Signs and symptoms attributed to “teething” are reported by parents as being very common, yet this survey found that although PDs were consulted about it regularly, this was not frequent (at most on a monthly basis, for almost half of respondents). This indicates that they are either not the first source of information for parents/carers, or other allied health care professionals (AHPs) were consulted, or that parents/carers do not tend to seek advice.
One of the limitations of this study is that, although this study accessed the vast majority of PDs by using BSPD mailing lists, it likely missed out accessing some private PDs who were not members of the society. These are likely to be small in number so probably did not affect the results. However, the response rate (27%) was low, and this potentially limits the generalisability of the results. The responses given regarding signs and symptoms, aligned with most other studies. The survey respondents had broad representation, including PDs who ranged up to 45 years since BDS qualification (range: 1975–2017) and across the spectrum of training, from experienced PD Consultants to practitioners who mainly treat children with no formal postgraduate training. Most were located in England which aligns with UK workforce distribution [21].
Despite the potentially limited generalisability of this study due to the participation rate there is evidence to suggest that there is a broad church of views on the existence of teething, advice that is given when requested and on awareness of teething guidance. There was a significant level of support for development of better guidance. This study is part of efforts to develop robust and comprehensive, evidence-based guidelines on teething advice for both health professionals and parents [20]. Such guidance could help parents and professionals make accurate differentiation and diagnoses on whether children are “teething” or have another illness. It will also inform advice and management in response to teething symptoms, driving these towards evidence-based options rather than resorting to medicalisation with over-the-counter teething products as a first line of treatment, especially as some of these contain ingredient which are potentially harmful for children [20].
Most signs and symptoms that respondents attributed to teething were localised manifestations such as drooling and irritability. Some PDs felt that teething was not associated with systemic illness. These views agree with research [7, 8] where an increase body temperature might be found but that fever is not associated with teething [9], and hence, further medical attention should be considered for babies and children with fevers. The views of PDs diverged from some that have been previous reported for similar groups of clinicians in the literature, in terms of associating fever with teething [13]. This might be due to differences in the cultural and clinical backgrounds. These discrepancies highlight how beliefs around childhood teething can be contextually related.
There was general agreement amongst PDs on recommending chewing a soft teething ring or using age-appropriate analgesia as first-line management strategies for teething symptoms. These non-invasive approaches, to treat mild signs and symptoms, are recommended by guidelines [11, 22]. However, around 30 of the PDs had no awareness on guidelines for teething.
At the time of the survey administration, there were three sources of advice on teething accessible to professionals in the UK. The Scottish Dental Clinical Effectiveness Programme’s Management of Acute Dental Problems [23] a reputable, evidence-based guideline. It mentions pain around “a newly erupted tooth” but does not mention teething specifically. The advice given concerns oral hygiene and self-care measures. The American Academy of Paediatric Dentistry guideline on Perinatal and Infant Oral Health Care recommend oral analgesia and chilled teething rings as well as avoiding topical anaesthetic gels [22] The NICE CKS summary of available evidence goes into more detailed recommendations, advising reassurance, basic oral hygiene advice and encouragement to seek dental care in the first instance [11]. However, there is no specific guidance relating to the management of teething symptoms. Respondents felt that advice regarding the management of teething should be developed for, and accessible to, primary dental care providers and other AHPs and there is evidence that providing parent/carers with information on managing teething symptoms can reduce medication use [24].
Simply producing guidance is not enough to make the target audiences, aware of it, and even when they are aware of it, it does not mean it will be adopted. Alongside producing guidance, barriers to the uptake of recommendations in everyday practice and use of strategies to overcome these in dissemination should be considered. Perhaps one of these barriers is that some PDs, as revealed in their comments, did not consider “teething” to be a condition in its own right. The existence of “teething”, and the degree to which the signs and symptoms commonly attributed to it actually are caused by tooth eruption, is controversial and an area that needs to be resolved [25, 26]. This gap in knowledge is currently filled with culture-inspired remedies and commercially available, OTC products that promise parents relief of their child’s discomfort, without the need to seek a professional opinion.
PDs are ideally placed to provide appropriate advice and reassurance to parents and are also as an expert source of information for other AHPs, such as Health Visitors, who are in regular contact with parents of teething infants. Up-to-date, accessible guidance should be available to PDs and for them to refer other AHPs.
Another limitation of the study was associated with the lack of a pre-existing questionnaire tool that could be adopted. The one we used was not formally assessed for its validity and reliability. Hence, the study findings need to be considered with caution. However, the content validity for the questionnaire was assessed through questionnaire piloting with a similar sample to the population of interest. Their feedback was incorporated into the final version of the questionnaire.
