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Teether

A teether, also known as a teething toy or teething ring, is a device specifically designed for infants to chew on during the teething phase, providing relief from the discomfort and soreness associated with emerging teeth by applying gentle pressure to swollen gums.^[1] These toys typically feature textured surfaces, such as nubs, ridges, or flexible protrusions, made from safe, non-toxic materials to prevent choking hazards and ensure hygiene.^[1] Teethers have a long history dating back around 8,000 years, with archaeological evidence from Neolithic Serbia revealing cow bone spoons used as weaning and teething tools.^[2] In medieval times, practices included rubbing animal-derived substances into gums for pain relief and providing hard objects like roots for infants to chew on.^[3] By the Victorian era in Europe, affluent families used coral set in silver rattles or ivory rings as both soothing aids and protective talismans against evil spirits, reflecting cultural beliefs in their efficacy.^[4] In the 17th century, items like teething whistles made of silver or bone were common gifts for upper-class children in colonial America, as evidenced by artifacts from Jamestown prior to 1610.^[5] Modern teethers, introduced in the 20th century with the advent of safer synthetic materials, prioritize infant safety and are often crafted from 100% natural rubber, food-grade silicone, or organic wood to avoid harmful chemicals like BPA or phthalates.^[6] They come in various forms, including rings, mittens, necklaces, and sensory toys with rattles or mirrors, helping not only with teething pain but also promoting oral motor development and self-soothing behaviors in babies typically aged 3 to 24 months.^[7] Pediatric experts recommend refrigerating teethers (without freezing) to enhance numbing effects, while emphasizing the importance of regular cleaning and supervision to mitigate risks like bacterial growth.^[1] As of 2025, the global market for teethers emphasizes sustainability, with brands focusing on eco-friendly, biodegradable options to meet parental demands for non-toxic products.^[8]

History

Early Teethers

Archaeological findings from Neolithic sites in present-day Serbia provide the earliest evidence of teething devices, dating to approximately 5800–5450 BCE. At the Grad-Starčevo settlement, small spoons crafted from cow bones exhibit microscopic marks consistent with gnawing by human primary teeth, suggesting their dual role in weaning infants and soothing teething discomfort through oral manipulation. These artifacts, requiring significant labor to produce—about 25 hours per spoon—indicate a deliberate cultural practice among early farming communities to support infant development during dentition. Across ancient and medieval societies, natural materials served as rudimentary teething aids, reflecting both practical needs and superstitious beliefs. From antiquity through the 18th century, items such as ivory, bone, and animal teeth—including wolves' teeth worn as amulets—were employed in Europe to ease gum pain and ward off associated ailments like convulsions. In early modern England, necklaces strung with peony roots were a common remedy, believed to transfer teething distress to the plant material while preventing epilepsy, a practice documented in medical texts and folk traditions.^[9] Snakes' teeth and other faunal elements similarly appeared in amuletic forms across various cultures, symbolizing protective magic against infant vulnerabilities.^[10] In Europe from the Renaissance period onward, more formalized teething rings crafted from coral or bone became status symbols for affluent families, combining utility with symbolic protection. These rings, often mounted in silver handles or rattles, allowed infants to chew safely on durable, non-toxic surfaces while the red coral was thought to possess apotropaic properties against evil spirits and illness. By the 19th century in Victorian England, such coral-set rattles were widespread among the upper classes, not only alleviating physical pain but also embodying parental hopes for the child's health and prosperity, as evidenced in period portraits and artifacts.^[11]^[12]^[10]

