Can teething cause inflamed lower gums and associated symptoms such as feeding refusal and excessive crying in a 5-month-old infant?

Can Teething Cause Inflamed Lower Gums in a 5-Month-Old?

Yes, teething can cause inflamed lower gums in a 5-month-old infant, and this is a normal physiological process that typically begins around 6 months of age. 1, 2

Understanding Teething as a Cause

Teething is the normal process by which primary teeth emerge through the gums, typically starting around 6 months of age, though some infants begin earlier at 5 months. 1 The process causes localized gum inflammation as the tooth breaks through the tissue. 1

Symptoms Directly Attributable to Teething

Based on a large prospective study of 125 infants tracking 475 tooth eruptions, the following symptoms are statistically associated with teething during the 8-day "teething period" (4 days before emergence through 3 days after): 3

• Gum inflammation and swelling (the most consistent finding) 4, 3
• Increased drooling 1, 4, 3
• Gum-rubbing and increased biting behavior 3
• Irritability and increased crying 1, 5, 4, 3
• Decreased appetite for solid foods 3
• Mild temperature elevation (but NOT high fever) 3
• Sleep disturbance and wakefulness 4, 3

Critical Limitations and Red Flags

However, no single symptom occurred in more than 35% of teething infants, and no symptom occurred more than 20% more frequently in teething versus non-teething periods. 3 This means teething cannot reliably explain all symptoms, and other causes must be excluded first.

Teething does NOT cause: 3

• Fever over 102°F (38.9°C)
• Vomiting
• Diarrhea (despite common belief among parents and some dentists) 4
• Life-threatening illness 3
• Severe systemic symptoms 3

Clinical Approach for This 5-Month-Old

Immediate Assessment Required

Before attributing symptoms to teething, you must rule out other serious conditions: 3

• Examine for signs of infection: Check for fever >102°F, which would indicate something other than teething 3
• Assess feeding refusal carefully: Determine if this is selective (refusing solids but taking liquids, consistent with teething) versus complete refusal (suggesting other pathology) 3
• Evaluate the quality of crying: Excessive, inconsolable crying beyond mild irritability warrants investigation for other causes 6
• Screen for child abuse: In any child younger than 5 years with oral trauma or unexplained oral findings, consider non-accidental injury 7, 8, 9

Examination of the Gums

Look specifically for: 1, 4

• Localized gum swelling and redness over erupting tooth sites
• Sensitivity to palpation
• Visible tooth buds beneath the gum surface

Red flags requiring dental referral: 7, 8

• Extensive gingival or facial swelling (suggests abscess) 7, 8
• Gray tooth discoloration (indicates pulpal necrosis) 7, 8
• Parulis formation on gingiva 7, 8
• Unexplained gum bleeding without recent trauma 8

Management if Teething is Confirmed

Conservative Measures (First-Line)

• Cold teething rings for the infant to bite on 1
• Gentle gum massage with clean finger 1
• Maintain normal feeding schedule but offer softer foods if solid foods have been introduced 3
• Reassure parents that symptoms are self-limited and typically last only 8 days per tooth 3

Topical Treatments

• Hyaluronic acid-based gum gels have demonstrated efficacy in reducing teething symptoms including irritability, crying, and gum redness in recent studies 5
• Analgesic/anesthetic gels (such as those containing choline salicylate) can be applied directly to inflamed gums 1

What NOT to Do

• Do not prescribe systemic antibiotics for uncomplicated teething 7, 9
• Do not attribute high fever (>102°F) to teething - investigate other causes 3
• Do not dismiss excessive crying as "just teething" without proper evaluation 6

Common Pitfall to Avoid

The most dangerous error is attributing serious illness to teething. 3 While mild symptoms are common, teething should be a diagnosis of exclusion after ruling out infection, gastroesophageal reflux disease (which can cause feeding refusal and irritability in this age group), and other pathology. 6 No teething infant in the landmark prospective study had a life-threatening illness attributed to teething, emphasizing that serious symptoms require investigation beyond teething. 3