Tooth eruption and otitis media: are they related?

The relationship between tooth eruption and otitis media has been a subject of debate in the literature. Teething may produce conditions conducive to the initiation or exacerbation of otitis media as well as other local and systemic clinical manifestations. A report of a child with bacterially involved pericoronitis associated with primary tooth eruption is presented. The potential relationship of the findings to otitis media is discussed. The eruption of the primary teeth and the coexistence of any systemic disturbances in the so-called "teething" process is controversial. 1-5 Some of the purported systemic disturbances have included diarrhea, irritability, fever, loss of appetite, rhinorrhea, excessive salivation (drooling), and vomiting. 1,2 The exact nature of the relationship of tooth eruption to that of other physiologic signs which occur concurrently has not been established scientifically and remains relatively dependent on accumulated observations of physicians and mothers. That there exists a localized gingivitis in the area concomitant with tooth exposure in the oral cavity is not disputed. Theoretically, teething has been thought to be either a normal physiologic phenomenon dissociated with the etiology of other signs, a pathophysiologic process with localized disturbances, or a generalized pathophysiologic process capable of mediating multiple systemic findings. 3 Clinically, one of the more frequently observed signs of teething is excessive salivation and drooling. 4 It has been suggested that the excessive salivation and drooling is associated in time with the maturation of salivary glands and may be unrelated to the concomitant process of tooth eruptiond This explanation is unlikely as the salivary glands reportedly mature in utero. 6 Furthermore, there is evidence that noxious stimulation in the oral cavity produces voluminous amounts of saliva. 7 Whether tooth eruption is, in itself, a noxious process is difficult to ascertain because of the inability of the infant to communicate specific information. Additionally, it is known that the placement of foreign objects (e.g., fingers) also reflexively produces increased salivary flow8 and teething infants frequently place their fingers in their mouths. Certainly any cause and effect relationship between the eruption of primary teeth and more remote systemic disturbances is difficult to establish. An example of this dilemma is described in the following case report.