles were classified as high or serious risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort, and excess salivation. One study showed a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gingival redness, and poor sleep quality. Another study applied non-pharmacological treatments, which were more effective, especially against excess salivation. Although the present systematic review suggests some therapies could have a favorable effect on signs and symptoms related to teething, definitive conclusions on their efficacy cannot be drawn because of the very low certainty of the evidence. The existing literature on the subject is scarce and heterogeneous and has methodological flaws; therefore, further high-quality investigations are necessary.

A questionnaire-based study of Paediatric Dentists' knowledge of teething signs, symptoms and management

INTRODUCTION

Signs and symptoms attributed to erupting primary teeth are commonly known as "teething". Its existence is controversial with concern that overusing this term might mask other illnesses and some treatments may be unnecessary or harmful. Parents/carers can access over-the-counter remedies and may seek professional advice. This survey-based investigation explored gaps in knowledge, training, perceptions and experiences of UK Paediatric Dentists (PDs) regarding teething in young children.

METHOD

Cross-sectional study with a convenience sample of PDs with different training levels, accessed through the British Society for Paediatric Dentistry membership lists. A 10-item questionnaire explored participants' knowledge of teething-related issues and management. Responses are presented using descriptive statistics.

RESULTS

Of 80 responding PDs (response rate 27%), 62-74% suggested drooling, irritability, oral fixation and flushed cheeks were attributed to primary tooth eruption. Fifty-eight (72%) participants were unaware of guidelines, yet 53 (66%) felt guidance was needed.

CONCLUSION

Signs and symptoms of teething might mask underlying conditions so it should be a diagnosis of exclusion. PDs attributed similar signs and symptoms to teething, as have been reported in the literature, although some commented that they did not think teething was a condition. There was a lack of awareness over guidelines.

Symptoms of the Eruption of Permanent Teeth

This prospective study examined a population of 520 urban and rural children aged 5 to 9 years. Every 2−4 weeks, the clinical symptoms accompanying primary tooth replacement such as a cough, a runny nose, pain, and body temperature were assessed in each child’s medical records. The authors were able to show in a statistically significant manner that the frequency, time, and type of cough were strongly related to the type of erupting teeth (p < 0.001 for each relationship). A cough dependent on the type of erupting teeth was observed in 86% to 92% of the examined children, with a morning bronchial cough being connected with an eruption of the lower teeth, and an eruption of the upper teeth producing an all-day pharyngeal cough caused by mucus secretions dripping down the back of the throat. A statistically significant relationship was also confirmed between the type of erupting teeth and the incidence of a runny nose (p < 0.001), the frequency of a runny nose (p < 0.001), and the time when runny nose symptoms occurred (p < 0.001). This study shows that the period when primary dentition is replaced with permanent teeth in children is characterized by a physiological cough and a runny nose.

Retrospective analysis of the effects of a hyaluronic-based gum gel to counteract signs and symptoms of teething in infants

BACKGROUND

Teething discomfort is a widespread disorder affecting a very high percentage of infants. It creates anxiety in parents, who look for help in pediatric clinics. The use of hyaluronic acid gels has been shown in the last 20 years to be an effective tool, generally devoid of side effects, in reducing oral mucosal inflammation in adults. Recently, such results have also been confirmed in infants affected by teething.

METHODS

From our routine practice results, we have retrospectively reported the efficacy and the safety profile of Bonjela® Soothing Teething Gel (Bonkela, Reckitt Benckiser, UK), a teething gel capable of addressing in a significant way this infant complaint, which improves all the clinical outcomes used in these types of study to describe the clinical condition of infants.

RESULTS

The time×group interaction showed significant differences in unexplained cry, irritability, inappetence, salivation and gum redness (P<0.01 for all comparisons), with lower Likert scores in the treated group respect to the control one.

CONCLUSIONS

The treatment with Bonjela® Soothing Teething Gel contributed to reduce some common symptoms of teething, in comparison to the standard use of a teething ring alone.

Mothers' false beliefs and myths associated with teething

BACKGROUND

Teething is a physiological process experienced by all children. However, many unrelated illnesses are blamed on teething.

OBJECTIVE

The aim of this study was to assess mothers' beliefs toward teething and to investigate the practices preferred by mothers to alleviate symptoms that might accompany the teething process.

