Treating the Toothache

Teething, like many other things “baby” has so many different suggested treatments that it can get really confusing. Are you currently struggling with a teething monster? Read my previous post to understand more of what is going on in your little one’s mouth. Do you want to know what is really worth your money and time? What is safe for baby? What really works?? I will try to answer these questions by looking at the most used treatments in more detail. If you are short of time skip down to the end to see my tips to calm your teething baby and to keep those teeth white and bright!

As I read about the history of teething, I was horrified at some of the treatments that were used in the past! Substances containing lead and mercury, opioids that caused babies to stop breathing, rubbing of alcohol on the gums (this is from the not too distant past) and even cutting into the gums to ‘relieve the pressure’ were common managements and caused more harm than good. I am wondering what our children’s children will think about the treatments we are using today…

So which medical treatments are available?

Teething gels / drops:

There are two broad groups of gels or drops that causes local pain relief:

  • Local anaesthetic (contains either benzocaine or lidocaine)

These gels / drops (Orajel, Prodol) causes numbing of the gums and tongue only for a short time (about 20 minutes) and although this could bring some relief for the irritation of the gums it may also cause more irritation for your baby. Have you ever had your gums numbed by a dentist? It is not a nice feeling. Some of these drops have a stronger alcohol-content than your glass of wine! Apart from that there is also a risk for a very serious side effect: methemoglobinaemia prevents the red blood cells from carrying any oxygen. The FDA and American Association of Pediatrics has strongly advised against the use of these gels and drops in babies.

  • Local analgesic or homeopathic gels

Some of these gels (Bonjela, Teejel) contain aspirin-like analgesics (choline salicylate) which could cause chemical burns on the gums or even add to the risk factors of Reye syndrome. Homeopathic gels could contain unknown amounts of Belladonna which could also cause severe side effects.

My conclusion would be to know what is in the gel you are using, know the possible side effects, weigh the risk vs benefit for your baby and then only use VERY SPARINGLY.

Systemic analgesia

These are safe to use at the specified dose and intervals, for not more than 5-7 days at a time. Remember that they can affect the liver and kidneys if misused, so only give when it is really necessary. Please consult your doctor or pharmacist about the correct dose for your little one as it should be calculated by weight and thus differs for different children of the same age.

  • Paracetamol (Panado, Calpol): for moderate pain and rise in body temperature
  • Ibuprufen (Nurofen): for inflammatory pain and rise in body temperature
  • Mefenamic acid (Ponstel): for inflammatory pain and rise in body temperature

As you can see all these medications treat roughly the same symptoms, so it works well to use paracetamol with either ibuprufen or mefenamic acid as you can then give analgesia more frequently while giving less of each individual drug. (Eg Paracetamol at 8am, Ibuprufen at 12pm, Paracetamol at 4pm, Ibuprufen at 8pm.) Be careful of combination preparations as you cannot work out the dose of each individual drug perfectly, and it usually contains some form of anti-histamine which is not safe to give to babies under 2years as it can have a lot of side effects.

So what should you do???,

“We have to do the best we can. This is our sacred human responsibility.”

Albert Einstein

A recent meta-analysis done in 8 different countries showed that there are some symptoms associated with teething, and yes, babies feel some discomfort and has a raise in their body temperature (NOT fever >38°C). However, when choosing what to give your baby, try to remember that teething is not a disease!

Instead of spending more money at the pharmacy, here are a few tips to try at home:

  • TLC: Tender, Loving Care. This works for anything from a broken heart to man-flu, it will definitely work for teething too. So amp up the cuddles and know that this will be over all too soon.
  • Chewing or rubbing the gums: let your baby chomp down on his favourite teether / sugar-free teething biscuit or massage his gums with a clean finger. This reduces the pain by overwhelming the pain-receptors in the gums, thus effectively blocking the pain-signal.
  • Cooling: we all know an icepack does wonders for a twisted ankle or a bump on your head. Giving your baby a cool washcloth or raw carrot to chew on also does wonders for irritated gums. Make some “breastmilk-ice lollies”, these are a huge hit for teething babes! The cold numbs the gums, and it also decreases the inflammation in the area.

“Weeping may endure for a night, but joy comes in the morning. “

Psalm 30:5 (AMPC)

The last teething-strategy I would like to address is the amber necklaces / bracelets. Although many moms have claimed that these worked for their babies, there is no scientific evidence to prove that they work better than the above-mentioned tips, and nobody can seem to prove exactly how they work. Add to that the big risk of choking or strangulation, and you can understand why the FDA and American Association of Pediatrics strongly advise parents to not use them. We all try to keep our babies away from plastic bags, peas and small toys exactly for this reason, so please do not attach something to their body that can end up in their airways!

When those little white pearls finally pop out, be sure to take good care of them from the start. We used a silicone brush that fits over our fingers from about 4months to get Eran used to the texture and feel of a toothbrush on his gums. Once the teeth are out brush twice a day with a soft-bristled toothbrush. In South Africa the water is supplemented with Fluoride, thus it is not necessary to use Fluoride containing toothpaste before 2yrs of age. While fluoride helps to protect the teeth against cavities, too much can cause spotting and weakening of the enamel of the permanent teeth. When you do start using fluoride-containing toothpaste make sure to only use a pea-sized smear. Take your little one to the dentist around their first birthday to get more advice and tips to keep those teeth in tip-top shape.

I hope this will help you to have a happier teether! Please share any other tips you have in the comments below or via Instagram / Facebook, I love to hear the creative ways you keep your little teething monster happy!

  1. Massignan C, Cardoso M, Porporatti AL, Aydinoz S, Canto GD, Mezzomo LAM, Bolan M; Signs and Symptoms of Primary Tooth Eruption: A Meta-Analysis; Pediatrics March 2016, VOLUME 137 / ISSUE 3
  2. Memarpour M, Soltanimehr E, Eskandarian T; “Signs and symptoms associated with primary tooth eruption: a clinical trial of nonpharmacological remedies”; BMC Oral Health. 2015; 15: 88.
  3. https://sciencebasedmedicine.org/separating-fact-from-fiction-in-pediatric-medicine-infant-teething/
  4. Tshang AKL; “Teething, teething pain and teething remedies”INTERNATIONAL DENTISTRY SA VOL. 12, NO. 5 pg48-61

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