Teething is a normal part of childhood and should not be treated with homeopathic remedies, like teething tablets, or prescription or over-the-counter (OTC) medications that are rubbed on the gums.

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 are not useful for treating sore gums due to teething because they wash out of a baby’s mouth within minutes. What’s more, they can be dangerous.

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.

That’s why the U.S. Food and Drug Administration (FDA) is warning parents and caregivers that benzocaine products should not be used to treat teething pain in infants or children.

What You Can Do for Teething Children

On average, children begin teething around 4 to 7 months, and have a total of 20 “baby teeth” by age 3.

According to the American Academy of Pediatrics (AAP), occasional symptoms of teething include mild irritability, a low-level fever, drooling, and an urge to chew on something hard.

Because teething happens during a time of much change in a baby’s life, it is often wrongly blamed for congestion, coughing, vomiting, diarrhea, and sleep disturbances.

If your child’s gums are swollen and tender:

• gently rub or massage the gums with your finger
• give your child a teething ring made of firm rubber to chew on

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.

Avoid Teething Creams and Gels

As a parent, grandparent or caregiver, you may look to soothe a teething baby by rubbing numbing medications on the child’s gums. However, the FDA warns against using any sort of topical medication to treat teething pain in children, including OTC creams and gels, as well as using homeopathic teething tablets. They offer little to no benefit and are associated with serious risk. Methemoglobinemia can occur when using any local anesthetic.

Adults Can Be Affected Too

OTC benzocaine oral health care drug products are also widely used by 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. However, 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.