METHODS

A cross-sectional study was conducted in Basra. The study population includes mothers of young children aged (6-30) months who had at least one erupted primary tooth, and who had no history of medical or systemic disease that might affect teething. Two hundred mothers of different age groups and educational backgrounds responded to a questionnaire that included information on the child's age and birth order, mother's age, level of education, occupation, number of children, beliefs toward teething symptoms, and the practices preferred to relieve the attributed symptoms. Data has been presented in numbers and percentages, the Chi-square test was performed where appropriate, and a p value of < 0.05 was considered significant.

RESULTS

All (100%) participants attributed at least one symptom or sign to the teething process. The most common symptoms reported were fever (70%), diarrhea (68.5%), and sleep disturbance (63.5%). Sixty-eight percent of mothers believed teething remedies were effective; only 10 (5%) did not give any treatment. Over half (62%) gave medications, such as antipyretics, antibiotics, and antidiarrheal agents. Some used teething gels (29%), pacifiers (50%), gum massage (22%), and hard foods such as biscuits and carrots (43.5%). Mothers of various educational levels reported attributed symptoms, and the result was statistically significant (p < 0.05). Mothers of a firstborn child were found to have a higher tendency to attribute symptoms to teething than those who had previous experience with children (p < 0.05).

DISCUSSION AND CONCLUSIONS

Teething myths and misconceptions are common among mothers. The study identified a significant number of doctors, dentists, and pharmacists still attribute many symptoms and signs to teething despite the lack of supporting evidence. Therefore, the findings of this study highlight the need for continuous medical education and nationwide prospective studies to eradicate these false beliefs.

Are teething gels safe or even necessary for our children? A review of the safety, efficacy and use of topical lidocaine teething gels

Lidocaine-based teething gels have been widely available in Australia for decades in both commercial preparations and those compounded by pharmacies. However, many case reports have highlighted potential risks and toxicity associated with lidocaine-based teething gels when used in infants and young children, including seizures, respiratory arrest and death. The Australian and New Zealand Society of Paediatric Dentistry and the American Academy of Paediatrics do not recommend topical agents for teething, and the US Food and Drug Administration does not recommend topical lidocaine for this purpose due to concerns of toxicity. Literature supporting the efficacy of lidocaine for teething is scant and difficult to interpret due to the flawed design of the trials conducted and varied formulations used. This opinion article aims to summarise the available literature showing the limited effectiveness and associated risks of topical lidocaine gels for use in teething. In light of these findings, the authors recommend that regulatory bodies such as the Australian Therapeutic Goods Administration review the efficacy and safety of this type of medicine and consider removing the indication for teething or limiting the age of use to older children.

Identification of oral cavity abnormalities in pre-term and full-term newborns: a cross-sectional and comparative study

PURPOSE

Compare maxillary labial frenum and lingual frenum topography, the ridges relationship and oral inclusion cysts occurrence between pre-term (PT) and full-term newborns (FT).

METHODS

This cross-sectional and comparative study was conducted through the evaluation of 74 PT and 100 FT. Data were collected from medical records: mother age, gestational age, gender, height, weight, and delivery type. The variables were verified by Chi-square test and Mann-Whitney U test, at 5% significance level.

RESULTS

Bohn's nodules and dental lamina cysts were more frequent in FT (P = 0.000). Epstein pearls occurrence was similar between FT and PT (P = 0.243). The lower alveolar ridge in distal position to the upper one was more prevalent in both groups. Abnormal upper labial frenum anatomy had been observed in 10.0% of FT. Upper labial frenum was attached in piriform papilla in 90.5% of PTG, whereas in FT, 61.0% were attached from crest of alveolar ridge to mucogingival line.

CONCLUSIONS

PT oral cavity presented some peculiarities when compared with FT: maxillary labial frenum insertion in the Piriform papilla and palatal cysts more prevalent than alveolar cysts.

Common parenting misconceptions regarding infant care: setting the record straight for parents (and some pediatricians)

PURPOSE OF REVIEW

First-time parents often turn to friends and family for advice regarding feeding, sleeping, bathing, diapering and toilet training, and childhood illnesses. Unfortunately, parents may at times be given incorrect and potentially dangerous advice as several widely embraced parenting practices are no longer deemed appropriate. In addition, young children are cared for by family and friends - many of whom are older and may still subscribe to outdated parenting practices.Parents and grandparents are not the only ones who subscribe to child care myths and misconceptions. Pediatricians also believe in the effectiveness of some outdated child care practices. Although some of these parenting myths are relatively benign, others may indeed pose a significant health risk or safety hazard to a young child. The purpose of this article is to review 10 commonly held myths or misconceptions regarding infant care.