Modern Developments

In the early 20th century, rubber teething rings were introduced as a safer and more hygienic alternative to traditional materials like coral or ivory, which had been used in earlier teething aids. By 1902, retailers such as Sears advertised these "new style rubber teething rings," highlighting their soft, chewable texture designed to soothe infants without the risks associated with brittle natural substances.^[13] This innovation marked a shift toward industrialized production, making teething relief more accessible beyond elite households.^[14] Following World War II, the advent of mass-produced plastic teethers revolutionized their availability, driven by postwar economic growth and advancements in synthetic polymers. Plastic models, often molded into simple rings or shapes with added rattles, became staples in households due to their low cost and durability, as U.S. toy industry sales surged from $84 million in 1940 to $900 million by 1953.^[15] The 21st century brought further evolution amid growing awareness of chemical safety, with a pivot to eco-friendly and hypoallergenic designs in response to concerns over bisphenol A (BPA) in plastics. BPA exposure risks, highlighted by studies linking low-dose effects to developmental issues, prompted industry-wide phase-outs; by 2012, the FDA banned BPA in baby bottles and sippy cups, accelerating the adoption of silicone teethers around the 2000s as a non-toxic alternative.^[16]^[17] Silicone's flexibility, heat resistance, and lack of harmful additives made it ideal for modern teethers, aligning with demands for sustainable, skin-safe materials. Consumer safety recalls significantly influenced these developments, particularly in the 1990s when issues like choking hazards prompted stricter design standards. For instance, in 1991, the U.S. Consumer Product Safety Commission recalled certain teething wheels due to potential breakage risks, underscoring the need for robust construction.^[18] Such incidents, including later concerns with liquid-filled variants in the early 2000s, drove innovations like seamless molding and non-leachable fillings to prioritize infant safety.^[19]

Design and Types

Common Shapes and Forms

Teething rings represent one of the most standard designs for teethers, typically fashioned as circular or oval grips that accommodate the small hands of infants for secure holding. These shapes facilitate easy manipulation and often incorporate textured surfaces, such as raised bumps or ridges, to enable gentle gum massage during use.^[20]^[21] Beyond rings, basic toy-inspired forms like keys, blocks, or animal figures are prevalent, each engineered to support grasping and chewing motions essential for teething infants. Key-shaped teethers, for instance, feature linked or bundled elements that mimic everyday objects, allowing babies to clutch and explore multiple segments simultaneously. Block designs offer stackable or cubic structures for varied chewing angles, while animal figures—such as giraffes, elephants, or bananas—provide playful contours that encourage hand-eye coordination through handling.^[20]^[22]^[23] Biscuit-style teethers, including rusks or edible ladyfingers, adopt a simple, elongated or rectangular form that dissolves gradually under pressure from emerging teeth, serving as a chewable aid suitable for supervised introduction around 6-12 months, once the baby shows readiness for solid foods such as sitting up unassisted and good head control. These consumable options prioritize a firm yet breakable texture to promote safe gnawing.^[24]^[25] Ergonomic considerations in these common designs emphasize accessibility, with features like multiple chew points distributed across surfaces to reach front and back gums, and integrated handles or loops for adult-guided play to prevent mishandling. Some ring and toy shapes can be refrigerated for enhanced cooling, though specialized cooling variants are addressed separately.^[20]^[26]

Specialized Variants

Specialized variants of teethers incorporate advanced features to address specific sensory or therapeutic needs during teething, building on foundational designs like simple rings to provide targeted relief. Refrigerated or freezable teethers often feature gel or water-filled inserts that firm up when chilled, offering a numbing effect on inflamed gums to alleviate discomfort more effectively than room-temperature options. For instance, products like Nuby's cooling gel teethers are designed to be placed in the refrigerator, where the gel maintains a cool temperature for extended soothing without freezing solid, reducing the risk of overly intense cold exposure. Similarly, Bright Starts Stay Cool teethers use water-filled compartments that chill in the fridge to gently numb gums, promoting relief through consistent pressure and temperature therapy.^[27]^[28] Multi-textured teethers enhance gum massage through varied surfaces, including soft bristles, raised ridges, and vibrating mechanisms that stimulate sensory nerves for deeper relief. Nuby's Hollow Sensory Tube Teethers include massaging bristles and multi-textured exteriors to encourage tactile exploration while applying gentle pressure to sore areas, aiding in the breakdown of built-up tension in the gums. Vibrating models, such as Infantino's Vibrating Teethers, activate a soothing vibration upon biting, combining textured silicone grips with rhythmic motion to massage gums and distract from pain, often in fruit-inspired shapes for added engagement. These elements provide a more dynamic interaction compared to smooth surfaces, fostering both physical comfort and early motor skill development through grasping and manipulation.^[29]^[30] Edible teethers, typically crafted from compressed grains or fruit purees, offer dual benefits of gum relief and nutritional intake, dissolving gradually to prevent choking while providing safe chewing practice. Teething biscuits are typically made from whole grains such as wheat or rice, sometimes flavored with fruit powders, creating a firm yet chewable texture that soothes gums as babies gnaw. These biscuits are recommended for supervised chewing to ease teething discomfort, as they break down easily without posing significant aspiration risks when introduced around 6-12 months, once the baby shows readiness for solid foods. Brands like Earth's Best produce organic versions using corn or multigrain bases, ensuring allergen-free options that align with pediatric nutritional standards.^[31] Sensory-integrated teethers merge teething functionality with auditory and visual elements, such as embedded rattles or LED lights, to support holistic developmental stimulation alongside pain relief. The NogginStik rattle features a light-up head with soft textures and a gentle rattle sound, promoting visual tracking and hand-eye coordination. Infantino's Discover & Play Rattle combines chewable elements with colorful, shaking components that produce engaging sounds, enhancing sensory processing and cognitive growth through multi-modal play. These designs, suitable from birth, encourage extended interaction, helping babies explore cause-and-effect relationships in a calming manner during teething episodes.^[32]^[33]

