Teething gets a bad rap. It always has (apparently, for thousands of years), from parents and healthcare providers alike. In fact, I’m fairly confident that there isn’t a single pediatric symptom that hasn’t, at some point, been ascribed to teething. I’ve always been skeptical, partially because it’s my nature, and partially because it just didn’t make sense that this totally normal process would be responsible for so many seemingly unrelated symptoms. I wondered which, if any, of these symptoms could actually be caused by teething; and which, if any, of the common treatments for teething actually work. So I started digging…and it’s absolutely fascinating how much we have (and haven’t) learned.

One of the earliest physicians to write about the hazards of teething was none other than Hippocrates himself. In the 4th century BC, the “Father of Western Medicine,” whose oath (albeit, in a heavily-modified form) remains part of a physician’s indoctrination today, noted that “teething children suffer from itching of the gums, fever, convulsions, diarrhoea, especially when they cut their eye teeth.” This theory persisted and permeated the field of pediatrics throughout much of modern history; until relatively recently, nobody bothered to challenge it.

But while it’s certainly good for a physician to recognize the symptoms Hippocrates described, the scientific mind soon begins to wonder: just what is it about teething that causes these sundry symptoms? It took a while to come up with an answer, but by the late-19th century, we were getting close. It had something to do with the nervous system. In 1887, J. W. White explained, “The nervous perturbation occasioned by the eruption of teeth increases the susceptibility and lessens the resistive power of the child.” Sounds science-y enough. I’d buy it.

So we’ve defined a disease; now we need a treatment (otherwise, there would be no need for doctors, and that’s bad for business). Only a few hundred years after Hippocrates wrote of the perils of teething, Soranus of Ephesus developed one of the earliest recorded treatments for teething—which was fortunate, considering the severity of the symptoms this common process could cause. It was pretty simple: kill a rabbit, cut out his brain, rub it on your kiddo’s gums. Can’t get much easier than that. This practice remained the standard of care for several hundred years; it was published in the medical literature of the time: “If they are in pain, smear the gums with dog’s milk or hare’s brain; this works also if eaten.”

Aetios of Amida, a physician in the 6th century AD, evidently hailed from an area where rabbits were hard to come by; he suggested that if a hare’s brain were difficult to obtain, a lamb’s brain would work equally well, “for by its nature it assists.” You can’t ask for a more scientific explanation than that. He also recommended another practice, which I found quite intriguing: “Root of colocynth hung on the child in a gold or silver case, or bramble root, or the tooth of a viper, especially a male viper, set in gold or green jasper, suspended on the neck.” What do you know? A teething necklace. I’ll come back to this.

Necklaces or amulets for teething remained quite popular for some time—we’re talking centuries. They usually involved a tooth, bone, stone, or root suspended around the infant’s neck in some manner or another. In 1668, François Mauriceau, a French midwife, discussed the use of “Silver Coral,” “small Bells,” or a “Wolfs tooth,” adding that “one must not however believe that these things have any peculiar property, as many Women imagine; but if they are helpful in this case it is because of their solidity, evenness and smoothness.” Silly women and their imaginations.

In 1682, the British philosopher and physician John Locke wrote of “convulsion fits” (seizures) that were attributed to teething. His recommended remedy: diacodium (a syrup made from poppies—essentially, opium), sweet oil of almonds, and, “if the child be vigorous and a year old,” bloodletting. A little bloodletting never hurt anybody.

Now, I understand that, for a parent, seizures can be really scary. But it’s not just the seizures you have to worry about. Dr. J. W. Holman authored a book on caring for children that was widely read by mothers in the 1840’s. It was the What to Expect of the mid-19th century. In it, he warns of some pretty serious complications: “Beside the general febrile symptoms attendant upon the teething of children, many other troublesome and sometimes fatal complaints follow.” Yes, “fatal.” Teething could kill your kid. His solution was to alter your child’s diet to carefully titrate the consistency of his stool. I’m not sure how this helped.

Now, death by teething sounds pretty severe—it can’t be that common, right? Au contraire. Dr. John Arbuthnot (1667-1735) was a British physician that served as the personal physician for Queen Anne, so you have to assume he knew his stuff. According to his records, “above a tenth part of Infants die in Teething.” Yep—if your baby girl gets teeth, there’s a better than 10 percent chance that she will die. (The follow-up study showed that over the next 70 years, the death rate from teething increased to nearly 100 percent…just kidding, but you can see how statistics can be misleading.)

