The present study investigated physicians and nurses’ attitudes and beliefs towards teething in infants and found differences between the pediatrician beliefs and those of other staffs.
Tooth eruption time varied in age 4-10 months. The first tooth eruption occurs in 1% before the 4th month when 1% of infants do not have any teeth until the 12th months (
19). In the present study, the mean time length of teething was 7.16 ± 1.60 months. The minimum and maximum age was 4-14 months. Physicians and nurses believed that teething is associated with some signs and symptoms.
In a study conducted by Wake and Hesketh on pediatric nurses, pharmacists, GPs, dentists and specialists demonstrated at least some infants or young children with signs and symptoms of teething and believed that the prevalence of symptoms of teething were quite different (
20). In a study by Sarrell EM, 76% of parents and 83% of nurses believed that tooth eruption is associated with infant mortality and parents’ views were different from those of doctors and nurses ( 5). Feldens, after studying 500 children reported that teething is correlated with irritability, fever, diarrhea and itching ( 21), which was similar to the outcomes. Barlow et al., said that more than half of parents and pediatric dentists believed that teething was associated with diarrhea ( 22). The current study results, compared to those of Barlow’s, showed that more than half of nurses agreed but less pediatric dentists had agreement. Baykan reported that almost all parents expressed that children had at least one of the symptoms introduced in the questionnaire. The most common reported symptoms were irritability, restlessness, fever and biting; similar to the current study findings ( 23). In another study, the majority of nurses believed that loss of appetite, crying, increased salivation, and increased excitability were essential components in the process of tooth eruption. The latter study said that about 82% of nurses agreed with fever and 61% with diarrhea, where the current study demonstrated that more than 70% of the nurses agreed with the two symptoms ( 13). Sarrell concluded that the most common symptoms associated with tooth eruption included irritability, fever, diarrhea and loose stools, ear infections, vomiting, wheezing and asthma exacerbations; similar to the results of the current study ( 3). Wake observed a relationship between temperature, mood disorders, pathological appearance, sleep disorders, drooling, diarrhea, smelly urine, red cheeks, rash or facial flushing with infant teething ( 6). Peretz observed that the most common symptoms associated with teething were drooling teeth (15%), diarrhea (13%) and drooling- diarrhea (8%), respectively. Fever and diarrhea were observed in 8% of the cases. The protests are often observed during the initial eruption of permanent incisors ( 24). Coreil observed that 35% of dentists agreed that teething is associated with diarrhea and it is less severe than other common explanations such as changes in eating habits, increased salivation and stress ( 25). A cohort study found that increasing the number of prospective biting, drooling, irritability, ear rubbing, facial rash, decreased appetite for solid foods and mild temperature increase were associated with the eruption of teeth ( 9). Wake also reported that most child health professionals (70% - 85%) believed that teething causes fever, pain, irritability, sleep disturbances, biting and putting objects to mouth, drooling and red cheeks ( 13). But in another investigation on 21 infants in Melbourne, Australia, no signs and symptoms were strongly correlated with teething, which was not consistent with the results of many other studies including the current one ( 19).
Macknin showed that signs and symptoms such as sleep disturbance, Shelley stools, increased stool frequency, decreased appetite for liquids, cough, rash on other parts of the body except the face, vomiting and fever over 38.8°C were statistically connected with the tooth eruption (
14). In another study very small number of healthcare providers believed that teething causes eczema and rash ( 18). Wake and Hesketh conducted a study on pediatric nurses, pharmacists, GPs, dentists and children specialists and in each group it was thought that at least some infants or young children had symptoms of teething, although beliefs toward the prevalence of teething symptoms were quite different in the groups ( 19).
Almost many pediatric health professionals believed that teething causes a wide range of symptoms and has many signs, most of which are minor and related to discomfort rather than physical illness. The current study did not approve an estimated strong correlation between teething and symptoms in children; although it cannot rule out the possibility of weak associations. The current study findings were consistent and in contrast with those of many other studies on professional beliefs toward teething symptoms and sings. These may create optimal management of common patterns of illness during teething and these beliefs and attitudes may sometimes stop physicians and nurses from effectively managing some of the common developmental issues of infancy and might lead to late diagnosis of important illness.
Although some health professionals such as nurses and physicians believe that some symptoms in infants are probably attributed to teething, further studies on this seemingly trivial issue are required. It is equally important to inform parents that some symptoms should not be attributed to teething, as they may have a more serious underlying cause, and provide parents with information about normal developmental phases of early childhood.