The current methods of the management of teething are presented in Table 4. Infants with severe systemic signs should be promptly referred to a physician for an accurate diagnosis and appropriate treatment.

Non-pharmacological management
The expression "born with a silver spoon in his mouth" has its origin as a teething remedy. This expression referred to wealthy 19th century parents who would give their teething children a silver spoon to bite on to relieve discomfort. Unlike many historical teething remedies, the "silver spoon" treatment was effective and still is used but has been replaced by more affordable textured or cold teething rings. The cold temperature of the object causes localized vasoconstriction, which decreases the inflammation, and biting on the object gives further relief by applying pressure to the gums.

A wide range of teething rings are commercially available for infants to 'gnaw'. Temporary pain relief is provided by the pressure produced by chewing the teething ring, maximal when chilled. Liquid-filled teething rings should be chilled in the refrigerator, not in the freezer, and should not be sterilized in boiling water or in the dishwasher (unless specified by the manufacturer). These should be attached to the infants clothing, and not tied around the neck, as strangulation could result. Many teething children are comforted by a pacifier, and will chew the teat to provide temporary pain relief.

Hard, non-sweetened rusks made from flour and wheat with no sugar or sweetener can also be attached onto the infant's clothing. A variety of fresh and frozen fruit and vegetables e.g., peeled cucumber, frozen bananas can be used by teething infants. Such remedies should not be used in children who are not yet taking solid foods, and foods that have high sucrose content are not recommended. Supervision is needed to ensure that small pieces of food do not break off and pose a choking hazard. Several of the methods described above involve the application of pressure to the painful area of mucous membrane, and mild pressure can also be applied with a clean finger (possibly with wet gauze) or a cold spoon. Excessive salivation commonly runs onto the infant's skin, and should be wiped away regularly otherwise, a rash (which may be considered pathognomic of teething) may develop. Reassurance can often be one of the most effective methods of calming a distressed teething child.

Table 4. Management of Teething

• Teething Rings (chilled)
• Hard sugar-free teething rusks/bread-sticks/oven-hardened bread
• Cucumber (peeled)
• Frozen items (anything from ice cubes to frozen bagels, frozen banana, sliced fruit)
• Pacifier (even frozen)
• Rub gums with clean finger, cool spoon, wet gauze
• Reassurance
• Analgesic/antipyretics
• Topical anaesthetic agents
• Alternative holistic medicine