What is teething pain?

Teething pain is discomfort from gum irritation around erupting teeth. It is normal and common in kids. That being said, many children go through teething with little to no trouble.

Teething can lead to temporary pain, irritability, drooling and low-grade fever. Your child could even resist eating. Babies often chew their fingers or other items to alleviate their discomfort. This can lead to an infection if their hands are not clean.

While some sources suggest teething may be linked to diarrhea or ear infections, this remains debated.

When does teething pain occur?

Teething typically begins around 6 months of age with the eruption of the first baby tooth. It can continue until about 3 years of age, when the last baby teeth come in.

Teething discomfort can also occur at ~6 yrs and ~12 yrs when the permanent molars are erupting.

How do I treat my child’s teething pain?

1) Pressure/massage

Parents can relieve pain by directly massaging the gums or using teething toys/rings (discussed below). Direct massaging can be done with the parent’s finger or a cloth.

Pressure helps distract your child in the same way as rubbing your foot helps when you stub your toe.

2) Cold home items/foods

Cool foods like refrigerated fruit or a cold towel can calm teething pain. You should supervise your child to minimize choking hazards. Other options include cold yogurt, apple sauce or pureed fruit.

Do not use frozen products or foods from the freezer. These can cause frostbite and soft tissue damage.

Teething biscuits are not recommended due to often high sugar content per the Canadian Pediatric Society.

3) Medications

You can use painkillers such as infant’s dose acetaminophen or ibuprofen.

These can be used sparingly when no other measures work. It’s important to remember teething is normal and routine medication use isn’t ideal. If no other measures work, then you can give medications for the few times your child absolutely needs it.

Do not use Aspirin for teething pain! Aspirin increases risk of Reye’s syndrome (liver and brain swelling) in kids so it is not recommended.

Teething rings/toys act through pressure to massage the gums. Teething toys are not always needed as there are multiple other remedies as stated above. If your child prefers teething toys, it is important to be fully aware of the different types as some carry harmful risks.

There are 3 types of teething rings: 1) Plastic, 2) Silicone and 3) Rubber.

Plastic teething toys should be avoided. These can contain harmful hormone-disrupting chemicals (bis-phenol-A “BPA”, parabens and phtalates). These chemicals can cause behavioral impairments, neurological, hormonal and fertility issues and others health issues. These chemicals leach out of the product when exposed to very high or low temperatures. Plastic products are also prone to bacterial contamination.

New plastic products claim to avoid harmful chemicals but the substitutes could still be unsafe.

Silicone is a synthetic rubber that is safe and approved by Health Canada for teething toys. Silicone does not contain BPA, parabens or phtalates. However, parents should still be aware of risks with poor-quality silicone products. Poor-quality products have been shown to leach methylsiloxanes, which can impact child development and metabolism.

Rubber teethers made of natural rubber or latex. These come from natural rubber trees and hevea trees. Natural Rubber and latex are acceptable as long as your child does not have an allergy. There are no known associated health impacts from natural rubber or latex. If your child is allergic, then a silicone teething toy would be safe.

Ideal teething toys should be a single piece. Single piece items are easier to clean. Products made of multiple pieces can hold onto bacteria more easily. It is best to avoid products with strings/necklaces, chains or beads due to strangulation risks.

Do not use a liquid-filled teething toy. Only use teething toys that are solid. Liquid teething risks can break (choking risk) or cause frostbite (if frozen).

What should I avoid?

1) Topical pain-killing gels, ointments or creams

Topical anesthetic gels contain a numbing medication called benzocaine. Benzocaine can cause methemoglobinemia in kids under 2 years old. Methemoglobinemia is a blood disorder that reduces the blood’s ability to carry oxygen to the body.

Topical benzocaine is not permitted for use in children under 2 years old by Health Canada or the FDA due to methemoglobinemia risk.

2) Teething Necklaces

Necklaces made of amber or hazelwood claim to have pain-relieving properties but have no scientific evidence to support this claim. Teething jewelry and necklaces are high risk of choking, thus are not recommended.

A case report discussed how teething necklaces can lead to death in infants. Teething necklaces are strongly discouraged by the Canadian Pediatric Society and American Academy of Pediatrics.

3) Homeopathic Products

The main concern with homeopathic products is the lack of scientific evidence. They are not as well-studied as conventional pharmaceutical medications like ibuprofen or acetaminophen.

