Is Orajel Safe for Babies?

There has been a rumor circulating on the web about Orajel safety, one with dire warnings serious enough to buy itself a page on Snopes.com. Some believe that the letter itself — telling of a mother whose baby turned blue after being given Orajel — is a hoax or a simple urban legend. Many point out that they themselves have used Orajel safely. As it turns out, there is some truth behind the basis of the story, regardless of whether the incident in the letter truly happened.

To help moms and dads decide whether or not it’s safe to use Orajel and similar teething gels for their babies, I decided to do some research to uncover the facts behind warnings about Orajel and benzocaine safety.

Read below about:

• Risks of Methemoglobinemia
• Danger of Choking
• Orajel Reviews
• Orajel Warnings
• My Bottom Line

What is Baby Orajel?

Quick summary: according to my research, the active ingredient in baby Orajel and Anbesol is benzocaine, a medication that numbs the area of application by blocking nerve signals to the brain. As an anesthetic, it’s used to ease pain, such as teething pain or sore throat. It is also used to numb the skin or surfaces during surgical procedures.

Benzocaine Side Effects

Although many parents cope with their baby’s teething pain by turning to more natural teething alternatives, the fact that Orajel is FDA approved makes it seem a viable option. Why not use medications for those times when baby’s pain seems unbearable, when we truly need relief, both for our baby and our own sanity?!

Like all things, Baby Orajel has a best case and worst case scenario, and for many parents the risks may not be worth the benefit.

Though teething medications such as Orajel and Anbesol have been approved for use, it’s important for us to remember that FDA approval (here in the U.S.) does not indicate a medication is without dangerous side effects. It simply means that these side effects are rare, or that the medication is safe for the majority of the population, despite a potential for negative reactions in some small minority.

WebMD, the leading online medical authority, itself states:

Many parents use other teething remedies, such as gels you put on a baby’s gums. Many experts question if these work and are safe. If you want to try these products, talk to your doctor about which types are safe and how often to use them. [Emphasis mine.]

• Methemoglobinemia

The fact of the matter is that benzocaine-based anesthetics like Baby Orajel and Anbesol have been linked to methemoglobinemia, a rare but life threatening condition also known as “blue baby syndrome.” No, you do not want your baby to have this reaction, and yes it could kill her.

In plain English, methemoglobinemia is a condition in which your blood stops carrying oxygen properly (remember, oxygen is the stuff we breathe: without it, we suffocate). Nitrates and topical anesthetics can cause your blood to produce too much metheglobin and not enough oxygen-binding hemoglobin. That’s what we don’t want.

Here’s the scientific version:

When hemoglobin becomes oxidized, it is converted to the ferric state (Fe³⁺) or methemoglobin. Methemoglobin lacks the electron that is needed to form a bond with oxygen and, thus, is incapable of oxygen transport. Because red blood cells are continuously exposed to various oxidant stresses, blood normally contains approximately 1% methemoglobin levels…

As methemoglobin levels increase, patients demonstrate evidence of cellular hypoxia. Death occurs when methemoglobin fractions approach 70%. Death can occur at lower levels in patients with significant comorbidities. — eMedicine, Medscape.com

Risks of methemoglobinemia are real, and the FDA has issued warnings regarding risks of methemoglobinemia in other applications of benzocaine, including its use for surgical procedures, cosmetic procedures, and its use during mammography and other medical testing.

The above video, while not related specifically to the use of teething gels, explains the risk of methemoglobinemia through benzocaine, the same medication used in Orajel and Anbesol.

• Decreased Gag Reflex

Because benzocaine is an anesthetic, it’s possible when using baby Orajel or Anbesol to unintentionally numb the areas of the mouth and throat that enable your baby’s gag reflex. The gag reflex is the signal your baby’s body sends when something is caught in his throat. As you know, when something’s caught in your throat, you immediately feel the desire to cough or sometimes even vomit. The goal is, essentially, to get the darned thing out of there toute suite!

