Pharmacological management:

Most parents prefer to avoid using pharmacological preparations during teething, however, a wide range of effective topical and systemic preparations are available when local measures fail to provide relief.

Topical agents:

• Lignocaine-based products
• Choline salicylate-based products
  This group of medicaments includes local anesthetics (lignocaine-based preparations) and minor analgesics (choline salicylate based preparations). Parents should be advised to wash their hands thoroughly before applying topical agents directly to the painful area of mucous membrane. Some of their reported relief may be due to the pressure of application. Lignocaine hydrochloride is a local anesthetic that is rapidly absorbed through mucous membrane giving prompt relief from pain. Gel should be placed on a clean finger or cotton bud, and rubbed onto the painful area. Salicylates are regarded as minor analgesics and penetrate mucous membrane readily to give prompt pain relief. They are also anti-inflammatory and anti-pyretic, thus reducing swelling which is an additional advantage. The link between aspirin and Reyes syndrome is not relevant for non-aspirin salicylates. Frequent applications of choline salicylate preparations to the oral mucosa may result in a chemical burn.

Systemic analgesics :

The conservative use of acetaminophen and ibuprofen can reduces pain and pyrexia caused by teething. Parents must know the correct dosage for their children. A sugar-free paracetamol elixir is the drug of choice. It acts by inhibiting prostaglandin production. The recommended paracetamol dosage is:

3-12 months = 60-120 mg; 1-5 years = 120-250 mg

These doses are repeated at 4-6 hourly intervals, with a maximum of four doses in 24 hours. A graduated syringe should be used for doses under 5 ml, and a calibrated spoon for doses over 5 ml. Underdoses of paracetamol for teething children are ineffective, whilst overdosing may lead to severe hepatocellular necrosis and renal tubular necrosis. Ibuprofen suspension can be given to children over one year.