Monday, August 1, 2016

Teething Pain? Nope

I wrote this on Cognitive Strain before I revamped it.


While reading research on teething pain, I came across a lot on the historic inanity with which the topic was treated. Ready for this?

Gum lancing:

"The procedure was conducted in the absence of any anaesthesia, generally requiring two incisions crossing at 90° overlying the 'difficult' tooth...Few doctors challenged (or would even contemplate challenging) the rationale for gum-lancing, such was their unquestioning belief in its potentially life-saving effect. Only in the late 19th century did a few sceptics publicly doubt both the rationale and supposed effect of gum-lancing"
Teething as the main cause of infant mortality:

Around one half of all infant deaths in 18th century France were attributed to teething, and teething accounted for 12% of the total deaths in children younger than 4 years old in the Registrar General's Report of 1842.
The hare brain solution to teething was pretty... hair brained:

In 117ad, the physician Soranus of Ephesus was the first to suggest using hare's brain to ease teething. This remained a favoured remedy until the seventeenth century. 
The seventeenth century! Oh, and if you run short of hare brain in your pantry worry not, lamb's brain will work just as well.

Not sure why your 6 month old is vomiting? Probably just teething:
Eighteenth and nineteenth century therapies were varied and depended on local superstition and the beliefs of the attending physician. Doses of mercury salts, opiates, purgatives and emetics were recommended, even if the child was experiencing diarrhoea or vomiting beforehand. With modern understanding of diseases it is likely that dehydration was largely responsible for many of the signs, symptoms and deaths associated with teething.
With teething myths permeating throughout time and culture, why should we expect anything different today? They don't generally take as radical form as these past examples, but I heard from more than one mommy that teething was the second most painful experience in life, next after childbirth. When reading research I come away believing that there's not much reason to believe that teething is painful whatsoever!
Teething pain, sometimes referred to as “dentitio difficilis”, is the commonest symptom associated with the eruption of the primary dentition. Despite a reported prevalence of around 85%, evidence for this condition is weak. Adults assume an infant is experiencing pain because they appear distressed, or because they believe the incisal edges of teeth “cut through” the alveolar bone and gingiva during eruption.
Weak evidence:
there is only weak evidence for pain and no evidence to support the wide array of systemic signs and symptoms often attributed to teething by parents, child carers and health care professionals...
 If some pain is experienced during teething, this will be impossible to assess reliably because infants cannot communicate their pain specifically or describe their pain experience explicitly. Instead, adults interpret various cues (vocalization, facial expression, body movements and changes in breathing rates) and attribute these to pain in the infant. Such cues are not specific and are caused by other forms of stress or distress.
A wastebasket diagnosis for when you can't find anything else.
Although many of the conditions historically thought to result from teething are now accurately diagnosed as specific clinical entities, the enigma of teething continues to endure as a somewhat wastebasket diagnosis, when no cause can be found for a particular sign or symptom.
'Teething' is an ill-defined non evidence-based entity proffered by both health care professionals and lay people as an inappropriate diagnosis for a wide variety of signs and symptoms...
RS Illingsworth statement, "Teething produces nothing but teeth." is a straightforward summation of the actual process of teething...
Studies could not identify systemic manifestations such as decreased appetite for liquids, congestion, sleep disturbances, daytime restlessness, loose stools, vomiting, cough, body rash, fever greater than 38.90C, an increase in finger-sucking, and gum rubbing to be associated with teething in children. 

 A Finland study found few symptoms of teething,
 Tasanen studied teething infants in North Finland, with daily recording of temperature, appearance of gums, presence of infections and disturbances of behaviour.2 He showed that tooth eruption bore no relation at all to infection, diarrhoea, fever, rash, convulsions, sleep disturbance, cough or ear rubbing.
 If teething is so painful, why doesn't it cause pain other times?

 the eruption of permanent teeth is free from the symptoms frequently ascribed to the eruption of the deciduous teeth.

Teeth, whether primary or permanent, do not “cut” through bone, connective tissue and oral epithelium during eruption as an eruption pathway is formed by via bone remodelling. The lack of any significant “teething pain” associated with eruption of permanent teeth is remarkable. Although it can be argued that in older children there is greater pain tolerance and lower pain sensitivity compared to infants.
 A common thread was that the contemporary myths of teething are common among parents as well as health care professionals. Of course when statistical literacy among doctors are lower than chance, what do you expect?

Also read, The Teething Virus.


I have one two-year-old child, and another on the way. I'm quickly beginning to realize that as I have more kids, more and more people are going to pop my bubble and ascribe teething pain to my children. I've given up winning arguments against adherents to popular superstitions, but when they come to me I can't help be get frustrated.

Also see Separating Fact from Fiction