Now, imagine if you had no gag reflex and something became caught in your throat. If you were a swift thinker, you might figure out something was inhibiting your ability to breathe, and the thing to do would be to intentionally start coughing and get that thing out of there, reflex or no! Babies, as you can imagine, just might not be that swift. Thus an impaired gag reflex could represent an increased danger of choking. This is true both while eating and while sleeping, especially when baby is producing an excess of saliva.

According to DrGreene.org:

Benzocaine teething gels are a mixed blessing. They do reduce pain, but they can also leave a baby’s mouth feeling as if he has just been to the dentist. Some babies are happy with the pain relief, but others object to the swollen, numb sensation as much as they do to the pain. Either way, the effect of these gels is very short-lived. And they do carry a small risk of allergic reactions and decreased gag reflexes.

Risk of Benzocaine Allergy

Benzocaine is a known immune system toxicant, as listed in the Skin Deep Database, capable of producing contact allergic reactions and dermatitis.

Dr. Ravel of DentalResource.org notes:

Benzocaine ointment may sensitize your baby to future benzocaine-related allergic reactions.

Though my knowledge of allergies is limited, I have always heard that if you have a history of allergies in your family it’s best to be cautious with known allergies. I can only imagine that this would be also be true of medications with known immuno-toxicity.

Does It Work?

The various risks involved with the use of Orajel must, of course, be considered in relation to the benefits.

I did locate several online reviews of Orajel, and many came up short:

Doesn’t work for more than 10 min and you can’t give it more than every 4 hrs. Worthless unless you need a minute to get baby to latch. — jhow32000 from the Mothering forums

You have a tired, cranky baby who is wailing in pain. You attempt to shove a Q tip or your finger in their mouth to “relieve” their pain. They wail louder. Chances are the poor thing is drooling, so the gel runs right back out of their mouth. Then they get a taste of the stuff. They wail even more. If you aren’t sure of why they are crying louder, taste the gel yourself. It is AWFUL.

So, you decide that once they are over the shock of the bad taste, the numbing relief will make things better. Wrong, again. Have you ever had your gums, tongue, or cheek numb? It is a terrible feeling. So the baby cries even more. - eclair20 from Epinions

When my 19 month old started cutting teeth I used Orajel and she would scream for hours after using it. At her 6 month well baby visit I mentioned it to the doctor, and he said to stop giving her the Orajel, she’s having a reaction to it. I immediately stopped giving it to her and I could deal with her better without the Orajel than with it. - Nannymom from the Mothering forums

[Edit: Two visitors to hippie dippie bébé have had negative, harrowing, emergency room experiences. They have graciously included their stories in my comments below; I include them here also for convenience:

NN Commented May 26th, 2009:

Our 13 month old, had to be transported w 911 to the ER, She had a one hour seizure in which time the Doctors couldn’t tell us whether or not that she would survive, she ended up spending 4 days in the hospital being checked from A to Z all without any results!, it hit like lightning out of the blue, no warning sign’s, one minute she was fine, next we where calling 911 / this is the first that I have heard of this today from another mom….. don’t know if it caused it, but I have used small amounts of both orajel and little teeters gel for a while (I tried this myself before applying it and only used a tiny bit to give her relief) If this in deed turns out to be the cause … throw the stuff away don’t even take a chance on a tiny weeny bit , we almost lost the love of lives .. it was a horrific experience !!

SherriMO, a registered nurse, shared her story on July 31st, 2009:

When my daughter was 18 months, she ingested oralgel and turned blue. I thought I was seeing things, since I am a nurse and was not familiar with this. I took her to the ER, still thinking I was seeing things, until I heard an ER nurse say, “oh my gosh, that baby is blue”. We were rushed to the childrens hospital placed in the ICU and given the antidote to oralgel. I have never seen anything like this, when they drew her blood it was brown. I am glad to say hours of getting the antidote, she improved and is now a healthy 6 year old! I wrote the FDA and oralgel- with no response. I just remember being so helpless, not knowing what caused her to turn blue, since the box said nothing about possible side effects! There should be clear labels on all teething gels, so parents can make informed decisions, about their child!

