TeethingSymptoms The Journal of Clinical Pediatric Dentistry Volume 34, Number 3/2010 201 INTRODUCTION T ooth eruption represents a natural physiological processbywhichatoothmovesfromitssiteofdevel- opmenttoitsfinalfunctionalpositionintheoralcav- ity. 1 However, general and oral symptoms have been related toteethinginearlychildhood. 2-5 Muchofthedataaboutpos- sible manifestations of tooth eruption have been obtained from studies with significant methodological limitations such as small sample size, cross-sectional design and sam- ples of institutionalized children. 4, 6-7 Furthermore, many studies rely on parents’information of symptoms that occur a long time prior to being reported, which indicates that information bias has probably occurred. 4 Symptomsattributedtotootheruptionareoftenresponsi- ble for the referral of toddlers to medical or dental profes- sionals or prompt parents to administer medications to chil- dren on their own initiative. 7-9 However, parents are con- fronted by a lack of consensus on the subject among health professionals. 9-10 In truth, it remains unclear whether these disturbances are caused by the eruption, are just related to it or whether they simply coincide with tooth eruption.A lack of evidence makes diagnosis problematic and may prevent professionals from effectively managing some common developmental issues of infancy and could lead to late diag- nosis of important illnesses. 11 Prospective studies investigating the distribution of the differentsymptomsobservedbyparentsduringthefirstyear oftheirchildren’slivesandassociatedfactorscancontribute to an understanding of these phenomena. This knowledge can help in differentiating between true symptoms of teething and the unfounded beliefs of each population, thereby contributing to adoption of the best management. The aim of this prospective cohort study was to estimate the occurrence of teething symptoms perceived by parents during the first year of life and its association with anthro- pometric,socioeconomicandgeneralhealthvariables.Addi- tionally, the parents’management of teething symptoms was also investigated. MATERIALAND METHODS Subjects and Study Design This cohort study is nested in a randomized trial which Teething Symptoms in the FirstYear of Life andAssociated Factors:A Cohort Study CarlosAlberto Feldens* / Italo Medeiros Faraco Junior** /Andréia Bertani Ottoni *** / Eliane Gerson Feldens **** / Márcia ReginaVítolo ***** Objective: To investigate the occurrence and management of teething symptoms during the first year of life and associated factors. Study design: 500 children were recruited at birth. Research assessments including structured interviews, anthropometric measurements and dental examination were carried out after birth, at 6 months and at one-year of age. The primary outcome of this study was defined as the occurrence of one or more teething symptoms within the first year of life, as reported by the mother. Results: Teething symp- toms were reported in 73% of the children analyzed (273/375). The symptoms most frequently reported were irritability (40.5%), fever (38.9%), diarrhoea (36.0%) and itching (33.6%). Dentists had little influence on the management of symptoms and self-medication to relieve them was a common practice.The risk of report- ing teething symptoms was higher for children from nuclear families (p=0.040) and for children from fam- ilies with higher income (p=0.040). Conclusions: Teething symptoms were highly reported in this popula- tion. Pediatric dentists should be accessible and provide adequate orientation when symptoms can be man- aged at home or immediate referral to health services when more serious diseases are suspected. Keywords: tooth eruption, teething, tooth, deciduous; primary, signs and symptoms. J Clin Pediatr Dent 34(3): 201–206, 2010 *Carlos Alberto Feldens, PhD, Department of Pediatric Dentistry, Universidade Luterana do Brasil. Canoas, Brazil. **Italo Medeiros Faraco Junior, PhD, Department of Pediatric Dentistry, Universidade Luterana do Brasil. Canoas, Brazil. *** Andréia Bertani Ottoni, MSc, Department of Pediatric Dentistry, Universidade Luterana do Brasil. Canoas, Brazil. ****Eliane Gerson Feldens, MSc, Department of Pediatric Dentistry, Universidade Luterana do Brasil. Canoas, Brazil. ***** Márcia Regina Vítolo, PhD, Department of Nutrition, Universidade Federal de Ciências da Saúde de PortoAlegre. PortoAlegre, Brazil Send all correspondence to: Carlos Alberto Feldens, Rua João Telles 185/1301, PortoAlegre-RS, Brazil, ZIP Code 90.035.121. Email: cafeldens@terra.com.br