TABLE 1

Summary of Descriptive Characteristics of Included Articles (n = 16)

StudyPopulationInterventionOutcome
Author, Year, CountryaStudy DesignSettingTotal nAge, Mean or Range, moClinical AssessmentBody Temperature °C (Who/How)QuestionnaireAssessed TeethSymptomsFollow-Up PeriodMTNED/ MTED (°C)Main Conclusion
Bengtson et al 1988 Brazil31PSInstitutionalized children living in a shelter365–11Children were examined for admission to the research. Examiner NI.Nurses/Daily. Type of thermometer, measurement NI.Nurses daily registered salivation, diarrhea, sleeping trouble, irritability, runny nose, rash, fever, decreased appetite, vomiting, strong urine, itching hearing, physical difficulty.7288.88% had salivation, 87.50% diarrhea, 72.22% sleeping trouble, 69.44% irritability, 68.05% runny nose, 61.11% rash, 58.33% fever, 50.00% decreased appetite, 11.40% no symptoms.4 moNI/NIChildren had their teeth erupted with symptoms.
Carpenter 1978, United States42RSWell-infant clinic of a medical university hospital (South Carolina)120 records4–10Medical student and a board-certified pediatrician. Records used in the study indicated teeth were erupting that time or in previous visit one month before.Medical student and a board-certified pediatrician/monthly rectal temperatures <37.77a were not recorded as fever.NNumber of teeth NI. Inferior primary central incisors.39.16% had 1 disturbance and 22.50% had ≥2 disturbances (fever, vomiting, diarrhea, drooling, irritability, facial rash and rhinorrhea) concurrent with teething; 17 patients had fever.NINI/ NIThere is a correlation between teething process and the occurrence of systemic disturbances.
Chakraborty et al 1994, India36PSPediatric departments of different hospitals of Calcutta and pedodontic department Dr. R. Ahmed Dental College2016–12Dentist/2-mo interval.NAParents were asked direct questions on the appointment day on extent and nature of local disturbances (inflammation of the gum, nonspecific oral ulcers, cheek flush, cheek rash, eruption cyst), within 2-mo period.NI80.08% suffered from at least 1 complication in relation to anterior teeth and 92.53% from posterior teeth. Inflammation of the gum was the most common complication.NINAEruption of anterior teeth was associated with fewer complications than posterior teeth.
Cunha, et al 2004, Brazil32RSInfant clinic of Araçatuba Dental School1165 records0–36Examiner NI/2-mo intervals.Parents were asked regarding the occurrence of fever, type of thermometer, measurement NI.Parents were asked regarding the occurrence of disturbances during eruption. Gingival irritation, runny nose, diarrhea, fever, general agitation, increased salivation, agitated sleep were analyzed.889b95% of the records reported some type of manifestation, 85% gingival irritation, 74% agitation, 70% increased salivation, 46% fever, 39% agitated sleep, 35% diarrhea, 26% runny nose. The most frequent teeth involved were the lower central incisors 52%, maxillary central incisors 20%.Records from Jan 1996 to Dec 2001 were analyzed.NI/NIChildren showed some type of disturbance during eruption of teeth.
Galili et al 1969, Israel39PSInstitutionalized children residents of a Wizo Baby Home, Jerusalem435–23 Mean 11.07 (± 0.8)Author/Weekly. Eruption was registered if any portion of the occlusal surface had penetrated the gingiva.Nurses/Daily/Rectal temperature of at least 37.5°C over a period of 2 d was designated as fever.Nurses daily registered stool, consistence and number, vomiting, sickness, drooling and restlessness. They referred the child to the resident pediatrician in case of any sign of disturbance.93The difference between eruptions in periods with fever of unknown origin and those in period of health is significant. The association between eruption and fever without apparent cause is significant. Multiple eruptions associated with fever and illness was significant.4 moNI/ NIThere was no association between tooth eruption and systemic disturbances. Eruption and fever without recognizable cause was associated. Multiple eruption and disease (respiratory and alimentary) was associated.
Hulland et al 2000, Australia30PS3 day care centers216–24 Mean 14.4 (± 4.9)Dental hygienist examined (tactile and visual) the alveolar ridges to identify redness or swelling and stage of tooth eruption/every weekday, mid-morning,NANA128Only 16 observations of swelling. Redness occurred in 85% of teeth in the early stages of eruption.7 moNA/ NADuring eruption most of teeth showed signs of gingival reddening (hyperemia) and soft tissue swelling is uncommon.
