Although newborns usually have no visible teeth, baby teeth begin to appear generally about 6 months after birth. During the first few years, all 20 baby teeth will push through the gums, and most children will have their full set of these teeth in place by age 3.

An infant's front four teeth usually appear first, at about 6 months of age, although some children don't get their first tooth until 12 or 14 months. As their teeth break through the gums, some infants become fussy, sleepless, and irritable; lose their appetite; or drool more than usual. If an infant has a fever or diarrhea while teething or continues to be cranky and uncomfortable, contact your baby's health care provider.

The FDA does not recommend gum-numbing medications with an ingredient called benzocaine because they can cause a potentially fatal condition in young children. Talk to your health care provider for advice on using these products for your teething infant. Other potential forms of relief for your infant include a chilled teething ring or gently rubbing the child's gums with a clean finger.

Teething is normal but may be a painful experience for infants and toddlers. Too often, well-meaning parents and caregivers who want to ease a child’s pain turn to medications and products that could be harmful.

Soothing children’s gums with prescription or over-the-counter (OTC) drugs, homeopathic drugs, or teething jewelry marketed for relieving teething pain may seem like good options. But those products can be dangerous and can lead to serious injury or even death. This also applies to older children with special needs who may use teething jewelry for sensory stimulation.

The American Academy of Pediatrics (AAP) recommends alternative ways for treating teething pain, including rubbing infants’ gums with a clean finger or providing a teething ring made of firm rubber to chew on. For children with sensory stimulation needs, parents and caregivers should talk to their child’s health care provider about safer options.

On average, children begin teething around 4 to 7 months, and have a total of 20 “baby teeth” by age 3. According to the AAP, occasional symptoms of teething include mild irritability, a low-level fever, drooling, and an urge to chew something hard.

Teething jewelry includes necklaces, bracelets, and other jewelry worn by either an adult or child, used by parents and caregivers, and is marketed to relieve an infant’s teething pain. It may also be marketed for use by people with special needs, such as autism or attention deficit hyperactivity disorder, to provide sensory stimulation or redirect chewing on clothes or body parts.

The beads of the jewelry may be made with various materials such as amber, wood, marble, or silicone. Jewelry marketed for teething is not the same as teething rings or teethers, which are made of hard plastic or rubber and not wearable by an adult or child.

There are serious risks associated with using jewelry marketed for relieving teething pain such as choking, strangulation, injury to the mouth, and infection. Other concerns include potential injury to the mouth or infection if a piece of the jewelry irritates or pierces the child’s gums.

Parents and caregivers might also look to relieve a teething baby by rubbing numbing medications on the child’s gums. But the U.S. Food and Drug Administration (FDA) warns against using any sort of topical medication to treat teething pain in children, including prescription or OTC creams and gels, or homeopathic teething tablets. They offer little to no benefit and are associated with serious risk.

Benzocaine — a local anesthetic — is the active ingredient in several OTC oral health care products such as Anbesol, Baby Orajel, Cepacol, Chloraseptic, Hurricaine, Orabase, Orajel, and Topex. These products should not be used for teething because they can be dangerous and are not useful because they wash out of a baby’s mouth within minutes.

The use of benzocaine gels, sprays, ointments, solutions, and lozenges for mouth and gum pain can lead to a serious — and sometimes fatal — condition called methemoglobinemia, in which the oxygen-carrying capacity of red blood cells is greatly reduced.

Prescription and OTC benzocaine oral health care drug products are also widely used in adults. Doctors and dentists often use sprays containing benzocaine to numb the mucous membranes of the mouth and throat or to suppress the gag reflex during medical and surgical procedures, such as transesophageal echocardiograms, endoscopy, intubation, and feeding tube replacements. But benzocaine sprays are not FDA-approved for these uses.

Talk to your health care professional about using benzocaine and other local anesthetics, especially if you have heart disease; are elderly; are a smoker; or have breathing problems such as asthma, bronchitis, or emphysema. Those conditions put you at greater risk for complications relating to methemoglobinemia.

When a baby is teething, many a mom or dad reaches for a pain remedy containing benzocaine to help soothe sore gums. Benzocaine is a local anesthetic and can be found in such over-the-counter (OTC) products as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase.

But the use of benzocaine gels and liquids for mouth and gum pain can lead to a rare but serious—and sometimes fatal—condition called methemoglobinemia, a disorder in which the amount of oxygen carried through the blood stream is greatly reduced. In the most severe cases, says FDA pharmacist Mary Ghods, R.Ph., methemoglobinemia can result in death.

And children under 2 years old appear to be at particular risk.

Since the Food and Drug Administration (FDA) first warned about potential dangers in 2006, the agency has received 29 reports of benzocaine gel-related cases of methemoglobinemia. Nineteen of those cases occurred in children, and 15 of the 19 cases occurred in children under 2 years of age, says FDA pharmacist Kellie Taylor, Pharm.D., MPH.

The agency repeated the warning in April 2011 and remains particularly concerned about the use of OTC benzocaine products in children for relief of pain from teething, says Taylor. This concern is fueled by the serious potential outcomes and the difficulty parents may have recognizing the signs and symptoms of methemoglobinemia when using these products at home. These symptoms may not always be evident or attributed to the condition.

For these reasons, FDA recommends that parents and caregivers not use benzocaine products for children younger than 2 years, except under the advice and supervision of a health care professional.

