How Much Does Teething Actually Hurt?

If you’re a parent, you’ve probably blamed teething for everything from crankiness to your entire household's sleep deprivation. It's an almost inevitable part of babyhood, often hyped with warnings of "excruciating pain" and worries that every sleepless night is tooth-related.

Spoiler: Teething isn’t the monster-in-the-closet it’s made out to be. While it can cause some discomfort (and plenty of drool), it's rarely behind serious illness.

To separate fact from myth, we asked experts what teething actually looks like, how to tell when it might be something more, and the safest, easiest ways to ease your baby’s symptoms.

What is teething, and when does it typically start?

Teething is one of those milestones every parent looks out for. It’s the slow, steady process of those tiny baby teeth pushing through the gums and finally making their debut. But here's something surprising: teeth actually start forming before birth.

“Teeth buds start developing in the womb, and over time, they gradually mineralize until they're ready to break through,” explains Dr. Sandip Sachar, a New York City–based dentist.

When it’s teething time, the root grows downward into the jawbone to build the pressure that nudges the crown up toward the surface. "The gum tissue thins until it finally splits, making way for the tooth to poke through," describes Sachar. "It's not the most comfortable process, but it's usually just mild irritation."

Wondering what comes first? Sachar notes that the lower front teeth typically erupt between six to ten months, quickly followed by the top two teeth. "New teeth usually appear every few months: first the lateral incisors, then molars, then canines," continues Sachar. "By age three, most kids are sporting a full set of baby teeth."

Common signs and symptoms of teething

What teething looks like

Dr. Liel Grinbaum, a board-certified pediatric dentist, points out that while teething starts in the mouth, its effects can impact the whole body. One commonly surprising sign? Flushed cheeks and a red chin.

“The cheeks often look red and can even get a bit dry,” Grinbaum describes. “That irritation usually comes from all the extra drooling, which can dry on the skin, leaving it a little rough or chapped.”

Increased drooling and chewing

Excess drool and irritability are other big signs that teething is underway. "The mouth has a salivary reflex that's triggered when new teeth start coming in, which leads to hypersalivation,” details Grinbaum.

On top of that, babies will start chewing on whatever they can reach. “Chewing offers comfort and helps relieve the pressure from the teething process,” Grinbaum shares.

Mood changes and sleep disruption

Mood changes and sleep disturbances often tag along with teething. Grinbaum observes that for some babies, the pain can feel very sharp, similar to how adults might feel with a headache or bodyache.

"This can make sleep disruptions and crankiness pretty common," he adds. "In some cases, a fever might show up, too."

Gum changes and feeding challenges

Parents might also notice changes in their baby's gums. "During teething, the gums can look inflamed and red," Grinbaum points out. "There's extra pressure on the gums, and that can make feeding a little tricky. That is why many babies find comfort with breast milk or formula, since liquids don’t add extra strain to sore gums."

Other symptoms to watch for

While most symptoms stick to the mouth and gums, sometimes the effects stretch a little further. “Some babies experience a mild fever, diarrhea, a runny nose, or even diaper rash,” Grinbaum notes. "Usually, these pop up because babies are always putting fingers into their mouths, which can bring in bacteria and other irritants."

Teething symptoms checklist:

• Red cheeks or chin
• Increased drooling
• Chewing on objects
• Sleep changes
• Crankiness

The truth about teething pain

How teething shows up in babies

Teething can make babies extra fussy, but cosmetic and restorative dentist Dr. Robert DiPilla, DDS, says it's not usually behind severe pain, high fever, or diarrhea.

“Some babies might get a bit irritable, drool more, or have tender gums, but these symptoms are usually mild and stay localized in the mouth,” DiPilla tells Today's Parent. “If a little one spikes a fever over 38°C (100.4°F), has persistent diarrhea, or just seems generally unwell, those signs aren't caused by teething and should always be checked out."

When it's more than teething

It's not always easy to tell teething apart from something more serious, but there are a few key distinctions. DiPilla shares that typical teething symptoms are pretty tame.

However, signs like a high fever, ongoing diarrhea, vomiting, extreme tiredness, or widespread rashes suggest your baby is dealing with an illness, not just teething. A baby shouldn't seem really unwell from teething alone," DiPilla emphasizes.

Why fever and illness coincide with teething

Some parents notice fever or diarrhea popping up just as teething emerges, but DiPilla suggests that’s usually just a coincidence.

"Around this age, babies lose some of their inherited immunity and start putting everything in their mouths, which means more exposure to more germs," he explains. “You might see colds or tummy bugs while your baby is teething, but teething itself isn’t to blame."

When to see a doctor

Ultimately, Dr. DiPilla cautions against dismissing serious symptoms as “just teething,” since that can delay important care.

“If your baby has a high fever or ongoing diarrhea, it could be an infection that needs prompt attention. Early action is key, so don’t brush off anything worrisome as part of teething," he advises.

Understanding different levels of teething discomfort

Teething isn't the same for every baby—some sail through with barely a fuss, while others deal with major crying spells and sleep disruptions. Dr. Thomas Dobie, DDS, MDS, MS, a board-certified orthodontist, notes that discomfort can range from almost invisible to much more dramatic. “Interestingly, some babies experience little to no pain at all,” he says.

Some teeth pack more punch than others. Molars, which are bigger and broader, typically cause the most discomfort because their wide surface makes it tough for them to push through the gums. "By contrast, incisors tend to slide through pretty easily," Dobie explains.

Pain can also vary widely between babies, thanks to differences in pain thresholds and gum swelling, Dobie adds.