Jaber et al 1992, Israel11PSAuthor’s private clinic to confirm tooth eruption466–18mothers examined gums daily. Professional confirmation of tooth eruption.Mothers/Daily/RectalMothers, daily noted if there was any diarrhea, convulsions, bronchial symptoms, or any other diseases; medications and medical examinations. All data refer to the previous 20 d.Number of teeth NI. Only data collected up to the eruption of the first tooth (incisors) were analyzed.Since the day that tooth eruption was registered was referred to day 0, and all data refer to the previous 20 d, the results of comparison of days 0 to 9 and 10 to 19 showed 47 vs 67 d of otitis media, 85 vs 72 d of diarrhea, and 52 vs 58 d with cough; no convulsions occurred.NIMTNED MDT 36.9 and 37.1 from day 19 to day 4. Three days before the tooth eruption occurred the MDT increased to 37.14 (0.66) on day 3, 37.2 (0.68) on day 2, 37.4 (0.76) on day 1.Infants cut their teeth with fever.
MTED 37.6 (0.85) on the day the tooth erupted (95% CI 37.33–37.86).
King et al 1999, United States43CSSG patient at a dental school pediatric dentistry clinic, a community hospital, and the private offices of a pediatric dentist and a pediatrician; CG selected by age-matching to SG, at local church’s infant care facility40 Total 20 SG distress from tooth eruption 20 CG no distress7–30Responsible personnel at each location made examination and viral sampling protocol for HVS, for SG and one of the authors for CG subjects. Samples for viral culture were obtained from subject’s gingiva in both groups.Examiner NI/Type of thermometer, measurement and frequency NI. When temperatures were obtained by other than the oral method (skin tape, rectal), they were adjusted to oral values for comparison purposes.N, only that information obtained on each subject was recorded on a prepared form and included name, age, gender, temperature, and oral findings.NISG Positive cultures for HVS in 9 infants, they presented inflammation, swelling, vesicles, ulceration) limited to area adjacent/ beyond to erupting tooth (teeth). CG all negative for HVS and normal oral findingsNA, Single clinical assessmentMTNED NAChildren had elevated temperature that could not be explained by other diseases during teething period.
MTED SG 7 from 9 positive for HVS had temperature >37.77a from 11 negative 5 presented elevated temperature CG all negative for HVS normal temperature.
Kiran et al 2011, India37PSDepartment of Pediatric and Preventive Dentistry, Institute of Dental Sciences, and the Department of Pediatrics, Rohilkhand Medical College8946–36Examiner NI/3-month intervals. Eruption was defined as visible clinical crown of the tooth, but not exceeding 3 mm of exposure in the oral cavity.Nurse/After dental examination. Type of thermometer, measurement NI.Parents were asked about the occurrence of local and systemic disturbances. Analysis of the records showed the presence of the following symptoms: gingival irritations; diarrhea; fever; loss of appetite; irritability; increased salivation; running nose; agitated sleep; fever with diarrhea; fever with increased salivation; diarrhea with increased salivation; fever with diarrhea and increased salivation.Number of teeth NI. Incisors, canines, and molars.95.7% reported some type of manifestations, gingival irritation was observed in 95.9%, irritability in 92.1%, fever in 78.0%. In the control group 92.1% of infants did not manifest any symptom.11 moNI/NILocal and systemic manifestations were more pronounced during eruption of primary incisors.
There was association between primary tooth eruption and incidence of signs and symptoms.
Noor-Mohammed and Basha 2012, India38CSChild health institute and research center11004–36One of the authors. Eruption was determined if the clinical crown of the tooth was visible, but not exceeding 3-mm exposure above the gingiva.Mothers complete a short and simple questionnaire in a yes/no manner including fever.Parents completed a questionnaire in a yes/no manner about 3 objective manifestations noted during the eruption of the primary teeth including drooling, diarrhea, fever, and the combination of these symptoms.Number of teeth NI.The most frequent clinical manifestations were fever (16%), drooling (12%), diarrhea (8%), fever-drooling (15%), fever-diarrhea (8%), drooling-diarrhea (6%), and the combination of fever-drooling-diarrhea (3%).NA, Single clinical assessmentNIThere was association between general objective signs (drooling, fever, and diarrhea) and the eruption of primary teeth. Most signs appeared during the eruption of the primary incisors.
Type of thermometer, measurement NI.Incisors, canines, and molars.
Frequency NA.