Well, I thought 10 percent sounded high, so I kept searching, thinking that perhaps Dr. Arbuthnot wasn’t the best pick for the Royal Doctor job. Maybe someone else’s outcomes looked better. I was wrong. In 1894, a dentist with a killer last name (Thrasher) reported even higher numbers: “So deadly has teething become, that one third of the Human family die before the twenty deciduous teeth have fully appeared.” I suppose I’ve been lucky so far; I have 2 kids, both of whom have teeth and neither of whom has died yet. Better not push my luck with number 3. But seriously, this is getting out of control—we have to do something.

Fortunately, while teething carried a 25% mortality rate, there were treatments (even beyond hare’s brains and necklaces). One of the mainstays of teething therapy was known as gum-lancing. It appears to have been developed by a French surgeon, Ambriose Pare, in 1575. He serendipitously discovered the value of this treatment during a child’s autopsy: “We diligently sought for the cause of his death, we could impute it to nothing else than the contumacious hardness of the gums…when we cut the gums with a knife we found all the teeth appearing…if it had been done when he lived, doubtless he would have been preserved.” No doubt.

Once it was established (without a doubt) that slicing open a kid’s gums would save his life, the procedure really caught on. But, as with any medical procedure, we have keep in mind our oath to “do no harm.” We need to be sure the benefits outweigh the risks. Dr. John Darwall laid these fears to rest in 1830, when he wrote: “With respect to the gums, the moment they become red and inflamed they should be lanced, nor can any harm result from this practice, if the lancet be clean.” OK, cool. So make sure your scalpel is clean, and you should be good. And, according to him, there was really no other option. “It will be in vain to administer medicines until the gums have been lanced.”

So we’ve seen that gum-lancing is effective and safe; it was also reported to be painless, as long as you use the right instrument. François Mauriceau, who we’ve already met, advised the following: “Let the Gums be cut with a Lancet where the teeth are ready; Nurses use to do it with their nails but ’tis better to be done with a Lancet because ’tis not painful.”

Some, however, seemed to disagree with Mauriceau’s assessment. It turns out that, while “’tis not painful” for the physician, gum-lancing wasn’t the most well-tolerated procedure for the babies (or their over-protective mothers). In 1862, Dr. Harrison explained, “I think all well educated medical men, in this country, are advocates for lancing the gums…Mothers, however, not unfrequently object; they think it a pity to hurt the little darling.” An article published around the same time discussed this issue as well: “The terrors of the mother and the restlessness of the infant, frequently render it by no means an easy operation.” I would imagine so.



But despite the protests of the “little darling” and his mother, a doc’s gotta do what a doc’s gotta do. We’re saving lives here. Dr. Marshall Hall emphasized this point when he wrote that he “would rather lance a child’s gums 199 times unnecessarily than omit it once if necessary.” I get it–you don’t want to miss something. And, besides, it’s not like the procedure wasn’t proven to be effective. In 1908, Dr. John Lovett Morse documented the impressive benefits of gum-lancing in one of his patients: “A boy, 17 months old, began to be fussy and a little feverish the night of April 14…The next evening the temperature was 103°F.” After Dr. Morse’s skillfully-performed procedure: “the next day 100°F. in the evening.” So there you go—undeniable scientific proof that gum-lancing works.

An even more impressive (and equally well-documented) fact about gum-lancing, is that if a child hasn’t been dead all that long, you might just be able to bring him back. David Francis Condie described such an event in his book, A Practical Treatise on the Diseases of Children, which was published in 1850. “A child, having suffered greatly from difficult dentition, apparently died and was laid out for internment. M. Lemonnier was desirous of ascertaining the condition of the alveola. He accordingly made a free incision through the gums but on preparing to persue further his examination, he perceived the child to open his eyes and give other indications of life. He immediately called for assistance; the shroud was removed from the body and by careful and persevering attention, the child’s life was saved. In due time the teeth made their appearance and the child’s health was fully restored.” As far as I can tell, this was the first (and possibly, the only) recorded dental miracle.