Materials

Traditional Materials

Traditional teething aids date back to prehistoric times, where parents in Neolithic communities, such as those in ancient Serbia around 6000 BCE, utilized cow bone spoons as tools for weaning and teething, providing a hard surface to soothe inflamed gums while serving practical feeding purposes.^[2] In indigenous designs across various cultures, bone was employed for its natural availability.^[3] During the Middle Ages in Europe, wooden teethers were used as alternatives to help soothe babies during teething.^[8] These simple, handcrafted forms helped alleviate teething discomfort by offering a firm yet safe texture, reflecting the era's reliance on locally sourced, organic materials for infant care. By the 18th and 19th centuries, European teething rings frequently incorporated coral and ivory, selected for their hardness to massage sore gums effectively and their cultural associations with protective qualities against illness.^[34] Coral, often set in silver rattles, was believed by ancient Greeks and Egyptians to ward off evil and ease pain, a tradition that persisted into Victorian times despite criticisms of its potential to cause injury if swung forcefully.^[35] Ivory rings, meanwhile, provided a smooth, dense surface thought to be gentler than coral, though concerns arose about its texture irritating delicate tissues.^[14] Ivory use has since been prohibited under international regulations like CITES since 1989 due to conservation concerns.^[36] In the 19th century, natural rubber derived from tree sap gained popularity for teething rings due to its inherent flexibility and chewable resilience, offering a softer alternative that conformed to a baby's bite without the rigidity of prior materials.^[14] This shift toward natural rubber addressed some durability issues of bone and wood while maintaining organic origins, though sustainability concerns later prompted transitions to synthetic options.

Contemporary Materials

Contemporary materials for teethers emphasize engineered properties that enhance safety, durability, and ease of cleaning, often prioritizing non-toxic compositions to address parental concerns over chemical exposure. These materials have largely replaced older synthetics in response to regulatory scrutiny on substances like bisphenol A (BPA).^[37] Food-grade silicone, a synthetic polymer derived from silica, has become a staple in teething products due to its inherent softness, which mimics the flexibility needed for gentle gum massage without risking injury. This material is inherently BPA-free and free of phthalates and PVC, ensuring it does not leach harmful chemicals even during prolonged chewing.^[38] Additionally, food-grade silicone is dishwasher-safe, allowing for thorough sterilization in the top rack to maintain hygiene and prevent bacterial buildup.^[39] Natural latex, sourced from the sap of Hevea rubber trees, undergoes minimal processing to retain its natural elasticity while eliminating synthetic additives, resulting in a resilient yet pliable material suitable for teething. This processing involves coagulating and molding the raw latex without introducing chemicals like BPA, phthalates, or nitrosamines, preserving its hypoallergenic qualities for most infants.^[40] The material's natural antimicrobial properties further contribute to its safety profile.^[41] Eco-friendly plastics such as thermoplastic elastomer (TPE) offer a versatile alternative, combining the flexibility of rubber with the moldability of plastic in a composition free of phthalates, PVC, BPA, and heavy metals. TPE's recyclability and low environmental impact make it a preferred choice for sustainable teether production, while its non-porous surface resists bacterial adhesion.^[42]^[43] Gel-filled components in freezable teethers utilize non-toxic propylene glycol mixed with water to provide a chilled soothing effect without the risks associated with freezing solid materials. This gel formulation remains stable at low temperatures and is encased in safe barriers to prevent leakage, ensuring compliance with food-contact standards.^[44]