Peretz et al 2003, Colombia34CSPublic child center5854–36Dentist/Single assessment.Nurse/Frequency NA/Type of thermometer, measurement NI. Fever was recorded when exceeded 39°C.Parents accompanying the child completed a questionnaire. Information was relayed in a yes/no manner about 3 objective manifestations noted during the eruption of the primary teeth, including drooling, diarrhea, fever, and the combination of these symptoms. The dentist and the nurse confirmed drooling and fever during the clinical checkup.Number of teeth NI. Incisors, canines, and molars.CG 93% of the children did not present any clinical manifestation. In the SG, only 39%. The most frequent clinical manifestations were drooling (15%), diarrhea (13%), and drooling-diarrhea (8%), fever and fever-diarrhea (8%).NA, Single clinical assessmentNIAn association has been shown between general objective signs (drooling, fever, diarrhea) and the eruption of primary teeth with drooling being the most prevalent sign.
145 SGEruption was determined if the clinical crown of the tooth was visible, but not exceeding 3 mm exposure above the gingiva.Most signs appeared during the eruption of the primary incisors.
340 CG
Ramos-Jorge et al 2011, Brazil33PS/RSResidences of the infants475–1511 validated trained dentists/ daily.11 validated trained dentists/Daily.Mothers were interviewed to investigate the occurrence of signs and symptoms such as increased salivation, rash, runny nose, diarrhea, loss of appetite, cold, irritability, fever, smelly urine, constipation, vomiting, colic, and seizure, in the previous 24 h and 1 week after the end of data collection, the mothers answered the same questionnaire.231 (incisors). Mean number of teeth per infant was nearly 5 (range=2–8).The associations between signs and symptoms reported by mothers and tooth eruption were statistically significant.8 moMTNED Tympanic 36.39 (0.26)There are associations between teething and sleep disturbance, increased salivation, rash, runny nose, diarrhea, loss of appetite, irritability, and a slight rise in temperature. Fever was more frequently reported in the RS.
NoninstitutionalizedMean 8.9 (± 2.7)The day of eruption was defined as the first day on which the incisor edge emerged in the oral cavity without being completely covered by gingival tissue.Infrared auricular thermometer and a digital axillary thermometer.The most common symptoms on days of eruption were irritability, increased salivation, runny nose, and loss of appetite. Fever was reported % times more often in the RS.Axillary 35.98 (0.36)
MTED
Tympanic 36.51 (0.20)
Axillary 35.99 (0.46)
Shapira et al 2003, Israel40PSDay care center165–14Pediatric dentist/Twice weekly. Eruption of the teeth was referred to the act of teeth breaking out the gum.Information provided by parents/caregivers. Twice weekly.The children’s signs and symptoms for each day were recorded by the examining dentist on the basis of the information provided by parents as well as caregivers at the day care center. The following signs and symptoms were recorded: fever; vomiting; gastrointestinal disturbances; drooling; behavioral problems; sleep disturbances; coughing; appetite disturbances; and biting; sucking.50 teeth (anterior), evaluated and samples from 21 of them for the test and the control group (fluid from the sulcus).During the teething period, behavioral problems were observed in 50% of the infants, compared with 16% in the control period (P < .01); fever was observed in 24% of the infants during tooth eruption and in 8% of the infants during the control period (P = .04); and coughing was observed in 12% during tooth eruption compared with 2% (P = .06) of the infants during the control period. In teething period vomiting (2%), drooling (12%), and appetite disturbances (12%), but were absence during the control period.5 moMTNED During the control period, 8% of the children exhibited low/moderate fever, no episodes of high fever were found.Teething was associated with fever, behavioral problems, coughing, and the cytokine tumor necrosis factor-α levels.
