Soothing Tender Gums Part 2 — Alternative Remedies

Last week, I addressed pharmaceutical options for relieving teething discomfort. There are a number of reasons a parent might want to consider non-pharmaceutical options, however. For instance, teething pain can cycle up and down for weeks at a time, and neither acetaminophen nor ibuprofen are appropriate for long-term use. Even clove oil, which is likely safer for long-term use than other pharmaceutical options, causes a tongue-numbing effect to which you may not want to subject your child on a routine basis.

Before considering the non-pharmaceutical options for relieving teething pain, there are some important points to address. First, while many parents feel that “natural” cures are safer than “chemicals” or “drugs,” this is simply not true. Not only are there a variety of toxic natural substances (in fact, the most toxic substance known to man — botulin toxin — is natural), the FDA regulates natural substances differently than they do drugs and pharmaceuticals per the Dietary Supplement Health and Education Act of 1994. In fact, the FDA does not require manufacturers of dietary supplements to prove safety or efficacy prior to distribution. Herbal treatments fall into the category of dietary supplements. Homeopathic treatments are regulated somewhat differently, and don’t fall into the category of dietary supplements as defined by the FDA. They’re a bit more tightly controlled than herbal remedies with regard to safety, but aren’t required to submit new drug applications (like over-the-counter and prescription pharmaceuticals), and aren’t required to provide efficacy data. The important thing to bear in mind when considering an alternative remedy for any condition — teething pain or otherwise — is that just because the remedy is natural doesn’t mean it’s safe. It could be inherently toxic, as some herbs are, or it could be contaminated with a toxic substance. Contamination is less likely to be discovered right away in a dietary supplement or homeopathic remedy than it is in a pharmaceutical because of differences in regulation. Finally, since homeopathic and herbal remedies don’t have to provide proof of efficacy, you could end up spending your money on something completely ineffective.

Because herbal compounds are regulated so loosely with regard to safety, and because there’s insufficient efficacy data for any herbal teething remedies, I will not address herbal compounds here; there’s simply no evidence to support their use in the case of teething.

Homeopathy is a type of alternative medicine that relies upon two principles. The first of these is the “Law of Similars,” which claims that symptoms are relieved by taking a substance that causes similar symptoms in healthy individuals. The second principle of homeopathy is that dilution strengthens the preparation. While there is no physical evidence or scientific hypothesis to support or explain this belief, homeopaths believe that the more dilute they make a solution, the more powerful it becomes. Many homeopathic remedies are so dilute that the odds are there is no longer even a single molecule of the remedy substance in the preparation. While most practitioners of traditional Western medicine (i.e. mainstream physicians) dismiss homeopathy and claim that any benefit from it is the result of a placebo effect, some scientific studies have shown that homeopathic remedies can be effective in certain conditions (see, for instance, Linde et al, who present a review of many homeopathic research trials). The Linde review, however, is by no means the only analysis of homeopathic research. Others (see, for instance, Shang et al) have also reviewed the body of published homeopathic research and have reached different conclusions. Notably, though they examined many of the same studies, the Linde analysis came to the conclusion that homeopathy can have a significant (i.e., not placebo) effect on some conditions, while Shang and colleagues reported just the opposite. Part of the confusion here is that there are no hard and fast “rules” for analysis of the research conducted by others; researchers conducting such analyses are free to interpret results as they deem most appropriate.

Unfortunately, while there are placebo-controlled, double-blind, high-power (basically, this all means well-conducted) studies documenting the safety and efficacy of homeopathy in treating some conditions — including allergies (Reilly et al) and diarrhea (Jacobs et al) — there are no such studies demonstrating that it has an effect on teething pain. Nevertheless, major homeopathic drug companies sell single substance remedies (generally chamomile) and compound remedies purported to help alleviate discomfort. Despite the lack of evidence to support efficacy of homeopathic teething remedies, these preparations are so dilute as to generally cause no adverse reactions, and have a good safety record, according to the National Center for Complementary and Alternative Medicine (NCCAM). While NCCAM doesn’t go so far as to recommend homeopathy (on the grounds that there’s no evidence to support its efficacy), and while they warn that liquid homeopathic preparations can be high in alcohol and present a hazard to children for that reason, they do not find any reason to warn against use of homeopathic pill preparations on safety grounds.

One popular compound preparation for teething, Hyland’s Teething Tablets, was recently pulled from the market by the FDA on the grounds that the pills contained inconsistent quantities of the active ingredients (particularly belladonna, which has the potential to cause severe adverse reactions in sufficient quantity). Hyland’s explains that adverse reactions to the tablets, which led the FDA to investigate further, were never conclusively tied to use of Hyland’s tablets. Further, they note that the quantity of belladonna in even the most concentrated tablets was insufficient to cause symptoms of belladonna poisoning. Regardless, the popular tablets are now back on the market, hopefully with greater preparation consistency.

