An 8-month-old girl has been referred to the emergency department by her general practitioner with a 24-h history of drooling, intermittent screaming and low-grade fever (maximum 38.2°C). She is refusing solids and her fluid intake has decreased. Her parents report that her nappies are drier than normal but her stools are looser. She has had some relief from oral paracetamol syrup. Her parents suspect teething.

On examination she is found to be miserable. She is not clinically dehydrated and has a diffusely hyperaemic right cheek. On examination of her mouth you notice a raw area on her upper gums where two teeth are erupting. No other abnormal clinical signs are noted.

You agree that the infant may be teething, but wonder if there are any symptoms that would distinguish between teething and an alternative diagnosis.

In an infant with suspected teething (patient), are there any symptoms or signs pathognomonic of teething (assessment) that would allow for the reassurance of parents without further management (outcome)?

Secondary sources: none.

Medline (1966–September 2006) using the Ovid interface was analysed for articles containing the keywords “(teething or tooth) and symptom$ and (infant or baby)”. Limits included human and English language only.

In total, 78 articles were identified, of which teething was the main focus in 21 articles. There were three prospective studies^1–3 and two retrospective studies⁴⁵ examining the …