Teething Gel Dangers and Safe Alternatives

baby teething products

Story at-a-glance -

  • The FDA is warning parents to stop using creams and gels containing the numbing agent benzocaine to calm pain in their teething children, as benzocaine has been linked to a deadly blood disorder
  • The blood disorder, methemoglobinemia, prevents the blood protein hemoglobin from releasing oxygen to tissues, thus resulting in oxygen deprivation to body tissues, including the brain, sometimes resulting in death
  • Although plastic teething rings are popular, they may leach bisphenol-A, an endocrine-disrupting agent associated with altered immune function, obesity, diabetes, hyperactivity and more
  • Research reveals teething toys, cuddling and rubbing baby’s gums are the most effective natural means of relieving pain and discomfort associated with teething; the American Academy of Pediatrics does not recommend gels and creams as they wash out easily and are quickly swallowed

By Dr. Mercola

Parents are familiar with the cries and discomfort of their teething children. While a normal part of growth and development, some strategies you may consider could have potentially dangerous side effects. No one likes pain, and when an infant is teething, a parent will do just about anything to relieve their discomfort. However, it's important to realize the potential dangers in reaching for a drug as the first line of defense.

All drugs have potentially serious side effects — even those sold without a prescription and used topically, as opposed to being swallowed. The U.S. Food and Drug Administration (FDA) has released a statement calling for manufacturers to pull products containing a popular topical numbing ingredient,1 as years of data have linked it to a dangerous blood disorder.

Benzocaine May Trigger Blood Disorder

In a press release, the FDA warned consumers over-the-counter teething products containing benzocaine may pose a serious risk to infants and children. Benzocaine is a pain reliever contained in many teething products for the temporary relief of sore gums. The FDA is asking manufacturers to voluntarily take products with benzocaine off the market and for companies to stop selling the products.

The FDA has been warning of the potentially deadly side effect for the last decade2 and now warns of legal action should manufacturers not comply. The FDA will also require manufacturers to update their warning labels on prescription local anesthetics for teething children to include the potential risk of methemoglobinemia.3

A variety of gels and creams containing benzocaine have been linked with a rare but deadly condition in children, especially those younger than 2 years. Reports of illnesses and deaths have continued over the past decade, prompting the FDA to take further action. Dr. Scott Gottlieb, FDA Commissioner, commented in the press release:4

"The FDA is committed to protecting the American public from products that pose serious safety risks, especially those with no demonstrated benefit. Because of the lack of efficacy for teething and serious safety concerns we've seen with over-the-counter benzocaine oral health products, the FDA is taking steps to stop use of these products in young children and raise awareness of the risks associated with other uses of benzocaine oral health products.

In addition to our letters to companies who make these products, we urge parents, caregivers and retailers who sell them to heed our warning and not use over-the-counter products containing benzocaine for teething pain."

Benzocaine is a local anesthetic commonly used in cough drops, throat sprays and gels or liquids for teething pain, canker sores and other oral irritations. Common brand names include Anbesol, Baby Orajel, Cepacol, Chloraseptic, Orabase, Orajel and Topex.5 Side effects from using these products may occur with a single use. In a seven-page letter to manufacturers,6 the FDA outlines the well-documented association between the medication and methemoglobinemia in the literature.

In conducting multiple reviews of the Federal Adverse Event Reporting System and published literature, the FDA estimated more than 400 cases occurred in the U.S. since 1971. The most recent reviews found 111 cases associated with topical drug products containing benzocaine, including four deaths. The vast majority, 97.5 percent, of the reported cases were considered to have triggered a serious medical condition.

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Methemoglobinemia Triggers Low Oxygen Levels

Manufacturers are expected to comply with this warning as soon as possible.7 Symptoms may occur after the first use or after previous uses and may occur within minutes or up to two hours after using benzocaine. The condition requires immediate medical attention to prevent fatality. The FDA is pushing to remove the products off the market as there's little evidence they actually work.

The American Academy of Pediatrics also does not recommend using creams or gels as they quickly wash out of the mouth and are simply swallowed once applied to the gums.8 Methemoglobinemia is a rare blood condition linked to potentially deadly breathing problems as it interferes with oxygen-carrying protein in the blood.9

Hemoglobin is the protein in red blood cells carrying and distributing oxygen throughout the body. Methemoglobin10 is a form of hemoglobin produced in abnormal amounts in some people when benzocaine is used. With an abnormal amount of methemoglobin, hemoglobin can pick up oxygen but will not release it effectively to body tissues, including the heart and brain.

The condition can be acquired through exposure to chemicals and drugs such as benzocaine, nitrobenzene, some antibiotics, including chloroquine and dapsone, and nitrites used as a food additive to prevent meat from spoiling. Foods containing a large amount of nitrates, such as spinach, beets or carrots — also should not be given to children younger than 6 months of age.11 Complications from the condition include shock, seizure and death.12 Symptoms of methemoglobinemia include:13

  • Pale, gray or blue colored skin, lips and nail beds
  • Shortness of breath
  • Fatigue
  • Headache and lightheadedness
  • Rapid heart rate

Baby Teething Schedule Is an Estimation

Your baby's teeth begin developing before birth. The first tooth begins protruding through the gums starting between 4 and 12 months. The first teeth are known as primary teeth, milk teeth or deciduous teeth.14 They often emerge in a specific order but exactly when they appear can vary. The first teeth to appear are the two lower central incisors, usually arriving at the same time. 