Purpose and Benefits

Teething Physiology

Teething, or the eruption of primary teeth, is a natural developmental process in infants that typically begins around 6 months of age.^[45] The first teeth to emerge are usually the lower central incisors, followed by the upper central incisors, with the process peaking between 6 and 12 months as multiple teeth begin to break through the gums.^[46] Primary dentition is generally complete by age 3, encompassing 20 deciduous teeth that support early oral function until their replacement by permanent teeth.^[47] During teething, infants often experience symptoms arising from the pressure exerted by erupting teeth on the gingival tissues, including gum swelling, excessive drooling, irritability, and an instinctive urge to chew on objects to alleviate discomfort.^[48] These signs stem from the resorption of bone and overlying soft tissue as teeth migrate into position, leading to localized inflammation and increased salivary flow.^[49]^[50] Mastication plays a key role in this process by applying mechanical pressure that aids tooth breakthrough and promotes jaw development through stimulation of mandibular growth and muscle strengthening.^[51] This chewing action not only facilitates eruption but also contributes to the proper alignment and maturation of the maxillofacial structures.^[51] Individual variations in teething are common, with premature infants often exhibiting delayed eruption when measured by chronologic age, though timelines align more closely with conceptual age adjusted for gestational maturity.^[52] Factors such as low birth weight can further influence this variability, potentially postponing the onset by several months.^[53] Teethers may serve as tools to satisfy the chewing urge during this period.^[48]

Therapeutic Effects

Chewing on teethers provides gum massage that helps reduce inflammation and pain associated with teething. The pressure applied through chewing stimulates blood flow to the gums, alleviating tenderness and swelling, as the massaging action counteracts the discomfort from emerging teeth. Pediatric recommendations from the American Academy of Pediatrics (AAP) endorse gentle gum massage via teethers or fingers as a safe method to soothe irritated gums, noting its effectiveness in easing pressure without medication.^[54] A 2021 pilot study on edible teethers demonstrated that this massaging effect leads to observable reductions in infant distress, with parents reporting significantly decreased crankiness (p=0.08, -31.1%) and stress levels (p=0.032, -30.5%) after use, which correlates with shorter durations of crying and irritability during teething episodes. In the study involving 12 infants aged 5-19 months, parental visual analog scale (VAS) ratings showed children were calmer (+58.8%, p=0.014) and happier (+48.2%, p=0.010) post-exposure, attributing these outcomes to the teether's soft, spongy texture that facilitates targeted gum pressure. While physiological measures like heart rate variability did not show significant changes, the perceived relief highlights the therapeutic value in managing acute teething symptoms.^[55] Teethers also promote oral motor skills development by encouraging repetitive chewing motions that strengthen jaw, lip, tongue, and cheek muscles essential for future feeding and speech. The textured surfaces of teethers provide varied resistance, aiding in the maturation of coordinated oral movements that support swallowing, biting, and articulation as infants progress to solid foods and verbal communication. The same 2021 pilot study noted that the edible teether's design fosters self-feeding and oral motor advancement through its chewable form, though quantitative data on long-term skill gains were not assessed.^[55] Beyond physical relief, teethers offer distraction and entertainment, engaging infants in a soothing activity that lowers overall stress during teething. By redirecting the natural urge to chew toward a safe object, teethers provide sensory stimulation that captivates attention and promotes calm, as evidenced by improved mood states in the 2021 study where infants appeared less fussy after 15-20 minutes of use. This entertainment value helps mitigate the emotional toll of teething without relying on pharmacological interventions.^[55] Finally, teethers contribute to hygiene benefits by offering clean, purpose-designed surfaces for gnawing, thereby preventing infants from mouthing potentially harmful household objects that could introduce bacteria or toxins. The American Academy of Pediatrics (AAP) recommends soft teething toys as a safe and hygienic alternative to other objects.^[54] Edible variants further enhance this by dissolving harmlessly, reducing residue and contamination risks compared to non-edible alternatives.^[55]

