Two of the best-known teething remedies are the ones safety authorities most often warn about. Oral benzocaine products can cause a rare but dangerous blood condition in young children, and teething necklaces carry choking and strangulation risks. What tends to help most is cheaper and safer: something cold to chew on, gentle pressure on the gums, and plenty of comfort.
Benzocaine gels are not for babies
Benzocaine is a local anaesthetic found in some numbing gels sold for mouth and toothache pain. In 2018 the US Food and Drug Administration said over-the-counter oral benzocaine products should not be used to treat infants and children younger than 2 years, because benzocaine can cause methaemoglobinaemia. This condition reduces the blood's ability to carry oxygen and can be life-threatening.
In Australia, no benzocaine product is registered specifically for infant teething, and the Therapeutic Goods Administration has consulted on warning statements for benzocaine medicines that include not giving topical oral preparations to children under 2. The practical message for parents is simple: do not use an adult numbing gel on a baby's gums.
Non-medicated cold gels are a different matter. The Australian Dental Association's teething factsheet says cold gels can help, although the effect may not last long because saliva washes them away, and a baby can swallow some of the gel. Ask a pharmacist before using any product on a young baby.
Teething necklaces and bracelets carry real risks
Amber and other beaded necklaces are often sold as a natural remedy. The Australian Competition and Consumer Commission warns that teething necklaces pose a serious choking hazard or strangulation risk to babies and toddlers, and its testing found some would fail the mandatory safety requirements for teethers. It also notes that harm can occur despite warning labels on the product.
The ADA's factsheet adds that beaded necklaces or bracelets may be a choking hazard and are not likely to help with pain. Anything tied around a baby's neck, wrist or ankle is best avoided, including during sleep.
A natural label is not a safety guarantee
Herbal and homeopathic teething products are sometimes assumed to be harmless because they are described as natural. That label says nothing about what is in the product or how much. If you are considering one, check with a pharmacist first, and stop using any product that seems to make your baby drowsy or unwell.
What does help
The ADA's patient site lists several comfort measures that are low risk and inexpensive:
- a cold, but not frozen, teething ring or a clean wet washcloth to chew on
- gently rubbing the gums with a clean finger or the back of a cold spoon
- a dummy, if your baby already uses one
- extra cuddles and attention
The ADA's advice is cold but not frozen, so a teether chilled in the fridge is the better option. If your baby is still uncomfortable, the ADA notes that pain relief medicines such as paracetamol or ibuprofen may be used, and advises asking a dentist, doctor, nurse or pharmacist before giving any pain medicine to make sure the product and dose are right for your baby's age and weight.
Symptoms that are not teething
Teething signs can start as early as 3 months and commonly include drooling, gum rubbing, fussiness, mouthing and biting. Teeth often start to appear around 9 months, although anywhere from 3 to 12 months is normal.
The ADA advises against assuming that a very high fever, poor appetite, trouble sleeping, coughing, rashes, diarrhoea, vomiting or seizures are due to teething. If your baby has any of these, see a doctor to rule out illness.
The first tooth is also the cue for a first visit
The Australian Dental Association recommends a child's first dental visit when the first teeth arrive. It is usually a short, relaxed appointment: a look at the gums and new teeth, and practical advice on cleaning and diet. Our guide to a child's first dental visit explains what to expect, and our article on cleaning baby and toddler teeth covers daily care once teeth appear. If your baby was born with a tooth, see our guide to natal and neonatal teeth.
Common questions
Can teething cause a high fever?
A very high fever should not be put down to teething. The ADA recommends seeing a doctor so other illnesses can be ruled out.
Is it safe for my baby to wear a teething necklace if I am watching?
The ACCC's warning covers choking and strangulation in babies and toddlers generally, and the ADA says such necklaces are unlikely to help with pain. A chilled teething ring is a safer choice.
How long does teething go on?
Discomfort tends to come and go as each tooth comes through, and the baby teeth arrive over the first few years of life.
Questions about your child's teeth
Our oral health therapists, Sabrina Tran and Jennifer Nguyen, see children and families and focus on prevention. Eligible children can be bulk billed under the Child Dental Benefits Schedule. For advice on your baby's teeth, contact the team at Lumi Dental in Melrose Park or see our current deals page. This article is general information and is not a substitute for advice from your pharmacist or doctor about a specific product.
Sources
- Australian Dental Association (teeth.org.au): Babies and toddlers
- Australian Dental Association: Teething factsheet
- ACCC Product Safety Australia: Teething necklace safety, avoid strangulation or choking
- US Food and Drug Administration: Safety communication on oral over-the-counter benzocaine products, 2018
- Australian Pharmacist: TGA seeks input on benzocaine advisory statements, 2018
