Teething gel guide: why the FDA warns against it and what helps instead
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- Firm rubber teething ring. Best for: Chewing to ease sore gums. See options on Amazon
- Solid silicone teether. Best for: Babies who prefer a softer chew. See options on Amazon
What the FDA says about teething gels
In its consumer update on soothing teething pain, the FDA says topical medicines containing benzocaine or lidocaine, including creams, gels and homeopathic teething tablets, offer little to no benefit and carry serious risks when used for teething pain in children. It lists several over-the-counter oral products that contain benzocaine, including Anbesol, Cepacol, Chloraseptic, HurriCaine, Orabase, Orajel and Topex, and says they should not be used for teething pain in children.
The FDA adds that prescription viscous lidocaine should not be used for teething in infants and young children; it can cause heart problems, severe brain injury, seizures and death.
Methemoglobinemia: the warning on the label
Benzocaine can cause methemoglobinemia, in which the oxygen-carrying capacity of red blood cells is greatly reduced, the FDA says. An Orajel 4X toothache gel label on DailyMed shows how this appears on packaging: it can occur even if you have used the product before, and you should stop use and seek immediate medical attention if you or a child in your care develops:
- Pale, gray or blue colored skin
- Headache
- Rapid heart rate
- Shortness of breath
- Dizziness or lightheadedness
- Fatigue or lack of energy
That label says children under 3 years should not use it and not to use it for teething in children under 3.
Teething basics
The FDA says infants begin teething on average around 4 to 7 months and have 20 baby teeth by 3 years. MedlinePlus lists signs such as crankiness, biting or chewing on hard objects, drooling, swollen or tender gums, refusing food and sleep problems, and says teething does not cause fever or diarrhea. Call your child's provider if your child has a fever or diarrhea and you are worried.
What helps instead
| Option | How to use it | Source |
|---|---|---|
| Clean finger | Gently rub or massage swollen gums | FDA |
| Firm rubber teething ring | Not liquid-filled and not frozen; supervise for choking | FDA, MedlinePlus |
| Cool, wet washcloth | Rub the gums; it can be chilled in the freezer first, then washed before reuse | MedlinePlus |
| Cool, soft foods | Applesauce or yogurt if your child already eats solids | MedlinePlus |
The FDA says if a teething object is too hard it can hurt the gums, and to supervise children so they do not choke on a teething ring.
What not to do
- No teething jewelry. The FDA has reports of deaths and serious injuries, including strangulation and choking, from teething jewelry such as amber necklaces. MedlinePlus says never tie a teething ring or any object around a child's neck.
- No homeopathic remedies or teething powders, MedlinePlus says.
- Nothing frozen against the gums, and no liquid-filled rings or plastic objects that might break.
- No aspirin or alcohol on the gums, and never cut the gums.
- Bottles. If a bottle comforts your child, fill it only with water; MedlinePlus says formula, milk or juice can cause tooth decay.
If an older child or adult uses a numbing gel
Benzocaine oral gels are still sold for toothache and gum pain in older children and adults. The Orajel 4X label gives these directions and warnings:
- Adults and children 3 years and over: apply to the affected area up to 4 times daily or as directed by a dentist or doctor; supervise children between 3 and 12.
- Do not use if you have an allergy to local anesthetics such as procaine, butacaine, benzocaine or other caine anesthetics.
- Do not use for more than 7 days unless directed by a dentist or doctor.
- Stop and ask a doctor if mouth soreness does not improve in 7 days, or if swelling, rash or fever develops.
Keep these products away from babies and toddlers.
Pain medicine
MedlinePlus says acetaminophen or ibuprofen can help when a child is very cranky or uncomfortable; ask your child's provider about the right medicine and dose for your child's age and weight, and read the package. If you have questions about any medication, the FDA's Division of Drug Information takes calls at 1-855-543-3784. Report side effects to MedWatch at 1-800-FDA-1088. For other baby care, see our infant gas drops guide and infant vitamin D drops guide.
What to look for when you buy
Firm rubber teething ring
Best for: Chewing to ease sore gums
The FDA suggests a firm, not liquid-filled, rubber teether instead of numbing gels.
Watch out: Do not freeze it; supervise to prevent choking.
See options on AmazonSolid silicone teether
Best for: Babies who prefer a softer chew
MedlinePlus advises avoiding liquid-filled rings or plastic objects that might break; a solid one avoids both.
Watch out: Never attach it to a cord around the neck.
See options on AmazonQuestions people ask
- Is teething gel safe for babies?
- The FDA warns benzocaine and lidocaine teething products offer little benefit and can cause serious harm.
- What is methemoglobinemia?
- A condition, linked to benzocaine, in which red blood cells carry far less oxygen; watch for pale, gray or blue skin.
- What can I use instead of teething gel?
- Rub the gums with a clean finger or give a firm rubber teething ring, as the FDA suggests.
- Are amber teething necklaces safe?
- No. The FDA has reports of deaths and serious injuries from teething jewelry.
- Does teething cause fever?
- MedlinePlus says teething does not cause fever or diarrhea; call your provider if you are worried.
Sources
- Safely Soothing Teething Pain in Infants and Children (fda.gov), U.S. Food and Drug Administration
- Orajel 4X Medicated Toothache and Gum gel label (dailymed.nlm.nih.gov), DailyMed, U.S. National Library of Medicine
- Teething (medlineplus.gov), MedlinePlus Medical Encyclopedia