RECENT FINDINGS

In this review article, we not only highlight many of the studies that document which outdated health beliefs are still endorsed by parents and/or pediatricians, but also review the specific health risks associated with these parenting myths or misconceptions.

SUMMARY

It is important that pediatricians educate parents and other primary caregivers about the potential risks of following outdated parenting practices.

Exploring Parental Knowledge and Indigenous Practices for Infant Teething in Indian Population: A Cross-sectional Study

To assess the parental knowledge and practices regarding infant teething and attitude towards infant oral health among parents of infants aged 6 months to 3-years.

Temporary exclusion of ill children from childcare centres in Switzerland: practice, problems and potential solutions

Background

In childcare centres, temporary exclusion of ill children, if their illness poses a risk of spread of harmful diseases to others, is a central approach to fight disease transmission. However, not all ill children need to be excluded. Previous studies suggested that childcare centre staff have difficulties in deciding whether or not to exclude an ill child, even when official ill-child guidelines are used. We aimed to describe, quantify and analyse these ambiguities and discuss potential solutions.

Methods

For this cross-sectional study, we sent postal surveys to 488 childcare centre directors in the Swiss Canton of Zurich, where no official ill-child guideline is in place. We asked for exclusion criteria for ill children and ambiguities faced when dealing with ill children. We checked whether existing guidelines provided solutions to the ambiguities identified.

Results

249/488 (51%) directors responded to the survey. The most common exclusion criteria were fever (87.4%) and contagiousness (52.2%). Ambiguities were mostly caused by conjunctivitis (23.7%) and use of antipyretic drugs (22.9%). Roughly one third of the ambiguities identified could have been resolved with existing guidelines, another third if existing guidelines contained additional information. For the last third, clear written directives are difficult to formulate.

Conclusions

Written recommendations may help to clarify when an ill child should temporarily be excluded. However, such a guideline should cover the topics antipyretic drugs and teething and have room for modification to local circumstances. Collaboration with a paediatrician may be of additional benefit.

Association between Fever and Primary Tooth Eruption: A Systematic Review and Meta-analysis

Aim

To perform a systematic review and meta-analysis to establish if fever is associated with primary tooth eruption.

Materials and methods

Literature searches involved Pubmed, MEDLINE, Web of Science, Scopus and Cochrane. The potentially relevant studies had the full text analyzed. Only studies concerning fever during eruption period of primary tooth in humans were included. Papers in non-English language, and papers that included syndromic patients or patients with any disease were excluded. The meta-analyses were performed with Review Manager (version 5.3). Only studies that reported the results as dichotomous data were analyzed with Cochran-Mantel-Haenszel test in meta-analysis function of Review Manager 5.3. The fixed-effects model was used to evaluate the association between tooth eruption and fever.

Results

Search identified 83 potential studies. After exclusion of the duplicated studies, or were not related to the criteria of inclusion only 6 studies were selected for the systematic review. In the overall meta-analysis, no association was found [OR = 1.32 (0.88-1.96)] between fever and primary tooth eruption. However, in the subgroup analysis, when the method used to measure fever was the rectal temperature there was an association [OR = 2.82 (1.55-5.14)] between fever and primary tooth eruption.

Conclusion

There are few suitable studies in the literature regarding the association between primary tooth eruption and fever. However, our study found an association between fever and primary tooth eruption only when rectal temperature was performed

How to cite this article

Nemezio MA, De Oliveira KMH, Romualdo PC, Queiroz AM, Paula-e-Silva FWG, Silva RAB, Kuchler EC. Association between Fever and Primary Tooth Eruption: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2017;10(3):293-298.

Mothers' teething beliefs and treatment practices in Mansoura, Egypt

Objectives

To reveal mothers’ beliefs about signs and symptoms associated with teething and their treatment practices.

Population and methods

A cross-sectional study done in Mansoura District on 457 mothers and their children with one or more erupted teeth. Mothers were interviewed during vaccination session at 25 chosen health facilities. Mothers were asked whether they agree or disagree about 24 signs and symptoms claimed to be associated with teething.

Results

Only 1.8% reported no symptoms at the time of teething. Majority had correct knowledge related to bite fingers/objects (70.5%) and drooling (60.0%). Inaccurate knowledge was reported as gum rubbing (42.0%), gum swelling (47.0%), diarrhea (51.0%), fever (83.2%) and weight loss (46.0%). Only 16.8% of mothers have good knowledge about teething problems. Logistic regression analysis revealed that the independent predictors of good knowledge are higher education (AOR = 3.7), urban residence (AOR = 2.5) and having a first-born child (AOR = 5.5). Only 13.4% of mothers did not give any treatment for teething problems. Antipyretics and antibiotics were the most frequently given treatments (71.3%, and 24.3%; respectively).

