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Early-life factors affect risk of pain and fever in infants during teething periods



This longitudinal study aimed to investigate the prevalence of teething-related pain and fever and the early-life factors that may affect the risk of experiencing these disturbances within the first 1.5 years of life.

Materials and methods

Participants were recruited (n = 1033) through the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 1237). Interviews were performed tri-monthly regarding the prevalence of teething pain and fever in children from 6 to 18 months of age. Crude and multivariable analyses were conducted using Poisson-log regression models.


Prevalence rates for teething pain and fever were 35.5 and 49.9 % respectively. Multivariable Poisson regression analysis showed maternal second-hand tobacco smoke (SHS) exposure to increase the risk of both pain (mean ratio = 1.35; p = 0.006) and fever (mean ratio = 1.22; p = 0.025), whereas SHS exposure plus active smoking further increased risk of teething pain in the children (mean ratio = 1.89; p = 0.029). Delivery via Caesarean section increased risk of teething pain (mean ratio = 1.27; p = 0.033), while prenatal plasma vitamin D insufficiency lowered such a risk (mean ratio = 0.62; p = 0.012). Compared to Chinese infants, Indian babies exhibited lower risk of teething pain and fever (both p ≤ 0.001).


Early-life factors such as tobacco smoke exposure and vitamin insufficiency during pregnancy, ethnicity and childbirth via Caesarean section may significantly affect the child’s susceptibility to teething-related pain and fever.

Clinical relevance

Knowledge of prevalence and risk factors of teething disturbances may better equip primary caregivers and healthcare professionals to accurately detect teething-related local and/or systemic signs/symptoms and effectively facilitate tobacco cessation among pregnant women.

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This study was funded by Singapore’s National Medical Research Council (NMRC/CIRG/1341/2012: R-221-000-059-511) and supported by the Singapore National Research Foundation under its TCR Flagship Programme on Developmental Pathways to Metabolic Disease (NMRC/TCR/004-NUS/2008 and NMRC/TCR/012-NUHS/2014). A special thanks is extended to the GUSTO sub-domains for their great support, Professor Michael Kramer for his important advice and input and Pang Wei Wei, Izzuddin Bin Mohd Aris, Tan Pei Ting and Priyangi Alwis for their valuable contributions. The continuous and skilful help of the home visitors and the clinical team from the National University Hospital and the KK Women’s and Children’s Hospital, as well as the database and biostatistics teams, is deeply appreciated.

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Correspondence to Chin-Ying Stephen Hsu.

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Un Lam, C., Hsu, CY.S., Yee, R. et al. Early-life factors affect risk of pain and fever in infants during teething periods. Clin Oral Invest 20, 1861–1870 (2016).

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  • Tooth eruption
  • Teething
  • Pain
  • Fever
  • Prenatal
  • Perinatal
  • Infants