There was a lot of back-and-forth about whose technique was the best, but the one thing you didn’t do was to deny that gum-lancing was the appropriate treatment. (It was, as you just read, scientifically-proven). In 1857, the Southern Journal of Medicine and Physical Science published the following: “The principal thing in the treatment of these cases, is to lance the gums freely. A superficial incision will be of no avail; the gums must be cut down until the lancet impinges on the approaching tooth.” The author went on to scathingly criticize opponents of this view: “The prejudices of former writers against this invaluable operation scarcely require comment; but…we still find a few, and we are happy to say a very few individuals, who retain a bigoted faith in the absurd dogmata of their forefathers,” who evidently felt that gum-lancing might not be all that beneficial.

Perhaps the dissenting forefathers would have been convinced if they had given gum-lancing another shot, this time with an adjunct treatment. In 1764, Dr. John Theobald wrote: “The cure must begin by applying a leach behind each ear, and when the swelling of the gum shows it is time to cut it…it should be cut quite down to the tooth, with a penknife.” Pure genius. How could placing leeches behind a child’s ears and then cutting his gums with a pocketknife not be helpful? In 1825, Dr. James Kennedy clarified the whole leech thing. Turns out, you can’t use just any leech. “When the leech is of the right or medicinal kind, its body has a blackish brown colour, marked on the back with six yellow spots, and edged with a yellow line on each side.” Just be careful picking one out–if in doubt, ask your pharmacist.

Fortunately, for those who—despite the overwhelming body of scientific evidence supporting this procedure—just couldn’t be convinced, there was an alternative therapy available. Dr. Valentine Mott wrote a chapter in an infant care handbook in 1844, in which he advised the following (slightly less invasive) treatment: “When a child, pent up in the confined and impure atmosphere of our cities, has become emaciated by teething…it is surprising to see with what rapidity he is restored, on removal to the pure air of the country…Accordingly, all our writers on diseases of children, recommend this as an indispensable, and the only remedy, almost, which is needed. We have been in the habit, for the last twenty years, of recommending to those who dwell in the city of New York, a daily trip, across the river to Hoboken, during the summer months, for children undergoing the process of teething, and we have found, where this has been practiced, that dentition has, in a very large majority of cases, been attended with little or no inconvenience.” It’s amazing what a little fresh air can do.

But teething is a tough disease to treat, and doctors aren’t perfect. Sometimes a physician’s best efforts just aren’t enough. Nathaniel Hawthorne (the 19th-Century American author, perhaps best known for writing The Scarlet Letter) had a wife, Sophia, who was totally incapacitated by teething—for 31 years. “Sophia had been a very sick child on account of teething, and was made a life-long invalid by the heroic system of medicine which was then in vogue.” She suffered from “among other things…an acute nervous headache which lasted uninterruptedly from her twelfth to her thirty-first year, and of course, shortened her life by an unknown quantity.” Heck of a headache. Her doctors were stumped: “The Boston physicians…tried their hands at curing her, and she went through courses of their poisons, each one bringing her to death’s door, and leaving her less able to cope with the pain they did not reach.” They tried everything: “mercury, arsenic, opium, hyoscyamus, and all.” They were bringing out the big guns. Teething was really kicking this lady’s butt. But, alas, she got better: “When Sophia Peabody became Sophia Hawthorne in 1842, she was, for the first time since infancy, in perfect health; nor did she ever afterwards relapse into her previous condition of invalidism.” So the honeymoon fixed her…maybe Nate’s talents weren’t limited to using his pen.Is that what I’m hearing?

I found all of these accounts to be fascinating and exceedingly entertaining. But, as a physician, reading these articles is humbling. These guys weren’t idiots. They were the most intelligent and respected thinkers of their day, doing the best they could with the information they had available. And you see how ridiculous they sounded. That makes me wonder: how much of what we “know” now will sound ridiculous in 10, 50, or 300 years? Probably a lot of it. But then, I’m reminded of a quote by Ralph Waldo Emerson: “Speak what you think today in words as hard as cannonballs, and tomorrow speak what tomorrow thinks in hard words again, though it contradict everything you said today.” So, in my next post, with the acknowledgement that everything I say may be proven wrong in the future, and based on the best medical evidence available, I’ll tell you what I think. Today.

Acknowledgements:

Without the prior work of T.E.C., Jr. and Martin Ashley, both of whom I have cited extensively above, writing this post would have fallen somewhere between difficult and impossible. Thanks for your efforts and your shared fascination with this topic.

The Disease and Cause of Death images are taken from http://www.antiquusmorbus.com/English/Periodontal.htm.