Parents and physicians have debated for years about whether there are symptoms associated with tooth eruption. Macknin and colleagues conducted a prospective study to determine if there are symptoms associated with tooth eruption and, if so, which ones could reliably predict such eruption in infants.

Families were recruited at an infant's four-month-old well-child check if at least one parent worked at the Cleveland Clinic Foundation. Although about 500 families were eligible, parents were told that completion of the study (ostensibly a study of normal behavior) would be difficult. Consequently, only 125 families enrolled. Each family was asked to check an aural temperature twice daily and complete a daily questionnaire about 18 symptoms. A teething period was defined as the period from four days before to three days after a tooth eruption. The study lasted eight months.

Of the 125 families, results from only 111 were available for analysis. At enrollment, the infants were between three and 5.6 months of age. Data were available for a median of 212 days per child. Eighty-nine children experienced 475 tooth eruptions during the study period; in 22 children, no teeth erupted. No one symptom occurred in more than 35 percent of children who had a tooth eruption, although a number of symptoms were significantly associated with the eruptions. The symptoms that were significantly related to eruption (during the teething period) were drooling, gum-rubbing, irritability, decreased appetite for solids and a temperature higher than mean plus one standard deviation (specifically, temperatures higher than 38.3°C [101°F] but less than 38.9°C [102°F] were significantly associated with tooth eruption). Tooth eruption was not associated with infection, diarrhea, cough or temperatures higher than 38.9°C.

The authors conclude that tooth eruption in infants is not associated with severe symptoms and that severe symptoms (such as a temperature higher than 38.9°C) should not be attributed to teething.