Teething gels and remedies: what US regulators warn is unsafe

The teething remedies most likely to be handed to a distressed baby — numbing gels and homeopathic tablets — are the ones US regulators single out as risky, and the harms they warn about include a rare blood disorder, seizures and death, against little proven benefit for teething [s1]. The Food and Drug Administration's guidance is that topical medications containing benzocaine or lidocaine "offer little to no benefit and are associated with serious risks" in children, and its recommended alternatives are not products at all but a clean finger or a firm rubber teething ring [s1].

What the regulator flags, and why

Benzocaine is the numbing agent in several non-prescription oral products the FDA names directly — among them Anbesol, Cepacol, Chloraseptic, HurriCaine, Orabase, Orajel and Topex — and the agency says these "should not be used for teething pain in children because they can be dangerous" [s1]. The specific danger is methemoglobinemia, a condition in which the oxygen-carrying capacity of red blood cells is greatly reduced; the FDA describes it as serious and sometimes fatal [s1]. Prescription viscous lidocaine, sometimes reached for as a stronger alternative, carries a separate warning: the FDA says it can cause "heart problems, severe brain injury and even death," and can trigger seizures in infants when too much is applied or it is accidentally swallowed [s1].

The caution extends beyond drugs. The FDA says it has received reports of death and serious injuries to infants and children — including strangulation and choking — caused by teething jewellery such as amber necklaces [s1]. The mechanism there is mechanical, not chemical: a cord that can catch, and beads that can come loose and be inhaled.

The gap between the warning and the shelf

None of this is new to regulators — the FDA first warned against benzocaine for infant teething in 2011 — but the products stayed within easy reach, and so did the habit of recommending them [s2]. A 2018 survey of 200 community pharmacists in the San Francisco Bay area, with a 94.3% response rate, asked what they would suggest for infant teething [s2]. Half (50.5%) said they would offer a non-drug option first, but a clear majority, 63.0%, would nonetheless go on to recommend a benzocaine-containing product — the exact class the FDA had cautioned against [s2]. The authors concluded that "despite warnings, the majority of pharmacists would still inappropriately recommend a benzocaine-containing product," and called for more education [s2]. If the professionals a parent asks are still pointing at the gel, the label warning alone is clearly not reaching the point of sale.

What teething actually needs

The reason the risk-benefit maths falls the way it does is that teething is a mild, self-limited process. Erupting teeth bring sore gums, drooling and fussiness rather than the kind of pain a potent anaesthetic is designed for, and — as covered separately — teething does not cause a true fever, so a genuinely feverish baby is a reason to look for an illness, not to reach for a teething product. Against symptoms that modest, a numbing agent that can rarely cause a fatal blood disorder is a poor trade, which is why the FDA's own advice is low-tech: gently rub or massage the gums with a finger, or give a firm, non-liquid-filled rubber teether, kept out of the freezer because an object that is too hard can hurt the gums, and with the child supervised so the teether itself is not a choking hazard [s1].

How to read this

This is a piece about avoiding harm rather than a treatment guide. The consistent thread in the regulator's guidance is that the marketed teething remedies — benzocaine and lidocaine gels, homeopathic tablets, and jewellery worn against the skin — carry documented and occasionally fatal risks while doing little for a self-limited problem [s1]. That a majority of surveyed pharmacists would still recommend one of them is a measure of how durable the habit is, not of the evidence behind it [s2]. This article is informational and not medical advice; questions about a specific product or an unwell child belong with a clinician or pharmacist, and suspected harms from a medicine can be reported to the relevant regulator.