Fluid from the sulcus was collected on the day of eruption or on 1 of the following 3 d, and was again collected for the control group from the same tooth 1 mo later.Type of thermometer, measurement NI.MDT NI
A child with a temperature <37.5°C was classified as having “no fever.” A temperature of 37.6°C to 38.5°C was regarded as low/moderate fever, and a temperature >38.5°C was classified as high fever.MTED In the teething period, 14% of the children exhibited low/moderate fever and 10% exhibited high fever MDT NI
Tasanen, 1969, Finland35PS/CSNursery, day-nursery, welfare center126 SG0–301 investigator with both medical and dental qualifications, daily, groups I /II and summoned when eruption occurred, group III. Eruption: first time the edge of incisor/cusp of molar emerges through gingiva and is palpable with the fingernail. Coincidental infection: if fever or other sign of infection was noted 1 wk before or 5 d after eruption, child was place in the infected group. Blood investigation: sedimentation rate per hour and total white blood cell count. Local investigations: condition of the mucosa: normal, slight redness and deep red. Sensitivity of gingiva: finger palpation, moderate pressure. Sensitivity of tooth to pressure: with special equipment 800 g. Histologic investigation: gum at the eruption site.Same investigator: rectal temperature, twice daily (morning/ afternoon), 1-minute thermometer °C.aBehavior disturbances: nursing staff/mothers. Symptoms: sleep, daytime restlessness, rubbing the cheek and ear, rubbing gum and sucking the finger, drooling, appetite and loose stools.192 (incisive, canine, molar).Infection during eruption: 26% SG, 15% CG. Temperature: NoI was in average of 0.1°C lower in pre- and post-eruptive phase. Sedimentation rate: during and after eruption not significant. White blood cells during eruption: significant only for lymphocyte ratio in SG compared CG. Disturbances in behavior: statistical difference only for restlessness and drooling in SG and appetite showed little decrease for SG. Local observation: gum color change: in 40% was deep red. Changes in mucosa: 28 in 126 cases showed slight hemorrhages, moderate pericoronorite, fistulas, swelling, or eruption cyst. No difference could be found in relation to the other findings. Pain was not found in pressure to the gingiva or to the erupting teeth. No investigation was made concerning correlation between clinical and histologic findings. At least 20% of mothers believed their children could present some of the investigated symptoms.Average period of 13.3 dMTPEEruption did not influence the body temperature or increase the possibility of infection. Sucking finger, rubbing gum, drooling, daytime restlessness, loss of appetite increased during teething. There was no change in the color of mucosa in one-third of the erupting teeth. There were some local complications during teething. Mother attributed some disease to teething.
SG: PS:107 CGQuestionnaire maternal opinion: 200 mother, 100 >40 y old. Symptoms: fever, sleep disturbances, restlessness during the day, gum rubbing and finger sucking, cheek and ear rubbing, appetite, drooling, diarrhea, convulsion.NoI 37.0
42 nursery GI+50 newborn andI 37.2
43 day-nursery GII50 teething children for evaluation of the gum colorMTED
41 welfare center GIII+17 mucosal specimensNoI 36.9
CG: CS:I 37.3
107 the same localsMTP
NoI 37.0
I 37.3
Wake et al 2000, Australia10PS/RS3 child care centers216 – 24Dental therapist examined for tooth eruption every weekday (midmorning). An eruption day was defined as the first day that the edge of an incisor or cusp of a molar crown could be seen or felt emerging through the gum.Dental therapist Every weekday (midmorning)/ Infrared tympanic thermometerTwo questionnaires: to staff (afternoon) and parents (morning) inquired about the child’s mood, wellness/illness, drooling/ dribbling, sleep, stools, wet diapers, and rashes/flushing over the preceding 24 h were answered every weekday. At the end of the study, parents completed a questionnaire about their beliefs and experiences related to teething.90 (incisive, canine, molar).Analysis did not indicate a relationship between tooth eruption and fever. All parents retrospectively reported that their own child had suffered teething symptoms.7 moMTNED 36.18Tooth eruption is not associated with fever, mood disturbance, illness, sleep disturbance, drooling, diarrhea, strong urine, red cheeks, or rashes/ flushing on the face or body.
Mean 14.4 (± 4.9)MTED 36.21
Yam et al 2002, Senegal41PSChild health institute Centre de Protection Maternelle et Infantile in Dakar-Médina4995–30Medical service Monthly.Information provided by parents.NINumber of teeth NI. Incisors, canines, and molars.Local observation: 7 hematoma of eruption, 5 widespread gingivitis, 297 local gingivitis. At least 60% of the children had ≥1 of the symptoms: hyperthermia, vomiting, diarrhea and appetite problems.NINI/NIChildren cut their teeth with local and systemic disturbances.
Mothers should bring the children if there were any signs or symptoms in this period.Type of thermometer, measurement NI
  • HSV, herpes simplex virus; I, infected; MDT, mean daily temperature; MTED, mean temperature in eruption days; MTNED, mean temperature in noneruption days; MTPE, mean temperature before eruption; MTP; mean temperature after eruption; NA, not applicable; NI, not informed; N, no; NoI, noninfected; PS, prospective study; RS, retrospective study; SG, study group.

  • a Data were modified by authors (°F to °C).

  • b Data calculated by authors.