Conclusions

The majorities of mothers had low knowledge about teething problems and gave unnecessary treatments.

The Internet versus pediatricians as a source of infant teething information for parents in Turkey

OBJECTIVES

Parents are increasingly searching the Internet to gather information about their children's health care. This study compared infant teething information obtained from publically employed pediatricians in Istanbul with that obtained from different Turkish websites (parenting, health, professional, news and commercial).

METHODS

This study had two parts. The first part used a descriptive design, with two checklists to assess the quality and comprehensiveness of the teething-specific content on 62 parenting or health websites. The second part was a cross-sectional study of 75 pediatricians at public hospitals who completed a structured self-administered questionnaire.

RESULTS

In total, 54 websites (87.1%) described infant teething as a normal developmental process. The lists that were found on the websites identified the most frequent signs of infant teething as fever and drooling/perioral rash. The most frequent management strategies were chewing non-chilled and chilled objects. For teething problems, some pediatricians recommended teething rings and oral benzocaine, while 23 pediatricians recommended nothing.

CONCLUSIONS

Parents should be informed by health professionals, especially regarding specific treatment strategies.

Infant oral mutilation in East Africa - therapeutic and ritual grounds

This paper reviews the practice and ritual traditions of infant oral mutilation, drawing on a literature search in PubMed and Google Scholar, historical reports, relevant textbooks, NGO materials and personal observations of the authors.

Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis

CONTEXT

Symptoms associated with the primary tooth eruption have been extensively studied but it is still controversial.

OBJECTIVE

To assess the occurrence of local and systemic signs and symptoms during primary tooth eruption.

DATA SOURCES

Latin American and Caribbean Health Sciences, PubMed, ProQuest, Scopus, and Web of Science were searched. A partial gray literature search was taken by using Google Scholar and the reference lists of the included studies were scanned.

STUDY SELECTION

Observational studies assessing the association of eruption of primary teeth with local and systemic signs and symptoms in children aged 0 to 36 months were included.

DATA EXTRACTION

Two authors independently collected the information from the selected articles. Information was crosschecked and confirmed for its accuracy.

RESULTS

A total of 1179 articles were identified, and after a 2-phase selection, 16 studies were included. Overall prevalence of signs and symptoms occurring during primary tooth eruption in children between 0 and 36 months was 70.5% (total sample = 3506). Gingival irritation (86.81%), irritability (68.19%), and drooling (55.72%) were the most frequent ones.

LIMITATIONS

Different general symptoms were considered among studies. Some studies presented lack of confounding factors, no clear definition of the diagnostics methods, use of subjective measures and long intervals between examinations.

CONCLUSIONS

There is evidence of the occurrence of signs and symptoms during primary tooth eruption. For body temperature analyses, eruption could lead to a rise in temperature, but it was not characterized as fever.

Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies

Background

To evaluate disturbances in primary tooth eruption and their management with nonpharmacological remedies.

Methods

In this nonrandomized clinical trial, 270 children aged between 8 and 36 months were selected and divided into 5 groups with 54 children initially enrolled in each group. The children were seen during an 8-day period during tooth eruption. At each appointment data were recorded from oral examination, tympanic temperature measurement and a questionnaire. The five methods used as remedies to reduce teething symptoms were: 1) cuddle therapy, 2) ice, 3) rubbing the gums, 4) teething rings and 5) food for chewing. Teething symptoms, the type of erupted tooth, symptoms of recovery and the mother’s satisfaction with treatment were evaluated.

Results

Two hundred and fifty four children (mean age 16 ± 7.2 months) completed the study. The most frequent teething symptoms were drooling (92 %), sleep disturbances (82.3 %) and irritability (75.6 %). These symptoms were more pronounced in low birth weight children (p > 0.05). Canine eruption led to more loss of appetite than incisor (p = 0.033) or molars eruption (p = 0.014). Low grade increases in body temperature were observed only on the day of eruption (36.70 ± 0.39 °C), when body temperature was significantly different compared to the day before and the day after eruption (both p < 0.001). There was no significant correlation between fever as reported by mothers and temperature readings obtained by the investigators. The most favorable results for time to recovery and the mother’s satisfaction were seen when teething rings were used, followed by cuddle therapy and rubbing the gums.