Safety and Regulations

Potential Hazards

Teethers pose several potential hazards, primarily related to choking from detachable or small parts. For instance, components such as snaps, strings, or wings on teethers can break off, creating small pieces that infants may swallow or aspirate. The U.S. Consumer Product Safety Commission (CPSC) has issued multiple recalls for such issues, including the 2025 recall of Chews Life silicone teethers where the safety snap clasp could detach, and the 2022 recall of Bebe au Lait teethers where strings could untie, releasing beads. Similarly, the 2021 Battat infant teether recall involved plastic wings detaching from the body. Liquid-filled teethers add further risk if they burst or leak, potentially releasing fluid or fragments that could be ingested; the FDA's 2025 recall of Gerber Soothe N Chew teething sticks highlighted choking dangers from breakage, while earlier incidents like the 2022 Lamaze Chill Teether recall noted potential microbial contamination from compromised fluid compartments, exacerbating ingestion risks. Uncleaned or porous materials in teethers can harbor bacterial growth, increasing the likelihood of oral infections in infants. Studies on children's toys, including those mouthed frequently like teethers, have detected coliforms and pathogenic bacteria on surfaces, particularly in porous or fabric-covered designs that trap moisture and saliva. The FDA has warned that fluid leakage from damaged liquid-filled teethers can introduce bacteria, potentially leading to gastrointestinal or respiratory infections if ingested. Regular cleaning is essential, as porous materials like certain rubbers or woods can foster mold and microbes if not properly maintained. Teething necklaces and bracelets present significant strangulation risks due to their corded designs, which can tighten around an infant's neck during movement or sleep. The FDA has documented reports of deaths and serious injuries, including strangulation, from such jewelry, advising against their use. In response, several U.S. states have prohibited teething necklaces in child care settings to mitigate these hazards, such as Michigan's rules banning them due to strangulation and choking risks. Low-quality plastic teethers may leach chemicals like bisphenol A (BPA) and phthalates during mouthing, potentially contributing to developmental issues. Phthalates, used to soften plastics, are endocrine disruptors linked to reproductive and neurodevelopmental effects in children, with studies showing leaching from toys into saliva. BPA exposure from similar plastics has been associated with hormonal disruptions and potential developmental delays, though levels in compliant products are regulated to minimize risks. Mitigation through federal regulations, such as the CPSC's phthalates prohibitions, helps reduce these exposures in modern teethers.

Standards and Recommendations

In the United States, the Consumer Product Safety Commission (CPSC) regulates teethers under the Federal Hazardous Substances Act (FHSA), specifically 16 CFR Part 1500, which bans hazardous substances including toxic chemicals like lead, phthalates, and other substances that could cause acute or chronic harm to children.^[56] Additionally, 16 CFR Part 1501 prohibits small parts in teethers and similar articles intended for children under 3 years of age to mitigate choking, aspiration, or ingestion risks, with teethers explicitly listed as covered items.^[57] These regulations require manufacturers to ensure teethers are free from detachable small parts and undergo testing for substance bans, with non-compliance leading to product recalls or bans.^[58] Complementing CPSC rules, the ASTM F963 standard serves as the mandatory consumer safety specification for toy safety in the U.S., directly addressing teethers in section 4.22, which mandates requirements for pacifiers, rattles, and teething toys.^[59] This standard incorporates limits on total lead content (not exceeding 100 ppm under integrated CPSIA provisions) and lead in surface coatings, alongside durability testing through mechanical and physical property assessments, such as drop tests and torque tests to prevent breakage or part separation during use.^[60] Compliance with ASTM F963 ensures teethers withstand normal and foreseeable abuse by infants, reducing risks like material degradation or hazardous fragmentation.^[61] The American Academy of Pediatrics (AAP) advises selecting BPA-free teethers made from safe, non-plastic alternatives like rubber or silicone to avoid exposure to endocrine-disrupting chemicals, emphasizing supervision during use to prevent misuse or ingestion hazards.^[62] AAP further recommends cleaning teethers after each use with soap and water to maintain hygiene and avoid bacterial buildup, while strongly cautioning against amber necklaces due to strangulation and choking risks.^[63] Similarly, the Mayo Clinic endorses chilled, solid rubber or silicone teethers free of liquid fillings that could leak, advising parents to supervise closely, clean regularly, and choose BPA-free options to ensure safety during teething.^[64] Internationally, the European Union's Toy Safety Directive 2009/48/EC harmonizes standards under EN 71, requiring teethers to use non-toxic materials with strict migration limits for heavy metals and chemicals in EN 71-3 to prevent health risks from ingestion.^[65] EN 71-1 addresses mechanical properties, including durability tests for chewable items like teethers to ensure they resist breakage, while mandating age grading to indicate suitability for infants under 36 months and warn of small parts hazards.^[66] These guidelines promote CE marking for compliant products, facilitating safe distribution across EU member states.^[67]

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