The issue with Bonjela Teething Gel, as sold in Australia, is the active ingredient, choline salicylate. In Europe, Bonjela Teething Gel contains Lidocaine hydrochloride and cetalkonium chloride and does not have choline salicylate in it. Choline salicylate belongs to a group of medications called NSAIDS (Non-Steroidal Anti-Inflammatory DrugS) which act by reducing the inflammation of the gums and hence reduces the pain of teething. The salicylate family includes common over-the- counter drugs such as Aspirin (acetylsalicylic acid) and Dencorub (methyl salicylate). Click here to view a comprehensive list of Salicylates to avoid.
As oral choline salicylate is structurally related to Aspirin (salicylic acid), and Aspirin is known to be associated with Reye's Syndrome, it is therefore possible that overuse can result in a child developing Reye's Syndrome. Reye's syndrome is a potentially fatal disease that causes detrimental effects to organs; particularly the brain, liver and kidneys. The disease causes “fatty liver” and severe encephalopathy (with swelling of the brain).
The Food and Drug Administration (FDA) recommend that aspirin and combination products containing aspirin not be taken by anyone under 19 years of age during fever-causing illnesses. On the 21st April 2009, the Medicines and Healthcare products and Regulatory Agency (MHRA) advised that products containing choline salicylate should not be used on children and adolescents under the age of 16. Such a warning is purely precautionary.
A review article published in the Journal of Emergency Medicine in January 2007 by J.E. Davis noted that there were some well documented deaths and life threatening toxicity in children under 6 yrs of age after a dosage of less than 5mLs (one teaspoon) of Oil of Wintergreen. Oil of Wintergreen contains 98% choline salicylate. The data from the study was obtained from a review of the existing medical literature on methyl salicylate (e.g. Dencorub) poisoning and data compiled over the past two decades by the American Association of Poison Control Centers (AAPCC).
Dentartisans recommend that you avoid choline salicylate in children and adolescents under the age of 16. Alternative teething remedies you can use are: teething rings, rusks, cold teaspoon, ice, chilled fruits, topical anaesthetics, toys with various hard and soft textures and cuddles. Nurofen for Children or Panadol for Children will also help. Herbal teething gels are also available on the market. These gels may work and but there are as yet, no available documented studies related to them. They may also have side effects of their own.