Teething: facts and fiction

Parental beliefs in and attitudes toward teething signs and symptoms: A systematic review

BACKGROUND

Parents believe that teething is associated with signs and symptoms, which may induce them to give medications that could harm their children. Some children may require alleviation of symptoms and overall attention.

AIM

To assess parents' beliefs in and attitudes toward teething.

DESIGN

Through electronic databases and gray literature, this systematic review identified cross-sectional studies reporting parents' beliefs in, knowledge about, and attitudes toward the signs and symptoms of primary tooth eruption in children aged between 0 and 36 months. Three reviewers independently selected the studies, collected the information, assessed methodological quality, and checked for accuracy with disagreements solved by a fourth reviewer. The Agency of Research and Quality in Health questionnaire for cross-sectional studies was used for quality assessment. Descriptive analysis with median and interquartile ranges was adopted.

RESULTS

Twenty-nine studies comprising 10 524 participants from all geographic regions were included. The methodological quality of the studies was moderate. Most parents have beliefs in signs and symptoms during dentition, the most reported symptom being the desire to bite. Oral rehydration was the most exposed attitude in the studies included. Only a small proportion of parents reported no attitude.

CONCLUSIONS

The majority of parents believed in at least one sign or symptom associated with teething, and only few of them would do nothing or just wait for the signs or symptoms to pass, with no difference among countries (Protocol doi: 10.17605/OSF.IO/S2KZ3).

Topical Anesthesia in Pediatric Dentistry: An Update

Topical anesthetics are very important tools for improving comfort in any dental procedure in children. different methods, techniques of achieving topical anesthesia are reported in the literature. The present narrative review focuses on explaining different types of topical anesthesia with a special focus on pediatric dentistry. How to cite this article: Tirupathi S, Rajasekhar S. Topical Anesthesia in Pediatric Dentistry: An Update. Int J Clin Pediatr Dent 2022;15(2):240-245.

Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age

Background

Irritability and discomfort are common symptoms during teething periods in infants and toddlers. Non-pharmacological remedies to relieve teething symptoms include teethers and food for chewing. However, the efficacy of such remedies for their soothing effect has been poorly investigated.

Materials and methods

In this home-based pilot study, the soothing effect of a novel edible teether with a slowly dissolvable texture was investigated in 12 children aged 5 to 19 months old during primary dentition age. After parents observed their child getting irritable, the child received the edible teether for an exposure duration of 15 to 20 minutes. Parental ratings of children's mood states (crankiness, stress, happiness, and calmness) were collected using visual analog scales, and child cardiac measurements (heart rate and heart rate variability) were assessed using a wearable device. The soothing effect was quantified via mood ratings and physiological calming responses as a before-after comparison using Wilcoxon signed-rank tests.

Results

Parents perceived their child as significantly calmer and happier, less stressed, and marginally less cranky after edible teether exposure than before. The child cardiac variables showed no significant changes; however, exposure to the teether induced a marginal increase in HR within normal ranges, potentially indicating a stimulation effect.

Conclusion

The pilot study provides the first insight on the soothing effect of a novel edible teether on parent-reported mood states in young children during primary dentition age. Further research is needed to understand the relative contribution of the different components of an edible teether to the observed effects, such as texture and exposure duration, and to demonstrate its efficacy against a control product.

Trial registration

Swiss registry of clinical trial: CER-VD 2019-02155.

How to cite this article

Lerond C, Hudry J, Zahar S, et al. Soothing Effect of an Edible Teether: A Pilot Study in Children during Primary Dentition Age. Int J Clin Pediatr Dent 2021;14(4):525–530.

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.

Evaluation of blood and tooth element status in asthma cases: a preliminary case-control study

Background

Asthma is a common respiratory disorder; some data were present on the correlation between increased levels of trace elements and the risk of asthma development. It was aimed to evaluate the levels of 13 selected blood and tooth elements (magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc, strontium, molybdenum, cadmium, lead, mercury) in a well-controlled asthma group and the control group.

Methods

During the study period, 17 asthma patients and 26 age and gender-matched healthy children donated shed deciduous teeth having neither decay nor filling and enrolled for the study. The element levels in blood and teeth matrixes were analyzed with inductively coupled plasma mass spectrometry. Differences in blood and tooth elements in groups were evaluated with generalized linear models after adjusting confounding factors.

Results

After adjusting the child’s “z scores of body mass index for age”, history of iron deficiency anemia, and status of parental smoking, the generalized linear model revealed significantly lower tooth magnesium levels, lower blood zinc levels, and lower blood zinc/copper ratio in the asthma group than the control group (p = 0.042, p = 0.034, p = 0.002, respectively). Other studied elements for tooth and blood matrixes were similar in groups.

Conclusion

Our study revealed some differences in tooth and blood element levels in the asthma group. Further studies on zinc and magnesium levels of severe asthma cases are necessary for the interpretation of the results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-021-01565-9.

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.

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.

Teething symptoms in children with congenital Zika syndrome: A 2-year follow-up

BACKGROUND

The eruption of primary teeth represents a stage of many challenges for parents.

AIM

To investigate the occurrence of signs and symptoms related to the eruption of the primary dentition in children with congenital Zika syndrome.

DESIGN

Longitudinal study developed with 79 children followed up for a period of 24 months. Data on sex, gestational age, low birthweight, microcephaly, signs and symptoms related to the dental eruption phase, and use and type of medication were collected. Data were presented by descriptive and inferential statistics (chi-square test).

