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If you’re looking for baby teething gels at the pharmacy, you may be surprised by what you find—and don’t find—in stock. Orajel, Little Teethers, Anbesol and other popular infant teething gels that contain the anesthetic benzocaine have quietly been pulled from store shelves in Canada.
The concern with the products is a rare but serious condition called methemoglobinemia, which results in low oxygen levels in the blood. In 2013, Health Canada told the companies that make teething gels with benzocaine to include label warnings about the risks of methemoglobinemia.
In the U.S., these products were banned outright for children under two by the Food and Drug Administration, back in May 2018.
But so far, there hasn’t been an official recall in Canada, and Health Canada won’t say why the whole class of products seems to have disappeared from stores. The manufacturers that we spoke to would only confirm they were no longer for sale in Canada.
“It’s a good thing that these products have been withdrawn from the marketplace,” says Nardine Nakhla, a pharmacist who teaches about over-the-counter medications at the University of Waterloo. “All the evidence suggests that there is no need for a gum-numbing agent, especially in light of the fact that there are significant safety concerns.”
She worries, however, that because there has been no information released to the public, parents may now inadvertently choose the more potent, and more dangerous, adult versions of these products. The adult gels—marketed for things like canker sores—contain as much as 20 percent benzocaine.
Also confusing is the fact that Orajel now has homeopathic versions, called Baby Orajel Natural Source, which contain alcohol, another ingredient that paediatricians warn against for young children.
Across the board, experts recommend against any kind of teething gel—including homeopathic ones, due to choking risks and possible allergic reactions—and suggest other pain relief methods instead.
Mike Dickinson, a paediatrician in Miramichi, N.B, says parents often assume putting a product on the gums would be safer than making a baby swallow medication like acetaminophen (Tylenol). “But this is just not true,” he explains.
He says that teething generally doesn’t cause kids a lot of long-term difficulty, but he knows it can be a big source of worry—and sleeplessness—for parents, especially if their baby is too fussy to sleep well when a new tooth is popping through.
Instead of using teething gels, he suggests rubbing your baby’s gums with a clean finger, offering a rubber teething ring or baby chew toy, using a cool or wet facecloth, or if needed, giving a dose of acetaminophen for babies under six months. (If your baby is older than six months, ibuprofen is also a safe option.)
Amber teething necklaces are also not recommended.
Teething isn’t a fun phase of babyhood, that’s for sure. And with 20 teeth coming in before your kid’s third birthday, it’s more like a near-constant event for young children.
But it’s not a serious health issue, says Dickinson. Parents shouldn’t reach for the still-available adult versions, because these formulations really could lead to a bad outcome in infants.
Michelle Ward is a paediatrician, associate professor and journalist in Ottawa.