Homeopathic products are subject to weaker regulations by Health Canada and the FDA, thus they have a lower standard to make their health claims.

Homeopathic teething products include Orajel Natural Source Homeopathic Teething Gel, Boiron’s Camilia Teething Droplets and Homeocan’s Teething Droplets. These all contain Chamomilla as the active ingredient (also in chamomile tea).

Chamomilla is known to have calming effect and relieves irritability. Chamomilla is not proven to be harmful but it also has not been proven to be effective for teething pain-relief in children. .

Avoid homeopathic ingredients that include Atropa Belladona, as this has been linked with heart and neurological issues. Generally products with Belladona have been recalled for kids due to health risks.

When to see your doctor or dentist?

You should see your physician or dentist, if your child has the one of the following:

• persistent, high-grade fever (Over 38°C or 100.4°F)
• not eating or drinking for more than 1 day
• severe or persistent diarrhea
• severe fatigue
• consistent medication use is required to relieve pain
• symptoms have not been relieved despite multiple attempts

It is possible that your child’s discomfort is not caused by teething. Other possible explanations include viral infections, cavities, dental infections, oral ulcer or trauma.

The final word…

Teething pain is a normal part of growth. There are multiple simple ways of managing the discomfort including pressure, cold items and medications. Teething rings are helpful but not mandatory! Parents should be aware that not all teething rings are safe. Parents should absolutely avoid teething topical gels, teething necklaces and homeopathic remedies. Finally, if you’re concerned, book an appointment with your doctor or dentist as there could be other causes for your child’s pain.

References:

Abdulsatar, F., Matsui, D., Miller, M., & Taheri, S. (2018). Teething necklaces and bracelets pose significant danger to infants and toddlers. Paediatric & Child Health, 24(2), 132–133. https://doi.org/10.1093/pch/pxy155

Abdulsatar, F., Miller, M. R., & Taheri, S. (2022, August 26). Use of unsafe teething remedies: A survey. J Can Dent Assoc 2022;88:m7. https://jcda.ca/m7

American Academy of Pediatrics. (2018, December 20). Teething necklaces and beads: A caution for parents. HealthyChildren.org. https://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Amber-Teething-Necklaces.aspx

American Academy of Pediatric Dentistry. (2025). Perinatal and Infant Oral Health Care. https://www.aapd.org/globalassets/media/policies_guidelines/bp_perinataloralhealthcare.pdf

Health Canada (2023, November 8). Baby bottles, pacifiers and teething necklaces. Canada.ca. https://www.canada.ca/en/health-canada/services/infant-care/bottles-pacifiers-teething-necklaces.html#a3

Health Canada. (2020, February 24). Chamomilla Product information. Licensed Natural Health Products Database (LNHPD). https://health-products.canada.ca/lnhpd-bdpsnh/info?licence=80097236

Health Canada. (2018, October 30). GERMAN CHAMOMILE –MATRICARIA CHAMOMILLA Oral. NATURAL HEALTH PRODUCT. https://webprod.hc-sc.gc.ca/nhpid-bdipsn/dbImages/mono_chamomile-german–oral_english.pdf

Health Canada. (2015, March 1). Hyland’s teething tablets (October 26, 2010). Recalls and safety alerts – Hyland’s Teething Tablets. https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2010/10049r-eng.php

Health Canada (2020, October 15). Recalls and safety alerts. Canada.ca. https://recalls-rappels.canada.ca/en/alert-recall/benzocaine-products-should-not-be-used-children-under-two-years-age

Health Canada. (2025, August 28). Oral Health For Children. Canada.ca. https://www.canada.ca/en/public-health/topics/oral-health/caring-your-teeth-mouth/children.html

Li, M. Y. L. (2022, August). Pediatric dentists’ recommendations and knowledge of teething. https://open.library.ubc.ca/media/stream/pdf/24/1.0416744/4

Office of the Commissioner. (2024, June 26). Safely Soothing Teething Pain in Infants and Children. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/safely-soothing-teething-pain-infants-and-children#:~:text=Benzocaine%2C%20a%20local%20anesthetic%20(a,because%20they%20can%20b

Xu, L., Zhi, L., & Cai, Y. (2017). Methylsiloxanes in children silicone-containing products from China: Profiles, leaching, and children exposure. Environment International, 101, 165–172. https://doi.org/10.1016/j.envint.2017.01.022