27 Sep 2012

In 2006 the FDA issued a warning about the use of Benzocaine containing products for the relief on minor tooth and gum pain in children under the age of 2. Benzocaine is the main ingredient in topical anesthetics in such over the counter products as Orajel and Anbesol among others which are popular for relieving teething pain. While very temporary pain relief can result from the use of these products when applied to the affected areas, Benzocaine has been linked to a rare condition call acquired methemoglobinemia. Children under the age of 2 appear to be at the most risk for this rare disorder. Methemoglobinemia is a blood disorder where hemoglobin, which carries oxygen to the tissues, is unable to release the oxygen molecule. Symptoms include grey/blue colored skin, lips and nail beds; headache; shortness of breath; and fatigue. In 2012 the FDA reissued the warning after 29 more cases were reported.

Clinically, I use Benzocaine on a limited basis to pre-numb an injection site. I carefully isolate the gel using a cotton roll or gauze pad to prevent it from spreading in the mouth. Use of this product on children under 2 is not used by me clinically since any treatment requiring its use under that age will be referred to my pediatric dentist to manage.

Alternatives to products containing Benzocaine to treat teething pain in children under 2 include cold teething rings. These are usually plastic with a liquid inside. I discouraging putting these in the freezer as the liquid can solidify and expand causing the plastic to crack and injure the child. Instead, I prefer they be placed in the refrigerator to cool and provide relief upon biting. A wet washcloth that has been frozen is also effective when chewed on by the child. While these are effective; I would like to make a recommendation as a personal more than professional recommendation. As a father of 3 boys, I have always had great success using the Hylands teething gel and tablet products. These homeopathic remedies contain Chamomile and other natural ingredients but no Benzocaine. The tablets dissolve under the tongue and provide a calming effect for the child. The get is applied directly on the affected area and provides relief as well as calming, with no numbing caused by chimicals. Since the products are natural, there is no Benzocaine so no adverse effects.

For more information:

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm306062.htm
http://www.hylands.com/products/teething.php

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