Danger Signs

Symptoms of methemoglobinemia include:

• pale, gray, or blue-colored skin, lips and nail beds
• shortness of breath
• fatigue
• confusion
• headache
• light-headedness
• rapid heart rate

“Symptoms can occur within minutes to hours after benzocaine use,” Ghods says. “They can occur after using the drug for the first time, as well as after several uses.”

If your child has any of these symptoms after using benzocaine, she adds, stop using the product and seek medical help immediately by calling 911.

Methemoglobinemia caused by benzocaine may require treatment with medications and admission to a hospital. Serious cases should be treated right away. If left untreated or if treatment is delayed, methemoglobinemia may cause permanent injury to the brain and body tissues, and even death, from the insufficient amount of oxygen in the blood.

Teething: What’s a Parent to Do?

As for the crying baby, what’s a mom or dad to do? The American Academy of Pediatrics offers some alternatives for treating teething pain:

• Give the child a teething ring chilled in the refrigerator.
• Gently rub or massage the child’s gums with your finger.

If these remedies don’t provide relief, contact your health care professional for advice on other treatments.

Adults Can Be Affected Too

Benzocaine products—which are sold as gels, liquids, sprays and lozenges—are also widely used by adults. Doctors and dentists often use sprays containing benzocaine to numb the mucous membranes of the mouth and throat during such procedures as transesophageal echocardiograms, endoscopy, intubation, and feeding tube replacements.

Even though children are more at risk, it’s still a good idea to talk to your health care professional about using benzocaine, especially if you have heart disease; are a smoker; or have breathing problems such as asthma, bronchitis or emphysema. These conditions put you at greater risk for complications relating to methemoglobinemia, says Taylor.

FDA advises consumers to:

• store any products containing benzocaine out of the reach of children.
• use benzocaine gels and liquids sparingly and only when needed. Do not use them more than 4 times a day.
• read the label to see if benzocaine is an active ingredient when buying OTC products. Labels on OTC products containing benzocaine are not currently required to carry warnings about the risk of methemoglobinemia. If you have any concerns, talk to your health care professional before using them.

If your child’s gums are swollen and tender, gently rub or massage the gums with your finger, or give your child a teething ring made of firm rubber to chew. Make sure the teething ring is not frozen. If the object is too hard, it can hurt your child’s gums. Parents should supervise their children so they don’t accidentally choke on the teething ring.

Parents and caregivers of children with special needs who may require sensory stimulation should talk to their child’s health care provider about safer options and treatment. Jewelry marketed for relieving teething pain and to provide sensory stimulation can lead to serious injuries, including strangulation and choking.

The FDA continues to closely monitor the use of teething jewelry and other teething pain relief products and is evaluating whether other actions are necessary to address the risks associated with these products, as part of its commitment to protecting public health – especially when it comes to the health and safety of children.

Consumers and health care professionals should notify the FDA of any adverse side effects when using drugs and devices the agency regulates, by reporting them online to MedWatch, the FDA’s safety information and adverse event reporting program, or by telephone at 1-800-FDA-1088.

It is exciting to see your baby’s first tooth! Baby (primary) teeth begin to come in when your child is about 6 to 10 months old. For some babies, teething hurts. As teeth come in, babies might be cranky or drool more. They might have sore or swollen gums. And they may chew on things.

Tips for helping your baby with teething pain:

• Check your child’s teeth and mouth.
• Rub your baby’s gums with a clean finger. The rubbing may make your baby’s gums feel better.
• Find teething toys that have solid pieces. Loose pieces can break off and make your baby choke.
• It is best not to use teething toys that have liquid in them. Your baby could chew a hole into them.
• Don’t put any teething toys or necklaces around your baby’s neck. And don’t pin or clip them to your baby’s clothes. The toy could get tangled around your baby’s neck and make her choke.
• Give your baby something cool to chew on. Clean, refrigerated spoons, pacifiers, teething rings, and wet washcloths are good choices. Don’t put teething rings in the freezer. That makes them too cold for your baby’s mouth.
• With your baby seated in a high chair, offer a chunk of frozen banana or plain bagel to chew on. Give your baby the whole piece of food. Don’t cut it into small pieces. Keep an eye on your baby when she eats in case she chokes.
• Don’t use teething gels or liquids on your baby’s gums. They are not safe.

Baby (primary) teeth are a child’s first set of teeth. A baby’s teeth start to come in at 6 to 10 months, and by the time a child is 2½ to 3 years old, all 20 baby teeth will have come into the mouth. Taking care of a child’s baby teeth is important for the child’s overall health and development.

Baby teeth are important for children to:

• Chew and eat foods. Children need to eat healthy foods every day to grow and be strong. Children with tooth decay are less likely to eat crunchy foods, such as fresh fruits and vegetables. Being able to eat these foods promotes good nutrition and a healthy weight.
• Speak clearly. Children who lose baby teeth too early may have trouble making certain sounds. This can make it hard to understand the child. A child may need speech therapy to improve speech problems that may develop because of missing teeth.
• Keep space for adult teeth. Baby teeth hold space for adult teeth growing in the jaw. If a baby tooth is lost too early, other teeth that are already in the mouth will move into the space. It can block out the adult tooth trying to come in and cause crowding. The upper and lower jaws may not meet properly because of the crooked teeth.
• Stay healthy. Tooth decay in baby teeth can lead to infections that can cause fever and pain. If not treated, the infection from tooth decay can spread to other parts of the head and neck and lead to severe swelling.
• Have self-confidence. Children with decayed front teeth tend to not smile or may cover their mouth when talking. Sometimes they stop playing with other children. A healthy smile helps give children the self-confidence needed to have good social experiences.