Conclusions

There was no association between teething and symptoms such as fever or diarrhea. Low birth weight children may have more teething symptoms. Teething rings, cuddle therapy and rubbing the gums were the most effective methods to reduce symptoms.

Trial registration

Iranian Registry of Clinical Trials: code IRCT201211127402N3

Infant teething information on the world wide web: taking a byte out of the search

INTRODUCTION

The purpose of this study was to describe and evaluate the quality of infant teething information on selected popular parenting Web sites.

METHODS

Two checklists were used to evaluate the quality of the 16 parenting sites and infant teething-specific content included on each site.

FINDINGS

Three of the 16 parenting sites did not contain teething-specific articles. Teething-specific content found on 13 of the 16 sites supported a connection between the process of teething and nonspecific symptoms with a perception that management is required. Popular management strategies included chewing on chilled objects, gingival massage, and the use of over-the-counter medications. Information about possible adverse effects of administering medications for infant teething was not found on the majority of sites. Eleven of the 16 sites advised parents to contact their primary care provider if they were uncertain about management for infant teething or whether the symptoms were related to illness.

IMPLICATIONS

Although infant teething has an evidence base from which parents and professionals can make safe decisions about symptoms and treatment, translating the evidence into professional practice and health-related information on the Internet remains a challenge. Parents and pediatric health providers would benefit greatly from the development of clinical practice guidelines summarizing our present-day understanding of teething symptoms and the limited evidence supporting the use of over-the-counter medications.

Comparing actual and perceived causes of fever among community members in a low malaria transmission setting in northern Tanzania

OBJECTIVE

To compare actual and perceived causes of fever in northern Tanzania.

METHODS

In a standardised survey, heads of households in 30 wards in Moshi, Tanzania, were asked to identify the most common cause of fever for children and for adults. Responses were compared to data from a local hospital-based fever aetiology study that used standard diagnostic techniques.

RESULTS

Of 810 interviewees, the median (range) age was 48 (16, 102) years and 509 (62.8%) were women. Malaria was the most frequently identified cause of fever, cited by 353 (43.6%) and 459 (56.7%) as the most common cause of fever for children and adults, respectively. In contrast, malaria accounted for 8 (2.0%) of adult and 6 (1.3%) of paediatric febrile admissions in the fever aetiology study. Weather was the second most frequently cited cause of fever. Participants who identified a non-biomedical explanation such as weather as the most common cause of fever were more likely to prefer a traditional healer for treatment of febrile adults (OR 2.7, P < 0.001). Bacterial zoonoses were the most common cause of fever among inpatients, but no interviewees identified infections from animal contact as the most common cause of fever for adults; two (0.2%) identified these infections as the most common cause of fever for children.

CONCLUSIONS

Malaria is perceived to be a much more common cause of fever than hospital studies indicate, whereas other important diseases are under-appreciated in northern Tanzania. Belief in non-biomedical explanations of fever is common locally and has important public health consequences.

Teething myths among nursing mothers in a Nigerian community

Background:

Many symptoms had been associated with teething in children with the possibility of overlooking potentially fatal condition. Symptoms that had been associated with teething include diarrhoea, fever, vomiting and cough. The possibility that any of these symptoms could have been due to other causes call for thorough investigation of the child before concluding that it is only “teething”.

Objectives:

The study was carried out to assess the beliefs of nursing mothers concerning symptoms that are associated with teething among children and to identify those that would seek medical treatments in case of their children having such symptoms during teething.

Materials and Methods:

Two hundred and ninety nursing mothers whose children had erupted at least a tooth were interviewed in the immunisation clinics of the University College Hospital and Adeoyo Maternity Teaching Hospital, both in Ibadan, Nigeria, on their beliefs and practice concerning teething in children.

Results:

One hundred and eighty-eight (64.8%) of the mothers associated symptoms such as fever, cough, catarrh and diarrhoea with eruption of teeth in their children. Over half of the women agreed that a child having either fever (51.0%), ear infection (57.6%) or cough (50.3%) should be promptly taken for medical consultation and not be tagged “teething”, while for other symptoms such as gum pain (74.5%), sleepless night (56.6%), vomiting (51.4%) and diarrhoea (51.7%), over half of the mothers believed that the symptoms will resolve following the eruption of the teeth.

