Can My Baby Use Orajel for Teething Pain?

Orajel is a topical numbing agent that’s uses range from relieving pain from canker sores, tooth and gum pain, as well as for cold sores.  The active ingredient in Orajel is 20% Benzocaine which is a topical local anesthetic (pain reliever).  Some formulations also contain Menthol which is obtained from mint oils.  Menthol increases blood flow to the area and provides at cooling sensation. 

Benzocaine has been used for decades to relieve oral pain temporarily.  Dentists most commonly use it to place on their patient’s oral tissue prior to an injection of numbing medicine.  How does it work?  Pain is caused by stimulation of specific types of nerve endings.  Benzocaine stops the nerve from being stimulated temporarily by blocking the uptake of the molecule that stimulates the nerve.

Like any drug, we must be aware of its potential side effects, especially when we are talking about young children.  It is generally safe and non-toxic when applied topically.  So, what’s the problem?

Benzocaine has been associated with an uncommon, but serious condition called Methemoglobinemia (pronounced Met–hemo– globe-in-emia).  I found out it was one of my husband’s pet peeves when it is called METH-hemoglobinemia.  To avoid a lengthy and yawn-inducing discussion over its chemical formula, and why it is called METhemoglobinemia, I am stressing its pronunciation.  Please!  Not again!

I will try to keep my “sciency stuff” to a minimum.  Bear with me.  Let me start with explaining what hemoglobin is.  Hemoglobin is the oxygen carrying molecule in red blood cells.  It delivers oxygen to the tissues in the body.  The oxygen bond with hemoglobin is not strong.  Some may say, it’s down-right weak!  It sounds terrible, but it is actually a great thing.  The weak bond of hemoglobin is what allows oxygen to be released to the oxygen-depleted tissues.  Methemoglobin is a different chemical formula of a hemoglobin molecule that binds strongly to oxygen, thus not allowing for its release to the body.  When this occurs, the body is unable to function well due to the decreased oxygen availability.

What is methemoglobinemia?  When benzocaine is applied to the tissue and is absorbed into the blood stream, it can convert normal hemoglobin to methemoglobin and cause an oxygen depletion.  It has been found to be severe, especially in children ages 2 and younger.  Unfortunately, this age group most often suffers from teething discomfort.

What are the symptoms of methemoglobinemia?  Pale, gray, or blue skin color, shortness of breath, fatigue, headache or lightheadedness, and rapid heart rate.  These symptoms can occur in minutes to hours after Benzocaine’s application.

What is the treatment to reverse methemoglobinemia? The child would be placed on oxygen and given a substance called methylene blue through an IV.  The improvement is typically rapid.

Methemoglobinemia is well known by the Orajel company, so they have come out with a children’s version without Benzocaine.  In fact, they have two kinds: daytime and nighttime teething gel.  It is called Orajel Non-medicated Cooling gels for Teething.  The active ingredient in the daytime gel is Simethicone.  It is commonly used to relieve colic in babies.  Simethicone drops allows for smaller gas bubbles to come together in the stomach and become one big bubble to aid in the baby burping.  I have been unable to find how it aids in relieving teething pain.  The nighttime active ingredient is chamomile in addition to the simethicone.

I love a good cup of tea and chamomile is one of my favorites, but I also have the unfortunate quality of being a skeptic when it comes to homeopathic remedies.  Some research out of the University of Michigan supports the use of crushed chamomile tablets mixed with water and given in a dropper to your child can relieve diarrhea associated with teething.  Many herbalists suggest that chamomile has anti-inflammatory and calming properties to alleviate teething pain, but currently there is not enough research I have found to prove or disprove this theory.  The bottom line is, chamomile has not been found to be harmful for children.  One way that it can be used is by making a cup of chamomile tea, dipping a corner of a washcloth in the tea then freezing it for your child to chew on.  The rule of thumb with anything is “Everything in Moderation.”

References:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-reports-rare-serious-and-potentially-fatal-adverse-effect-use-over

http://www.med.umich.edu/yourchild/topics/paininf.htm