Teething gels sit in an awkward middle ground in the pharmacy: prominently shelved, marketed straight at sleep-deprived parents, but actually carrying real safety concerns in some formulations and minimal effectiveness in the rest. Reading the active ingredients on the back of the box is the difference between a useful purchase and a genuinely dangerous one. For a wider view, see our complete guide to child health.
What's Actually in Teething Gels
Teething products fall into two broad groups:
Gels containing local anaesthetics or salicylates. The "active" formulations. The numbing agents — lidocaine, benzocaine — and the salicylate-based ones (choline salicylate) work by reducing the gum's pain perception on contact. They look reasonable on paper. In infants the problem is that the oral mucosa is thinner and more permeable than in adults, and these agents are absorbed systemically far faster than the marketing implies.
Gels without local anaesthetics. Typically sugar-free, sometimes with chamomile or other mild botanicals. Safer, but the supporting evidence for actual effectiveness is thin — and saliva clearance limits any local action to seconds.
The Safety Case Against Anaesthetic Gels
Benzocaine
Benzocaine in young babies can cause methaemoglobinaemia — a state in which the iron in haemoglobin is oxidised so it can't release oxygen to tissues. The clinical picture: the lips and skin go grey-blue despite normal oxygen in the air, oxygen saturation drops, and the baby may become breathless and lethargic. Serious cases need methylene blue treatment.
The FDA issued a safety warning in 2011 and strengthened it in 2018, recommending against benzocaine-containing oral products for children under two and asking manufacturers to either reformulate or stop selling them for paediatric use. The UK's MHRA has issued similar advice. Some products (Orajel formulations in the US) were withdrawn from the under-two market as a result.
If a baby has been given benzocaine and you notice grey-blue lips or unusual sleepiness, seek emergency care.
Lidocaine
Viscous lidocaine oral solution — sometimes used off-label by parents looking for stronger relief — has caused reported infant deaths from systemic absorption causing seizures and cardiovascular collapse. The FDA issued a black-box warning in 2014 specifically against using viscous lidocaine for teething pain in infants. Despite this, lidocaine-containing teething products continue to be sold in some markets, and parents occasionally encounter them online or abroad.
The MHRA recommends against teething gels containing lidocaine in young children. The risk-benefit profile is genuinely poor — the relief is brief and the worst-case scenario is severe.
Choline Salicylate
Found historically in some "adult-strength" Bonjela and certain mouth ulcer preparations. Choline salicylate is chemically a salicylate — related to aspirin — and salicylates carry a risk of Reye's syndrome in children under 16. Reye's is rare but devastating: encephalopathy plus liver failure, often after a viral illness.
The Bonjela line has had paediatric formulations specifically without choline salicylate for years, but if you're given older stock, picking up an unfamiliar product abroad, or using a generic adult mouth-ulcer gel, it's worth checking the label. The rule is simple: no salicylates of any kind in babies and children.
What This Means in Practice
In the UK, the MHRA position on teething gels in young children is that lidocaine and choline salicylate should be avoided. Any teething gel used for a baby should be checked specifically for these ingredients on the active ingredients list (often in small print on the back of the carton).
Products marketed as baby formulations — Dentinox Infant Teething Gel, Calgel (the current paediatric formulation, which contains lidocaine in some markets and not others), Bonjela Junior — use safer ingredient profiles in their UK paediatric versions, but the actual pain-relieving effectiveness is modest at best.
Two reasons effectiveness is limited even for the safe gels:
- Saliva clears them in seconds. Whatever active is in the gel gets diluted and washed away from the gum surface almost immediately.
- Most baby teething distress isn't actually a topical surface-pain problem. It's more a pressure-from-below sensation that responds better to counter-pressure (chewing) than to surface numbing.
What Works Better
For mild teething discomfort:
- Chilled (not frozen) teething rings — fridge temperature, not freezer — combine counter-pressure and mild cold
- Gentle gum massage with a clean finger — pressing firmly but gently against the gum ridge over the erupting tooth
- Distraction — being held, played with, or taken outside
- Chilled foods for weaning babies — refrigerated cucumber sticks, cold pieces of fruit (always supervised — choking risk)
For more significant distress:
- Infant paracetamol (Calpol or generic) from birth — weight-appropriate dosing per the label, typically 2.5 ml of the 120 mg/5 ml suspension for babies 3–6 months
- Infant ibuprofen from 3 months and 5 kg — 2.5 ml of the 100 mg/5 ml suspension for babies 3–6 months. Ibuprofen has an anti-inflammatory action that can be slightly more effective than paracetamol for the gum-pressure aspect.
Both have decades of safety data behind them and far better real-world effectiveness than topical gels for the moderate-to-significant teething discomfort that prompts most parents to reach for something.
Checking a Product Before Use
Before using any teething preparation, read the active ingredients list and screen for:
- Benzocaine — avoid in children under 2
- Lidocaine — avoid in children under 2 (and use cautiously at any age)
- Choline salicylate — avoid in anyone under 16 (Reye's syndrome risk)
- Any other salicylate — same age cut-off
If you're unsure, a pharmacist will tell you in 30 seconds. The safer non-anaesthetic gels are fine to use if you find them comforting to apply, but expecting them to deliver substantial pain relief is setting an unrealistic bar — that job is better done by chilled counter-pressure and, when needed, weight-appropriate paracetamol or ibuprofen.
Key Takeaways
Benzocaine teething gels can cause methaemoglobinaemia in babies and the FDA has recommended against them under the age of two since 2018. Lidocaine teething gels have caused infant deaths and are explicitly warned against in the UK by the MHRA. Choline salicylate (in older Bonjela formulations) is chemically related to aspirin and risks Reye's syndrome — avoid in anyone under 16. Sugar-free non-anaesthetic gels are safe but largely ineffective because saliva washes them off in seconds. Chilled (not frozen) teething rings, gentle gum massage, and weight-appropriate paracetamol or ibuprofen do more for less risk.