Conclusion:

The study demonstrated that mothers in the study attributes several symptoms to teething, which could be detrimental to the survival of their children as the symptom could have been due to other causes. There is, therefore, need for public enlightenment to create awareness on the possible effect of presumptuous belief that childhood diseases are due to teething process.

Teething disturbances; prevalence of objective manifestations in children under age 4 months to 36 months

Objective: The aim of this study was to present data as responded by parents on teething manifestation during eruption of primary teeth and the occurrence of objective manifestations in children ages 4 months to 36 months. Settings and Design: Hospital based face-to-face questionnaire study. Study Design: One thousand and one hundred children ages four to 36 months who had at least one erupting tooth were included in the study. Parents were asked to complete a short questionnaire and children were then checked by one of the authors. Statistical analysis used: Chi-square analysis was performed to analyze information obtained. Level of significance was set at P<.05. Results: There were 660 girls (60%) and 440 boys (40%) in the study. The most frequent clinical manifestations were: Fever (16%), drooling (12%), diarrhea (8%), fever-drooling (15%), fever-diarrhea(8%) and drooling-diarrhea (6%). In the study sample, boys demonstrated a higher prevalence of diarrhea than girls (P<.05). No statistical significance regarding other clinical manifestations and gender were observed. Teething manifestations were most prevalent during the eruption of primary incisors. Occurrence of clinical manifestations in 4-12months and 13-24 months age was statistically significant when compared with 25-36months age (P<0.05). Conclusions: An association has been shown between general objective manifestations like fever (the most prevalent), drooling and diarrhea, and the eruption of primary teeth. Most manifestations appeared during the eruption of the primary incisors.

Key words:Teething, primary teeth, eruption.

How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial

BACKGROUND

Teething, especially in their first child, continues to be a daunting problem for parents.

OBJECTIVE

The objective of this paper was to assess the effects of providing first-time mothers with information about symptoms commonly associated with teething and ways to manage these.

METHODS

In a randomized controlled trial to decrease the incidence of early childhood caries, we included information on teething as another issue in a child's oral health. Mothers in the intervention group received three rounds of printed information: at enrolment during pregnancy and when the child was 6 and 12 months old. Information on teething arrived when a child reached 6 months of age. Outcome assessment was at 20 ± 2.5 months of age. Data were complemented with a systematic search for evidence on teething symptoms and how to alleviate them in other populations.

RESULTS

Of 649 expectant mothers enrolled in the study, 441 completed the 'Child's oral health' questionnaire. There were no significant differences in teething symptoms reported by mothers in the intervention (n = 232) and control (n = 209) groups. However, mothers in the intervention group were less likely to use topical and oral medications to manage teething problems (P < 0.03) and relied more on rubbing the gums to ease discomfort (P < 0.005) than mothers in the control group.

CONCLUSIONS

Providing mothers with information on how to address teething symptoms markedly reduced the use of medications for symptom relief. There is still need for better evidence, first, on what symptoms can or cannot be attributed to teething and, second, on what is effective in alleviating them.

Prospective longitudinal study of signs and symptoms associated with primary tooth eruption

OBJECTIVE

To assess the association between primary tooth eruption and the manifestation of signs and symptoms of teething in infants.

METHODS

An 8-month, longitudinal study was conducted with 47 noninstitutionalized infants (ie, receiving care at home) between 5 and 15 months of age in the city of Diamantina, Brazil. The nonrandomized convenience sample was based on the registry of infants in this age range provided by the Diamantina Secretary of Health. Eligible participants were infants with up to 7 erupted incisors and no history of chronic disease or disorders that could cause an increase in the signs and symptoms assessed in the study. Tympanic and axillary temperature readings and clinical oral examinations were performed daily. A daily interview with the mothers was conducted to investigate the occurrence of 13 signs and symptoms associated with teething presented by the infants in the previous 24 hours.

RESULTS

Teething was associated with a rise in tympanic temperature on the day of the eruption (P = .004) and with the occurrence of other signs and symptoms. Readings of maximal tympanic and axillary temperatures were 36.8°C and 36.6°C, respectively. The most frequent signs and symptoms associated with teething were irritability (median: 0.60; P < .001), increased salivation (median: 0.50; P < .001), runny nose (median: 0.50; P < .001), and loss of appetite (median: 0.50; P < .001).

CONCLUSIONS

Irritability, increased salivation, runny nose, loss of appetite, diarrhea, rash, and sleep disturbance were associated with primary tooth eruption. Results of this study support the concept that the occurrence of severe signs and symptoms, such as fever, could not be attributed to teething.