Sherri further clarified her feelings on the situation as a professional, in a later comment, on February 5th, 2010:

The FDA needs to have the manufacture indicate on their label the risk of Methemoglblinemia! I am an RN and I work for a pharma company and I just can’t figure out why this has not been placed on the box. When we give Cetacaine to patients we know that risk. It is made of the same compounds, so it only makes sense to inform the consumers. ]

Orajel Warnings

If you do decide to give Orajel a try, consider these warnings, which come from the various medical sources I’ve researched for this article. Of course, do not let this article or anything you find online substitute for the advice of your qualified medical practitioner! I am not a doctor, but I can read! Here’s what I’ve found:

• Never feed your baby or put her to sleep after administering Orajel or Anbesol.
• Never give Orajel or Anbesol to an infant younger than four months of age.
• Never exceed the recommended dosage of any benzocaine-based product. Exceeding the recommended dosage of benzocaine has, in fact, been potentially linked to infant death in an ear drops medication containing benzocaine. Remember that exceeding dosages can occur in a single application or in multiple applications over the course of time. If a medication works once, don’t just keep repeating it every fifteen minutes unless instructed to do so! Read the labels carefully and when in doubt, consult your doctor!
• When giving your baby Orajel or benzocaine, take special care to apply the solution only to the area affected. If your baby happens to be drooling profusely… well, maybe you should consider a more natural teething remedy. Excess saliva increases the likelihood of numbing areas of the throat and reducing your baby’s gag reflex, which can increase chances of choking on food or saliva.
• If you do choose to give your baby Orajel or Anbesol, watch for symptoms of methemoglobinemia. These include bluish coloring of the skin, shortness of breath, and lethargy (lack of energy).
• Consider alternatives especially if your baby or your family has a history of breathing problems, asthma, or hemoglobin abnormalities. These can increase the risk of methemoglobinemia.
• Finally, suspected teething problems such as fever or discomfort may mask a more serious illness. Always consult with your qualified medical practitioner when you suspect illness.

The Bottom Line: Would I Use It?

Is Orajel “bad for babies”?

The first thing I like to remember is that teething in and of itself is completely natural, and  by avoiding medications we recognize that, at worst, our babies will suffer discomfort, and at best we can ease their pain and soothe their gums. There are natural teething remedies available to choose before or instead of resorting to synthetic medications.

Secondly, I keep in mind why a medication like Orajel, despite its potential dangers, is allowed on the market. If all medications with a narrow potential for side effects were disallowed, many medications whose benefits outweighed certain risks would be made unavailable to those who truly need them. Yet, when dealing with a medication that *does* have the potential for life-threatening reactions, I essentially consider whether the benefits are worth the risk.

Would I give Orajel to my baby in cases of extreme pain?

Bottom line, no, I personally would not.

My personal assessment is that application to the mouth is an inexact science. Even when considering the teething swabs versus the teething gel, the possibility of numbing the throat and the rare risk of death from methemoglobinemia are just too great for my personal comfort zone. Add to that the potential for benzocaine allergy and allergic sensitization to future medications, and I’d simply rather try any number of the possible natural teething tricks and remedies available to me before resorting to a potentially risky anesthetic!

So that’s my take, in a relatively long-winded nutshell. I hope this article has helped you to consider the risk vs. benefit equation of Orajel and benzocaine for baby’s teething pain. If it has, please let me know your thoughts! Always happy to know I’ve shared some useful knowledge!

Love,

Mama Hope

Disclaimer: The above content is for informational purposes only and is not intended to give medical advice. This content not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional advice or delay in seeking it because of content found on this site.

Love this article? Give it a tweet!