Another option for relieving teething pain, popular with some moms, are Baltic amber teething necklaces. These necklaces are designed to be worn, not chewed, and supposedly help to reduce teething pain due to an analgesic compound in the amber that absorbs into the body via the skin. The compound, succinic acid, is a small carbon-based molecule. There is scientific evidence to suggest that succinic acid has biological activity (Haeseler et al showed that it affects muscle excitability) and it has been shown in some cases to diminish physical affects of stress (Rachkov), but there is no plausible explanation for analgesia produced by topical application of the molecule. Succinic acid has a chemical structure that makes it incapable of penetrating the skin. As such, while there may be some other compound responsible for the suggested analgesic effects of a Baltic amber necklace, no plausible hypothesis has yet been proposed. Neither is there any scientific evidence to suggest that such necklaces are effective.

Science Bottom Line:* There is no scientific evidence to support use of herbs for teething pain. While there is some scientific evidence to support the use of homeopathy for some conditions, there is no such evidence to support the use of homeopathy for teething. However, it’s unlikely that there are major concerns associated with trying homeopathic teething remedies. It’s probably worth using a remedy whose ingredients are non-toxic (like chamomile), rather than a remedy with toxic ingredients (like belladonna), on the off chance that pills have inconsistent quantities of the active substance. There is no scientific evidence to support use of an amber teething necklace.

 

What are your favorite alternative teething remedies?

 

References:

FDA Dietary Supplements. Accessed 26 Sept 2011.

FDA Conditions Under Which Homeopathic Drugs May be Marketed. Accessed 5 Oct 2011.

FDA Consumer Safety Alert, Hylands Teething Tablets. Accessed 5 Oct 2011.

Haeseler et al. Succinylcholine metabolite succinic acid alters steady state activation in muscle sodium channels. Anesthesiology. 2000 May;92(5):1385-91.

Hyland’s Teething Tablets Recall Information. Accessed 5 Oct 2011.

International Academy of Classical Homeopathy, Materia MedicaChamomilla. Accessed 5 Oct 2011.

Jacobs et al. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics. 1994 May;93(5):719-25.

Linde et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet. 1997 Sep 20;350(9081):834-43.

National Center for Complementary and Alternative Medicine Homeopathy. Accessed 5 Oct 2011.

Rachkov, A. [Metabolic effects of succinic and nicotinic acids in emotional pain stress]. Farmakol Toksikol. 1988 May-Jun;51(3):41-5.

Reilly et al. Is evidence for homoeopathy reproducible? Lancet. 1994 Dec 10;344(8937):1601-6.

Shang et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet. 2005 Aug 27-Sep 2;366(9487):726-32.

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2 Comments (+add yours?)

  1. J
    Jan 28, 2012 @ 02:38:48

    Interesting. I’d be interested in your perspective on whether teething is really the big issue or cause of fussiness that so many parents assume it to be. I’m always surprised when parents claim to know that the cause of a baby’s fussiness is clearly that they are teething or assume that teething must be incredibly painful. (eg, is it painful for 7y/o kids when their permanent teeth come in? We don’t automatically assume it is, and regularly dose them up on Tylenol or homeopathic remedies…) I certainly couldn’t tell whether a particular bout of fussiness (accompanied by excessive chewing and drooling) was the result of teething, or just coincidental (eg due to gas, wet diaper, mental developmental milestone).

    My chosen teething “remedy” was a cold washcloth, rubber teething chew toy, or refrigerated teething chew toy — really the lowest-risk options out there.

    Reply

    • SquintMom
      Jan 28, 2012 @ 18:06:45

      You know, I think it depends upon the kid. Each of us has a unique anecdotal perspective; we know our own kids very well. Some moms swear they can tell when their kids are teething, and others can’t tell at all. W has only one tooth so far, and she was definitely cranky for several days right before it came in. But…with a sample size of one, my observation of her doesn’t count as any sort of data! It’s very possible that she was simply cranky for some other reason. If I happen to notice that she’s cranky for a few days EVERY time a tooth comes in, then I’ll have more information, but it will only be valid for W, and won’t be generalizable to other kids.

      I am willing to accept that teething is more painful for a baby than for a seven year old getting permanent teeth, because in the case of permanent teeth, they’re pushing up through already-disrupted gum tissue (except in the case of the molars, and those aren’t a good example to cite, because it’s entirely possible that it hurts more for incisors to push through the gums than for molars…there’s no way to know). I agree that a rubber chew toy, cold washcloth, etc is a great teething “remedy.” However, I think there’s so little risk associated with occasional and appropriate Tylenol use that I’m perfectly happy to give it to W if she’s having trouble at night and I suspect she’s teething. If she can’t sleep and she’s grabbing her ears, banging her cheeks, shoving her fist in her mouth and crying…something’s hurting her, and even if it isn’t her teeth, the Tylenol will help. Low risk, high benefit!

      Reply

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