Mothers' beliefs about infant teething in Enugu, South-east Nigeria: a cross sectional study

Background

Parents and Health Care Workers have traditionally attributed a variety of symptoms to teething in young children. Some of these symptoms may however connote underlying serious medical condition in a child. There is little evidence to support these beliefs despite their implications on management of a symptomatic teething child. This study therefore seeks determine the beliefs and problems mothers associate with teething in Enugu, South-east Nigeria.

Findings

A cross-sectional survey involving sixty mothers presenting at a Children's clinic in Enugu metropolis using questionnaire. More than 90% of the respondents thought that babies can experience medical problems as a result of teething. The commonest medical problems perceived to be associated with teething were fever (71.7%), loose stools (58.3%) and vomiting (35%).

Conclusion

Mothers still associate a variety of symptoms of childhood illnesses to teething and this association is not evidence based and could lead to delayed interventions, increased morbidity and mortality of children. It is important therefore that mothers and health workers caring for young children are educated on the need to seek prompt medical attentions in a symptomatic child.

Nursing strategies to reduce the incidence of early childhood caries in culturally diverse populations

In the United States, early childhood caries (ECC) is a major unmet health care need adversely affecting the overall health of young children from diverse ethnic populations. Nurses who work in the newborn nursery, pediatrics, public, and community health centers have a unique opportunity to positively influence a change in this epidemic of ECC. Guided by Leininger's theory of cultural care, these authors describe ways to implement a comprehensive culturally sensitive oral health education program for parents of newborns and infants. Interventions based on the best available evidence for oral health education, a culturally sensitive caries risk assessment, recommendations for fluoride varnish treatments, and ways for parents to establish a dental home for the infant by 12 months old are presented.

Clinical practice: sleep problems during infancy

Sleep problems are very prevalent during infancy. The most common problems are those related to night wakings and sleep-disordered breathing (SDB). Most common night waking problems do not have identified physiologic etiology. Their causes appear to be behavioral or developmental by nature, and they usually respond well to behavioral interventions. SDB may result from a variety of anatomic and neurologic factors and is associated with a variety of medical and developmental disorders. Because of the high prevalence of sleep problems during infancy, their persistence, their potential adverse developmental effects, and the positive treatment outcomes, pediatricians should serve as the primary address for screening and referral to proper assessment and treatment.

Conhecimentos e condutas de médicos pediatras com relação à erupção dentária

OBJETIVO: Verificar o conhecimento e a conduta de médicos pediatras frente a possíveis manifestações locais e sistêmicas ocorridas durante a erupção dentária, uma vez que a relação desta com o aparecimento de manifestações orgânicas na criança tem constituído, ao longo da história das ciências médico-odontológicas, um assunto controverso. MÉTODOS: Estudo observacional no qual o instrumento de coleta de dados foi um questionário dirigido a todos os médicos pediatras (n=21) da cidade de Bagé, Rio Grande do Sul. Este questionário foi constituído por perguntas sobre a opinião dos médicos se a erupção dentária seria a causadora de alterações que surgem durante o irrompimento dos dentes e quais são as condutas por eles tomadas. Após a confecção do banco de dados, foram realizadas as freqüências simples e percentuais das variáveis avaliadas no estudo. RESULTADOS: Dos médicos pediatras entrevistados, 76% acreditam que o processo de erupção dentária pode estar associado a manifestações sistêmicas e/ou locais; 94% dos entrevistados observaram como manifestações ansiedade/irritabilidade e coceira/sucção de dedos ou objetos. A conduta clínica mais adotada pelos médicos pediatras foi a orientação aos pais/responsáveis (37%). CONCLUSÕES: A maioria dos médicos pediatras entrevistados acredita que possam ocorrer manifestações sistêmicas e/ou locais devida à erupção dentária e que a conduta clínica de eleição é a orientação familiar.

Factors affecting the timing of teething in healthy Turkish infants: a prospective cohort study

BACKGROUND

Teething is a developmental process and occurs over a broad chronological age range.

OBJECTIVE

The objective of this study was to evaluate the effects of feeding pattern and growth parameters on teething time of healthy infants.

METHODS

A total of 1200 term newborn infants followed up in Gazi University well-child clinic infants were evaluated, and their growth parameters, feeding patterns, and timing of the eruption of the first tooth were noted. The routine visit times of the clinic were chosen as the cut-off values for teeth eruption for logistic regression analysis for investigating factors that determine the timing of teeth eruption.

