Studies examining the link between teething and systemic symptoms
| Authors | Study group | Study type | Methods | Key outcomes | Comments |
|---|---|---|---|---|---|
| Wake et al1 (Australia) | 21 children from 3 day-care nurseries assessed over 2067 days. 90 teeth erupted during the study period | Level 1b: prospective cohort study with objective assessment | Daily assessment for 7 months by independent practitioner, including temperature and gum examination with daily symptom questionnaire recorded independently by parents and staff | No association between teething and fever, mood disturbance, appearance of illness,sleep disturbance, drooling, diarrhoea,strong urine, red cheeks, or rashes/flushing on the face or body. Parental data suggested an association between loose stools and teething, but this was not seen in data from assessing staff | 78% enrolment rate. 6% of dental therapist and 13% of day-care staff data not available.Mean age of children enrolled = 14.4 months. This is the only study with an objective assessment of teething and a clear definition of teething. No description of statistical method, but logistical regression used in results |
| Macknin et al2 (Cleveland, USA) | 125 infants enrolled at 4 months assessed over 19 422 days. 475 teeth erupted during study period | Level 2b: prospective cohort study with parental assessment | Twice-daily assessment for 8 months by parents, including temperature and gum examination with daily symptom questionnaire recorded by parents | Symptoms significantly associated with teething: increased biting, drooling, facial rash, irritability and fever (all <38.3°C). No symptom occurred in >35% of infants during the teething period; no symptom occurred in >20% more often in the teething period than in the non-teething period. No symptom reliably predicts teething. Diarrhoea/cough/vomiting/fever >38.9°C not associated. No serious illnesses | 25% enrolment rate —presumably only highly motivated families 14 (>10%) of families enrolled provided no information. No objective assessment of tooth eruption. Power study and appropriate statistical method presented. |
| Jaber et al3 (Israel) | 46 infants enrolled prior to first tooth eruption | Level 2b: prospective cohort study with parental assessment | Daily assessment by parents, including temperature and gum examination with daily symptom questionnaire recorded by parents Presentation with tooth eruption confirmed objectively Data from 20 days preceding tooth eruption used for analysis | Significant difference in temperature, using 37.5°C as a cut-off value, was found between day of tooth eruption and preceding days (χ2 test p<0.025) | Parents blinded as to reason for daily symptom recording, but asked to present child when tooth eruption suspected. No discussion of prevalence of other symptoms Temperature data analysed with discontinuous statistics |
| Peretz et al4 (Colombia) | 585 children assessed at clinic (145 infants with erupting teeth, 357 controls) | Level 3b: retrospective –case control study | Single clinical assessment of tooth eruption. Retrospective questionnaire completed by parents | 40% of teething children were asymptomatic. 93% of control children were asymptomatic. 60% of children had at least one of the following symptoms reported: drooling (32%), fever >39°C (25%), diarrhoea (35%) Presence of drooling and fever were assessed at clinic visit | No comparison of study and control groupsData not presented on 83 children in control group (19%). No distinction between objective and reported symptoms. Temperature cut-off of >39°C used and analysed with discontinuous statistics |
| Cunha et al5 (Brazil) | Records of 1813 children aged 0–3 years seen at dental baby clinic | Level 4: retrospective case series | Case note analysis for specific symptoms associated with tooth eruption | 1165 records (64%) had sufficient information.95% of children had some symptoms associated with tooth eruption, but these included gingival itching and irritation | No control patients. No definitions of symptoms or signs. No ability to determine whether any results were significant |