The next two are the two front teeth between 8 and 12 months followed closely by lateral incisors between 9 and 13 months, arriving just left and right of the upper teeth. Your baby's first upper molars will come in on the top between 13 and 19 months and on the bottom between 14 and 18 months. By the time your child is 3 years old they'll have a full set of 20 baby teeth, which will not start to fall out until the permanent teeth are ready to come in around age 6.15

Each baby responds to teething pain in a different manner, in much the same way every child or adult responds to pain in a different way. Some of the more common signs your baby is uncomfortable with teething may include:16



Swollen and sensitive gums

Gnawing or chewing behavior

Refusing to eat

Trouble sleeping

Drooling, which can sometimes cause a facial rash

Low grade fever less than 101 degrees F (38.3 degrees C)

Although many report their baby experiences diarrhea or a runny nose before a new tooth arrives, there is no research indicating a majority of children experience these symptoms. If your baby experiences a fever over 101 F (38.3 C) with symptoms of vomiting, lethargy or diarrhea, it's important to seek medical care to rule out anything more serious.

Your child will begin losing their primary teeth around the age of 6. The first to be lost are usually the central incisors. The permanent teeth follow closely afterward and do not often give children any great discomfort. However, eruption of the six-year molars may trigger headaches and ear or jaw pain for a few days.17

Wisdom teeth are a third set of molars erupting in the back of the mouth, usually between the ages of 17 and 25.18  Many people have them removed if they are impacted (do not come in normally, being trapped in the jaw bone or gums), come in at the wrong angle or if your mouth isn't big enough to accommodate the extra set of molars.19

Steer Clear of Toxic Teethers

Teething rings and toys are an effective means of helping babies manage swollen gums and discomfort. However, many include bisphenol-A (BPA), a chemical associated with significant long-term health hazards. Early exposure to BPA have a greater potential for impacting your child's neurological, digestive and immune systems.

In a study20 published in the Journal of the American Chemical Society, researchers found endocrine-disrupting chemicals like BPA leach from plastic products. As a result of this study,21 the European Union restricted BPA in baby bottles, followed by the U.S. restricting use in baby bottles and sippy cups.

However, BPA continues to be used in children's toys and teething products. Kurunthachalam Kannan, Ph.D., scientist at the New York State Department of Health and author of the study, finds recent studies suggest just a nanogram may be harmful, commenting:22

"Putting this cocktail of chemicals, even in low amounts, during critical stages of development of many organs, can have an effect in many stages of life. That's why we're concerned about it — the early-life exposure and epigenetic changes that results from the EDC's [endocrine-disrupting chemicals] can contribute to some of the disease and development of some of these diseases later in life. We should have policies limiting exposure."

BPA, and common replacement chemicals such as bisphenol-S and bisphenol-F, are known to disrupt your endocrine system, which produces and secretes hormones affecting almost every cell, organ and function in your body. Hormones are instrumental in regulating mood, growth and development, tissue function, and metabolism. BPA has been linked to a number of health concerns, particularly in pregnant women, fetuses and young children, including:

Hyperactivity, increased aggressiveness and impaired learning23

Changes in gender-specific behavior and abnormal sexual behavior

Increased fat formation and risk of obesity and diabetes24

Early puberty, stimulation of mammary gland development, disrupted reproductive cycles, ovarian dysfunction and infertility25

Increased prostate size and decreased sperm production26

Stimulation of prostate cancer cells27

Breast cancer28

Increased risk of high blood pressure and heart disease29

Reduced efficacy of chemotherapy treatment30

Structural damage to your brain

Altered immune function31

Preterm birth32

Natural Teething Options Are Effective

In a clinical trial33 with 270 children aged 8 to 36 months, researchers concluded low birth weight children may suffer more teething symptoms, and that teething rings, cuddle therapy and rubbing the baby's gums were the most effective methods to reduce symptoms.

A safe alternative to plastic teething rings is to dampen a clean washcloth made of organic materials and place it in the fridge or freezer. Once cooled, your baby can safely chew on this under supervision. You may also consider opting for organic cloth teething toys dyed with vegetable or metal-free dyes. These too can be dampened and refrigerated.

Another option is using teething toys made from 100 percent natural rubber.34 A drawback is that many rubber products contain latex, and chronic exposure may lead to a latex protein allergy.35 This allergy may become serious, and in some instances fatal. Those who become allergic to latex may exhibit local or generalized symptoms.

Generalized symptoms include itching, stuffy or runny nose, asthma-type symptoms, or hives usually beginning within minutes after exposure. Localized contact dermatitis results a rash and blisters resembling a poison ivy rash beginning one to three days after exposure.

If you're looking for a cold option to help reduce pain and inflammation of swollen gums, consider a breast milk freezer pop.36 Also called a momsicle, these frozen treats are filled with breast milk or formula. Store bought versions such as Popsicles contain sugar and additives dangerous to your child's health. Frozen breast milk or formula helps to soothe baby's gums.

You may have to hold the momsicle until your baby has the coordination to hold it themselves. Another option is to freeze breastmilk in an ice cube tray filled halfway up. The frozen cube can then be placed in a mesh teething feeder.37 The teething feeder is cold to soothe the gums and releases breast milk as the cube melts. As your baby begins eating solid food, consider adding a little pureed banana, avocado or applesauce to the breast milk.