RESULTS

Timing of the eruption of the first tooth ranged from 4 to 13 months. On the sixth month visit, 24.3%, and on the ninth month visit 84.5% of all infants had at least one tooth. Height-adjusted weight and height percentiles being less than 50, being fed by cow's milk or by formula in the first year, were independent factors negatively influencing teeth eruption by the sixth month, while all but height-adjusted weight percentiles being less than 50 had negative impact on tooth eruption by the ninth month.

CONCLUSION

Growth parameters and feeding pattern may be determinants of the timing of teeth eruption in healthy infants.

Diarrhea in American infants and young children in the community setting: incidence, clinical presentation and microbiology

OBJECTIVE

The characteristics and microbiology of the full spectrum of pediatric diarrhea occurring in the U.S. community setting are not well-understood.

METHODS

Six-month prospective cohort study of 604 healthy 6- to 36-month-old children recruited by the Slone Center Office-based Research Network.

RESULTS

The incidence of parent-defined diarrhea was 2.2 episodes per person-year. The median duration of diarrhea was 2 days with a median of 6 stools per episode. Outpatient visits and hospitalization were prompted by 9.7 and 0.3% of episodes, respectively. The most common microorganisms identified in healthy baseline stools were atypical enteropathogenic Escherichia coli (12.2%), enteroaggregative Escherichia coli (3.7%), Clostridium difficile (3.5%) and Clostridium perfringens (2.9%), and each of these was no more common in diarrhea stools. In contrast, all of the viruses analyzed were more prevalent in diarrhea specimens than in baseline specimens: enteric adenovirus (5.7% diarrhea versus 1.4% baseline), rotavirus (5.2% versus 1.4%), astrovirus (3.5% versus 1.4%), Sapporo-like virus (3.0% versus 0.8%) and norovirus (1.9% versus 0.8%). A likely pathogen was detected in 20.6% of diarrhea specimens. Vomiting and > or =16 stools in an episode were predictive of isolating a pathogen from the stool, each with a relative risk of approximately 2.

CONCLUSIONS

Healthy young children in this study experienced more than 2 cases of diarrhea per person-year, but most were brief and do not require medical attention. Although most diarrhea-associated pathogens were viruses, no likely pathogen was found in almost 80% of cases; possible etiologies for these cases include currently unknown gastrointestinal infections, nongastrointestinal illnesses and dietary/environmental factors.

Parents' and medical personnel's beliefs about infant teething

Many symptoms are attributed to teething. Little evidence exists to support these beliefs, despite their implications on clinical management. This study attempted to investigate parental and medical personnel's beliefs about teething. The study was conducted by means of a questionnaire, submitted to 55 pediatricians and 130 nurses. A parent survey was conducted simultaneously. We evaluated 462 questionnaires. An association of teeth eruption with infant morbidity was believed to exist by 76% of the responders, mostly by parents and nurses, and less so by physicians. Irritability, fever, and loose stools/diarrhea were believed to be the most common symptoms associated to teeth eruption. We conclude that almost all parents, the majority of nurses, and many physicians believe that teething is associated with the appearance of symptoms, most of which are minor and relate to discomfort rather than physical illness, but a substantial minority still ascribes potentially serious symptoms to teething.

Experience of Turkish parents about their infants' teething

AIM

To evaluate Turkish parents' experience about their infants' teething; which symptoms they have seen and attributed to teething and how they have acted to manage these symptoms.

METHODS

A questionnaire form was applied by face-to-face interview to 335 families who have children less than 18 months of age and have at least one tooth. They were asked questions to clarify the eruption time and sequence of primary teeth of their infants and whether their infants had some symptoms they attributed to teething.

RESULTS

The mean eruption time of the primary teeth was 7.4 +/- 2.0 months, with a range of 3-17 months. Teeth eruption time was found similar in both genders. Teeth eruption time of the term and preterm infants was similar. (P > 0.05). The first tooth erupted was the lower central incisor in the 288 infants (86.0%) and upper central incisor in 44 infants (13.1%). Most of the families (98.8%) reported that their children had suffered from at least one of the symptoms that were mentioned in the questionnaire. The most commonly reported symptom was increase in biting, followed by irritability and fever. Of the children who were taken to a health care centre, in 78.8% the symptoms were attributed to teething and in 7.1% a bacterial infection was found and antibiotics were prescribed.

CONCLUSION

When an infant at teething age has some symptoms, they may be attributed to teething but other possible causes must be ruled out first.