Teething Medicine May Cause Serious Reaction

What is benzocaine and what is it used to treat?

It is a pain reliever often used to numb mouth pain caused by teething in infants and toddlers, or from toothaches, braces, dentures, sore throat, or other mouth sores. Benzocaine products are also used to relieve pain associated with earaches, hemorrhoids, and skin disorders.

Is there a danger to using benzocaine?

The US Food and Drug Administration (FDA) issued a warning about a rare blood disorder caused by some over-the-counter (OTC) mouth sore or teething pain relievers. These pain relievers contain the drug benzocaine and are available as sprays, gels, creams, and liquids. The blood disorder is called methemoglobinemia (pronounced met-ˌhē-mə-ˌglō-bə-ˈnēmē-ə). The disorder prevents the blood from carrying oxygen to all parts of the body. People who develop the disorder may have difficulty breathing; feel tired or confused; have a headache and faster heartbeat; and their skin, lips, and nail beds may become pale, gray, or blue. These symptoms usually appear within minutes or hours after using the product.

What products contain benzocaine?

Examples include (listed by brand names): Americaine, Anbesol, Boil Ease, Cepacol Sore Throat, Cetacaine, Dermoplast, Exactacain, Hurricaine, Lanacane, Orabase with Benzocaine, Orajel, and Skeeter Stik. For a list of more OTC products that contain benzocaine, click here. Labels on these OTC products currently do not contain warnings about the possibility of developing this blood disorder.

Brand Name	Benzocaine Content
Anbesol Baby	7.5%
Anbesol Jr.	10%
Anbesol Regular Strength	10%
Baby Orajel	7.5%
Baby Orajel Nighttime	10%
Hurricaine	20%
Orabase	20%
Orajel Maximum Strength	20%

Who should use benzocaine?

The warning issued by the FDA states that products containing benzocaine, such as Anbesol and Orajel, should no longer be used for children under the age of 2, except under the advice and supervision of a doctor. For older children and adults, directions on the package label should be closely followed. The FDA will continue to evaluate the safety of benzocaine products and update the public as needed. For safer alternatives to relieve teething pain in children younger than 2 and general safety when using benzocaine products, see the next Question and Answer.

What are some general safety strategies I can use when using benzocaine containing products?

Follow these recommendations to reduce the risk of developing methemoglobinemia, a rare blood disorder, when using products containing benzocaine.

Do not use products that contain benzocaine in children less than 2 years old. Instead try these options:

Massage your baby's gums. Use a clean finger, moist gauze pad, or damp washcloth.
Offer a teething ring. Chill a non-toxic rubber, silicone, or silver teething ring that is solid or filled with water. Avoid embedded objects in the teething ring and do not freeze.
Dry the drool. Wipe away excessive drooling to prevent irritation.
Try other OTC pain relievers. Ibuprofen (Motrin, Advil) can help reduce teething discomfort; choose the correct dose according to the baby's weight and doctor's instructions.

Store products out of reach of children. Benzocaine products as well as all medicines and vitamins should be stored out of reach of children.

Follow directions on the package. Use the products according to the instructions written on the label. For gels and sprays, use sparingly and only when needed. Do not use benzocaine products more than four times a day.

Watch for signs and symptoms, which can occur within minutes to hours of using these products. Know the signs and symptoms of methemoglobinemia. These include: