Motrin or tylenol for teething: Tips for Teething Pain: What’s Safe—and What’s Not

Tips for Teething Pain: What’s Safe—and What’s Not

Published on 

August 5, 2020

Categories: 

Health and Safety Tips

Special thanks to Marie Lafortune, MD, Attending Physician in the Division of General Pediatrics at Children’s Hospital Los Angeles, for contributing to this article.

Teething can be tough on babies—and their parents. It hurts to have those new teeth grow in, and that can lead to a lot of crying, sleepless nights and frustration.

What can you do to make it better? Here’s what you need to know about teething, including what’s safe—and not safe—to give your baby.

When does teething start—and end?

In general, teething starts around 6 months of age, but it varies. It can begin anytime from 6 to 12 months.

Your child will be getting new teeth, off and on, for a couple of years. The two sets of front teeth—typically bottom and then top—come in first. The molars (in the back of the mouth) are the last to appear, sometime between the ages of 1 and 3 years. These tend to be more painful.

Signs and symptoms

• Fussiness and crying. Teething hurts! Your baby has good reason to be fussy, irritable and quick to cry.
• Drooling. Teething stimulates saliva—and drooling. Many babies drool a lot! There isn’t much you can do about this. Just stock up on bibs, and keep your child’s mouth and face as clean and dry as possible.

One note: Many babies drool even before their first teeth come in. Just because you see drooling doesn’t mean your baby is teething. 

• Putting things in their mouth. Babies like to do this regardless, but those who are teething will often bite or gnaw on things to ease gum pain.
• Low-grade fever. Teething can sometimes cause a very mild, low-grade fever. Higher fevers—101 F or above—are not caused by teething.

Best remedies for teething pain

• Something cold. Keep a clean, damp washcloth or small damp towel in the fridge. Once it’s cold, give it to your baby to hold and gnaw on. (You can knot one end to make it easier.) This is very soothing for sore gums.

Teething rings are also a good option. They should be made of firm rubber. Put the ring in the fridge and give it to your child cold. Do not put it in the freezer—this makes it too hard and too cold.

• Massage. Teething causes gums to be swollen and tender. Using a clean finger, gently rub or massage your baby’s gums for a minute or two to relieve discomfort.
• Pain medicine. The safest choice is acetaminophen (Tylenol) for babies 2 months and older. Ibuprofen is not recommended for children until they are at least 6 months of age. Follow the directions on the label for your child’s age and weight.
• Lots of cuddling and rocking. This really does help!

What to avoid

Many products sold for teething pain don’t work—and some can even hurt your baby. Stay away from:

• Teething necklaces. The Food and Drug Administration issued a warning against these necklaces in December 2018. The beads can break off, and your child could choke on them. Plus, the necklace can get caught on something and strangle your child. (A reminder: Babies should never wear any jewelry!)
• Frozen teething rings. As noted above, these become too hard and cold and can harm your baby’s gums.
• Topical gels. Many gels were taken off the market in 2018 because they contained benzocaine, which is not safe for children under age 2. What about gels without benzocaine? It’s best to pass on these; you can’t truly be sure what’s in them. Besides, remember all that drool? Gels wash away too quickly to have much of an effect.
• Teething tablets. Some tablets contain belladonna, which is toxic in high enough amounts. There have been cases where teething tablets contained more belladonna than stated on the label. Avoid these tablets.

When to call the doctor

Teething is a normal—and luckily, temporary—part of baby and toddler life. That said, you know your child best. Be sure to talk to your pediatrician if you feel anything is amiss. Symptoms like high fevers, cough, runny nose and diarrhea are most likely not caused by teething, but by another illness. You should also talk to your doctor if your child hasn’t gotten their first tooth by 16 months of age. When in doubt, see the doctor to check it out.

Tolerable Teething – PARENTGUIDENEWS

Carrie Kennison

June 16, 2022

The birth of a baby brings happiness and joy to a growing family. While the baby cries, the tears are usually relieved with food, a clean diaper or a nap. Within a few months after birth, however, a baby begins drooling, fussing and crying for no apparent reason. What happened to that sweet little baby? The answer for your baby’s change in behavior is likely teething.

Some parents breeze through the teething process with their sanity intact and a jovial toothy toddler grinning at them. For the rest of us, though, teething can be a time of whiney, clingy, irritable babies who no longer sleep through the night and don’t want to eat. Fortunately, there are ways to improve a baby’s reaction to teething. By following a few basic steps to ease a teething baby’s pain and symptoms, teething can be a tolerable time for you and your baby.

Teething starts as early as 2 months, with the front top or bottom teeth usually being the first to appear. Before teeth are actually visible, your baby should show early signs of teething. Drooling, interrupted sleep, a change in appetite, fussiness, biting and low-grade fever are all signs your baby might be getting a tooth. The gum area may be red or swollen where the first tooth will appear. You may also notice that teething babies put just about anything in their mouths and start chomping away. Fingers, toes, toys, crib side rails and blankets are all fair game for a teething baby. Teething continues into toddlerhood when the last teeth to arrive are the two-year molars, which are the farthest back in the mouth.

Teething pain can be managed in a variety of ways. A simple and by far the cheapest method to ease teething is by using gentle pressure with your fingers. Rubbing the baby’s gums with clean fingers may alleviate the pain, as well as coax a tooth to break through the gums. Remember to always wash your hands first to keep your baby as healthy as possible.

When your fingers are occupied, giving the baby teething toys to bite on is helpful. Teething rings are great when refrigerated; the coolness decreases pain and swelling. If you don’t have a teething ring handy, offer a damp and cool washcloth.

Acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) also serve as wonderful options in relieving teething pain. Acetaminophen is as the best choice of medicine for children’s early months of teething. When children are over the age of 6 months, ibuprofen can be used to relieve pain. “Pain relievers like ibuprofen or acetaminophen can be helpful for a very fussy teething baby,” says Lisa Bickford, a pediatric pharmacist. “I almost always recommend a non-medicinal course of treatment first or as an adjunct to giving a pain reliever.”

Many parents wonder which is the better choice, acetaminophen or ibuprofen, as they both are reliable medications. Bickford says both have advantages. Acetaminophen, she explains, is not associated with an upset stomach. But, ibuprofen has been proven to work faster and longer than acetaminophen.

Orajel is a topical numbing agent that can temporarily relieve pain directly from the surface of the gums. Although effective, “the short-acting numbing ingredient, benzocaine, gets quickly washed off of the gums by saliva so any relief is very short lived,” says Bickford. “More concerning for me is the potential for the medication to get to the throat and cause numbness there too, which could possibly lead to a choking issue.” In other words, use Orajel cautiously, and watch your baby’s reaction before giving any food or drink.

Teething tablets from Hyland’s are a popular alternative for treating teething pain. An abundance of moms praise the tablets’ effectiveness. While Bickford’s experience with the tablets is limited, Hyland’s have been safely used by millions of children for more than 60 years. The tablets are homeopathic, meaning the drugs are diluted down to a miniscule amount. As the FDA regulates homeopathic products, they must conform with many standards, such as cleanliness and consistency in product. Children tend to like the little dissolvable sweet tablets that assist in lessening teething pain.

During this stage of teething, your child probably has tooth pain as well as a variety of other symptoms. Perhaps you have noticed that your baby’s eating habits have changed. This is because it becomes painful for a teething child to breast or bottle feed. They may refuse some feedings, cry during feedings or bite to try to comfort their pain as they eat. To encourage your little one through feedings, attempt to use a pain management method before starting a feeding. This should aid in getting your child through meals.

Teething also brings a constant flow of drool. Try to keep your child’s chin and shirts dry. Having a continuously wet face and neck can lead to a rash. Let your baby wear a bib during playtime and change the bib whenever it gets wet. Make a habit of drying your child’s face with the bib when necessary to keep your child’s chin rash-free.

While a baby is fussy, irritable and clingy, the ideal thing to do as a parent is to spend more time with the child. When kids are in pain or sick, their reaction is the same; they seek comfort in the ones they love and trust most: mom and dad. Spend more time holding and comforting your teething child.

Similar to feedings, sleep is often interrupted while a child is teething. When a teething child awakes in pain, it is usually with a louder panicked cry than the child’s normal middle-of-the-night cry. Such a child needs extra soothing to get through the wee hours. To nurture your child in sleeping through the night, offer pain soothing methods before bedtime. For babies waking up many times a night, try administering acetaminophen or ibuprofen before bed.

Teething may seem to last forever. But rest assured, it will pass. In the meantime, aim to make the teething process more tolerable by curbing your child’s symptoms. Allow your child to chew to get the much-needed pressure on baby’s gums. Treat the pain with medication if it seems uncontrollable. Also spend increasing time holding and comforting your baby. This may be a difficult stage in parenting. Yet, like every other stage, you will cherish these moments in your baby’s life.

Ibuprofen versus paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth

Review question

This review by the Cochrane Oral Health Group compared the effectiveness of two commonly used pain relievers, paracetamol and ibuprofen, alone and as a single tablet combination, in relieving pain after surgical removal of lower wisdom teeth.

Relevance

A huge number of wisdom teeth surgeries are performed worldwide, with approximately 63,000 extractions performed annually in England alone in National Health Service (NHS) hospitals. This significantly affects the quality of life of patients and many patients need a break from work. However, despite these consequences, people are most often worried about pain after surgery, which can be very severe. It is assumed that the most pronounced pain is felt three to five hours after surgery. Pain experienced after oral surgery is widely used as a model for measuring the effectiveness of pain medications in general.

Paracetamol and ibuprofen are often used to relieve pain after surgical removal of lower wisdom teeth. In 2010, a new pain reliever (branded as Nuromol) containing paracetamol and ibuprofen in one tablet was licensed for use in the UK.

All drugs studied in this review produced minimal side effects when used correctly for short-term pain relief.

Study Profile

The evidence in this review is current to 20 January 2013. This review included seven studies involving 2241 people that directly compared ibuprofen and paracetamol or a combination of the two. All participants underwent mandibular or wisdom teeth extractions that required partial bone removal or caused at least moderate or severe pain. The studies compared painkillers at different doses taken after surgery.

Most of the studies were conducted in the USA and one study was conducted in Puerto Rico. Four of the clinical trials were conducted at clinical research institutions, two at university dental hospitals, and one at a private dental surgery clinic. The age of the participants varied slightly across the studies, but was generally similar and ranged from 15 to 65 years. All studies involved men and women.

All studies included in this review only looked at information on pain relief and pain intensity after a single dose of pain medication after surgery. Pain is known to continue afterward, and the drugs studied in this review are typically administered every six to eight hours (maximum four times a day).

Main results

Ibuprofen was more effective than paracetamol at all doses studied in this review. Based on limited evidence, the combination of paracetamol and ibuprofen was no more effective than either drug alone when assessed two hours after surgery. However, again based on limited evidence, the combination of these drugs was more effective than their use alone when assessing the effect six hours after surgery. Participants who took the combination remedy were less likely to require emergency medicines.

Available information on adverse events in the studies (including nausea, vomiting, headaches and dizziness) indicated that they were comparable between treatment groups. However, the review authors were unable to formally analyze the data because they could not figure out how many adverse events there were.

Quality of evidence

All results (outcomes) comparing ibuprofen with paracetamol were of high quality. This means that further research is unlikely to change our confidence in the estimate of the effect.

When comparing the combination with drugs alone, the quality of the evidence for the proportion of patients with >50% maximal pain relief at two and six hours was rated as moderate due to imprecise estimates based on single studies. This means that further research is likely to significantly affect our confidence in the estimate of the effect. The quality of the evidence for emergency drug use was rated as high.

Translation notes:

Translation: Tashtanbekova Cholpon Bolotbekovna. Editing: Yudina Ekaterina Viktorovna. Project coordination for translation into Russian: Cochrane Russia – Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]; [email protected]

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