RESULTS

The majority (94.9%) exhibited simultaneously two or more signs and symptoms related to dental eruption. Increased salivation (91.1%), irritability (86.1%), and gingival itching (83.5%) were the most commonly reported signs and symptoms. Bivariate analysis showed association between elevation of body temperature and sex (P < 0.05). Almost two-thirds of mothers (63.3%) reported using medication to relieve symptoms presented by the child; however, the use of topical medication prevailed (57.1%).

CONCLUSION

All children with congenital Zika syndrome presented manifestations related to the eruption of primary teeth, with increased salivation, irritability, and gingival pruritus. The use of ointments and gels was the option of mothers in the treatment of the oral discomfort presented by infants.

Contribution of capsaicin-sensitive innervation to the continuous eruption of the rat mandibular incisors

A major component of tooth innervation is made of capsaicin-sensitive primary afferents (CSPA). These fibers play a key role in tooth pain and inflammation; little is known, however, about the role of CSPA in tooth eruption. The aim of this study was to examine the role of the capsaicin-sensitive afferents in the process of eruption of intact rat incisors. CSPA fibers in several rat groups, were subjected to one of the following experimental procedures: systemic chemical ablation, systemic ablation followed by chemical sympathectomy and localized activation. The observed effects on incisor eruption were compared to those made on controls. The total amount of eruption in control/naïve rats, measured over a total period of 144 h, was 3.18 ± 0.07 mm and decreased to 2.43 ± 0.08 mm (n = 7; p < 0.001) following systemic ablation of CSPA. Further decrease to 2.24 ± 0.08 mm (n = 7; p < 0.001) was noticed when chemical sympathectomy was added to CSPA ablation. The average rate of eruption was 1.7 ± 0.25 mm following CSPA activation, compared to an average of 0.8 ± 0.07 mm for controls (n = 7; p < 0.001). Capsaicin sensitive fibers play an important role in tooth homeostasis, and intact neural supply is required for tooth growth under normal conditions.

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.

Teething

Misconceptions about the teething process has led to high infant morbidity and mortality, which was recently experienced in Nigeria due to consumption of an adulterated drug used in the prevention and treatment of teething-related illnesses in infants. It is however, unknown if these misconceptions still persist in a rural town in Nigeria despite oral health awareness campaigns targeted at this. The aim of this study is to assess the beliefs and practices of residents in Igbo Ora, a rural township in Nigeria, regarding the teething process. A descriptive cross-sectional study was conducted among 393 adults in Igbo Ora using a 33-item, semistructured questionnaire. Symptoms such as diarrhea (80.7%), fever (69.2%), and boils (64.4%) were still considered as a must to accompany teething. Teething powder, teething syrup, and traditional concoctions were commonly recommended by (42.0%), (31.6%), and (48.1%) of the respondents, respectively, to treat and prevent teething symptoms. This study revealed that misconceptions about teething are still highly prevalent among the populace in Igbo Ora, and a structured oral health education intervention at the community level is urgently needed.

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.

Infant dental enucleation: A literature review on a traditional remedial practice in East Africa

OBJECTIVE

To summarize and review the literature on infant dental enucleation, a traditional remedial procedure prevalent mainly in East Africa.

MATERIALS AND METHODS

Literature searches were made electronically using general and specialized search engines. The main search was performed through a systematic strategy in PubMed, comprising tabulated keywords, search codes, and translated and transliterated terms. Criteria for the selection of studies were designed to provide a general understanding of the procedure. The findings were synthesized into two sections: a summary of the population prevalence studies, and a thematic literature review.

RESULTS

An overview of the known prevalence and clinical specifications was established. Insight was gained into the purpose of the procedure and the factors influencing its performance. Diverging suggestions were seen with regard to the rationale for use of infant dental enucleation between different populations. Moreover, reports of complications and consequences involving the general health and the dentoalveolar structures of patients were examined.

CONCLUSIONS

Prevalence, clinical features and risks of infant dental enucleation point to a need for greater awareness of the procedure. Further, there is a need for specific guidelines regarding management of suspected cases within dental and healthcare communities.

Premasticating food for weaning African infants: a possible vehicle for transmission of HIV

BACKGROUND

Although premastication of food for weaning infants might have nutritional benefit, it is also associated with transmission of pathogens. We investigated premastication practices in Cape Town, South Africa, in lower socioeconomic status caregivers of infants below 2 years of age.

METHODS

A previously reported questionnaire was adapted for South African conditions. A convenience sample of infant caregivers was captured at public maternal/pediatric and HIV outpatient clinics and home visits.

RESULTS

We interviewed 154 caregivers, 92% of whom were the biological mothers (median age: 29). Of these, 70% were black, and 29% were colored. There were 106 (69%) caregivers who practiced premastication. The median age of infants who received premasticated food was 6 (interquartile range: 4-6) months. Forty-six (43%) infants were teething, and 44 (42%) had oral mucosal lesions while receiving premasticated food. Fifty-five (52%) caregivers reported an oral condition, mostly bleeding gums, mouth sores, and thrush, and 41 (39%) caregivers reported blood in the food. Premasticating caregivers had a significantly lower educational level than those caregivers who did not engage in this practice. Premastication practices were cultural (40%), habit (20%), and on mother's advice (75%). Reasons for premastication were to pretaste (68%), encourage eating (61%), estimate food temperature (85%), and homogenize food (60%).

CONCLUSIONS

Counselors and caregivers should be aware of the adverse effects of premastication. Education should include advice to avoid premastication and to seek health advice for oral conditions in the caregiver and child. More studies are needed to better define the extent and risks of premastication, including its possible role in increasing HIV-1 transmission.

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.