Safe and effective remedies for teething discomfort

Soothing options without medicine

There are plenty of safe ways to ease teething discomfort, and medicine isn't always needed. Grinbaum suggests starting with a gentle gum massage to help soothe soreness.

Cold is another proven hack: “Anything cold can help relieve the discomfort from the gums,” says Grinbaum. “Ice rings or blended fruit with water, frozen into small pieces, not only calms irritation but can also reduce gum inflammation.”

Other non-medicinal options include teething rings, chilled washcloths, age-appropriate biscuits, or frozen purées. "Just steer clear of teething necklaces," Grinbaum warns. "They can be a serious choking hazard."

And sometimes, simple comfort is the best remedy of all. “Soothing your baby can help redirect their thoughts and feelings,” adds Grinbaum. “A change of scene, like a stroller walk or a little dance to music, can work wonders for distraction.”

Teething-friendly foods

When it comes to solid foods, Grinbaum recommends sticking with options that are gentle on tender gums, like cold yogurt or applesauce.

"Harder textures aren’t off-limits, though— a big slice of apple or a chilled banana can be great for gnawing, which can help ease gum pressure in a different way."

When medicine is needed

When it comes to over-the-counter pain relief, Grinbaum recommends caution. “This really depends on parent preference and what works for each child,” he explains.

Grimbuam also doesn’t advise leaning on Tylenol or Motrin throughout the entire teething phase, but small doses—like during a tough night—can help with pain or a low-grade fever.

He also stresses the importance of avoiding teething gels with benzocaine and homeopathic teething tablets. “Just like other OTC medications, it’s best to check in with your pediatrician or pediatric dentist for a plan that suits your child,” Grinbaum notes. "For babies under two, benzocaine isn't safe at all.  It interferes with oxygen levels in the blood, which is extremely dangerous."

Teething Remedy Checklist:

• Massage gums with a clean finger.
• Offer something cold (teething, puree, washcloth).
• Try soothing foods (yogurt, applesauce, banana).
• Comfort with cuddles, walks, or music.
• Avoid teething necklaces, gels, and tablets.
• Use medicine only if advised by your pediatrician.

When to consult a healthcare professional

Normal vs. concerning teething symptoms

"Most babies just deal with mild gum discomfort, crankiness, drooling, or disrupted sleep once teething kicks in," details DiPilla. Temporary skin irritation around the mouth or chin from excess saliva can also appear," he adds.

But DiPilla notes that there are true red flags: a persistent fever (over 100.4°F or 38°C), vomiting, diarrhea, refusal to nurse or bottle-feed for an extended period, or a widespread rash all point to an illness, not teething, and should mean a call to the pediatrician.

"A dentist can also help if there are worries about delayed tooth eruption, unusual gum swelling, or any dental injury," DiPilla adds.

Other reasons to call the doctor

“Severe or inconsolable fussiness, dry mouth, fewer wet diapers, sunken eyes, or lethargy could signal dehydration or another underlying issue, so these always deserve prompt medical attention,” cautions DiPilla. "While mild feeding changes or occasional crankiness are normal, persistent refusal to feed or symptoms that don’t get better after a few days are signs it’s time to check in with a healthcare professional."

Debunking common teething myths

Myth 1: Teething causes high fever

Dr. Carey Chronis, MD, a board-certified pediatrician, says that despite what many believe, teething has never been found to cause a high fever.

"Some studies show a very slight temperature bump, less than one degree, but nothing higher," he shares.

Myth 2: Teething causes diarrhea

Ask any parent, and they will tell you that babies and toddlers often get diarrhea, but "Although it is easy to suspect an association between teething and diarrhea, tooth eruption is not to blame," explains Chronis.

Myth 3: Teething causes severe pain that requires strong medication

Although tooth eruption doesn't cause severe pain, Chronis states that mild discomfort is possible. "A cold teething toy is usually enough to ease the pain," he advises. “If things are more uncomfortable, some ibuprofen or acetaminophen can help with the pain.”

Myth 4: Teething causes ear infections or colds

"Teething does not cause ear infections or common colds," says Chronis. "Babies and young children love putting their hands in their mouths and touching everything, so if your child gets sick while teething, it’s probably from something they picked up."

Myth 5: Teething necklaces are safe and effective

Teething necklaces come with serious safety risks. "Beads can break off and pose a choking hazard," warns Chronis.

A safer bet? Try a gel-filled chew toy that can be refrigerated—cool relief for sore gums and much safer for little ones.

The bottom line

Teething isn’t fun, but it’s not a medical emergency. Think of it as a rite of passage—messy, drooly, and totally survivable.

Dr. Elizabeth S. Gosnell, DMD, MS, a board-certified pediatric dentist, says it helps to know what’s coming and how to ease your baby’s discomfort: “In preparation for teething, it’s best to educate yourself on what to expect and what you can safely do to help your child. And remember, this will pass. With some time and comfort, your child will successfully teethe and move on to their next milestone.”

Hang in there. You’ve got this—and so does your tiny tooth warrior.

Experts

• Dr. Sandip Sachar, DDS, is a New York City–based dentist.
• Dr. Liel Grinbaum, DMD, is a board-certified pediatric dentist.
• Dr. Robert DiPilla, DDS, is a cosmetic and restorative dentist.
• Dr. Thomas Dobie, DDS, MDS, MS, is a board-certified orthodontist.
• Dr. Carey Chronis, MD, is a board-certified pediatrician.
• Dr. Elizabeth S. Gosnell, DMD, MS, is a board-certified pediatric dentist.