Home' News Bulletin : ADA News Bulletin July 2015 Contents 36
Teething and its
There are few sounds more heart-rending than the cry of an
inconsolable baby. It’s a siren call for many a parent to come to
their baby’s aid and DO something to soothe their discomfort.
How frustrating and exhausting it is when the baby won’t be
soothed and can’t tell you why they’re upset! No wonder the
convenient diagnosis of “teething” remains so popular to explain
away miserable babies aged between six months to three years.
I know dental professionals are well aware that teething is an
unlikely diagnosis for anything other than erupting teeth, but this
is poorly understood in the community and the misunderstanding
contributes to delayed and inappropriate diagnosis of many sick
infants and children, while exposing them to ineffective and
sometimes toxic treatments.
I also regularly receive enquiries on the Pharma-Advice Line from
young dentists with teething infants of their own, who wish
to know more about currently available treatments so they can
answer the teething questions they’re hammered with from
parents at play-groups and day care.
Our primary challenge is to educate consumers and other health
professionals that teething may cause local discomfort but is
an unlikely cause of systemic symptoms. Evidence suggests that
erupting teeth may legitimately be accompanied by symptoms
such as drooling, biting/mouthing, gum rubbing, irritability and
a low grade fever.
However, symptoms such as loss of appetite,
difficulty sleeping, cough, rash, diarrhoea, high fevers, vomiting
and even seizures should be more appropriately diagnosed.2 -6
For legitimate teething discomfort, textured and cold teething rings
are very useful. The cold temperature of the object causes localised
vasoconstriction, which decreases inflammation and biting on the
object gives further relief by applying pressure to the gums.
Conservative use of analgesic/antipyretic medicines such as
paracetamol and ibuprofen is reasonable in the management of
teething discomfort as long as systemic symptoms are not being
masked. We must ensure that analgesics are not used for longer
than three days without medical supervision, and that the child is
being dosed by weight rather than age, (use average weight for
age) and maximum daily doses not exceeded.
not-so reasonaBle treatMent
Few teething remedies are as famous as ‘Bonjela’ and ‘SM33’ gel,
yet there is no evidence that they actually work and may actually
be harmful. The active ingredient in Bonjela is choline salicylate,
and in SM33 it’s salicylic acid and lignocaine. At first glance, these
gels look pretty tame but there are published case reports of
infants who have been hospitalised due to salicylate toxicity from
over-enthusiastic application by parents who believed them to
Excessive use of salicylate teething gel has also been
associated with Reye’s syndrome in children.8 In the UK, teething
gels for children have had the salicylate removed and replaced
with lignocaine and the adult salicylate-based gels carry warnings
they are not to be used in children younger than 16 years.
Unfortunately, no such warnings have been mandated in Australia.
Local anaesthetic gels are also available for teething, generally
based on lignocaine. Some dental professionals also recommend
compounded or imported products containing up to 20%
At-home use of topical local anaesthetics in infants is a dangerous
practice since it is difficult to determine the amount the infant
ingests. Swallowing can numb oropharyngeal mucous membranes,
impairing the gag reflex and increasing the risk of choking or
aspiration. Significant absorption of lignocaine can also cause
cardiac rhythm disturbances and seizures. Benzocaine use is
discouraged due to the risk of methaemoglobinaemia which can
occur within minutes of exposure, even the first time it is used. It
is not very common, but infants appears to be more at risk. This
issue was the subject of an FDA alert in 2011.9
In 2014, the FDA reviewed 22 case reports of serious adverse
reactions including deaths, in infants and young children aged 5
months to 3.5 years who were given 2% viscous lignocaine (”Viscous
Xylocaine”) for the treatment of mouth pain, including teething and
stomatitis, or who had accidental ingestions. Subsequently the FDA
made a statement warning that viscous lignocaine 2% and topical
local anaesthetic gels should not be used to treat infants and children
with teething pain, and have added a boxed warning to this effect.
hoMoeopathic taBlets and gels
Hopefully you know that true homoeopathic products are
based on poisons infinitesimally diluted. In my experience most
consumers don’t know what homoeopathy is and think it means
either “natural” or “home-made”. Once the basis of homoeopathy
is explained, I find many are no longer so enamoured.
Don’t make the mistake of dismissing homoeopathic remedies
as dilute placebos though. One popular brand has been subject
to a recall where the belladonna content of their teething
tablets greatly exceeded that which it claimed and some babies
Secondly, this brand’s homoeopathic
teething tablets are little lumps of lactose onto which the
homoeopathic liquid has been poured. Not only would these
tablets pose a caries risk, but they are a choking hazard as well.
All I’m going to say about amber beads for teething (so obviously
a choking hazard!) is that one of my university-based pharmacy
colleagues had a string of amber beads tested for the succinic
acid which is supposed to convey the analgesic effect.
12 None was
detected. Need I say more?
References supplied are available on request from firstname.lastname@example.org
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