FDA Warning On Benzocaine Ointments

Benzocaine  Alert

The FDA has recently published a recommendation and warning against the use of Benzocaine topical anesthetic ointments that could result in a rare condition called methemoglobinemia.  Since their original report in 2006 there have been 29 cases of methemoglobinemia reported and of those, 19 were children, 15 were under two years old.

Benzocaine is a local anesthetic and can be found in such over-the-counter (OTC) products as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase.

Mothers with babies that are teething may resort to some of these gels or ointments in an effort to soothe their babies gums, but this can result in the rare but almost always fatal condition.

The FDA rec­ommends that parents and care­givers not use benzocaine prod­ucts for children younger than 2 years, except under the advice and supervision of a health care professional.

The symptoms can be confused with other problems, here is a list of the signs of methemoglobinemia:

• pale, gray, or blue-colored skin, lips and nail beds

• shortness of breath

• fatigue

• confusion

• headache

• light-headedness
• rapid heart rate

If your child has any of these symptoms after using benzocaine discontinue using it and call 911.

As an alternative to ointments, you can use a chilled teething ring or gently rub your child’s gums with a clean finger.

Children present a higher risk, but adults can be affected also.

For the original article by the FDA please see the link below:

http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM306069.pdf

FDA advises consumers to:

• store any products containing ben­zocaine out of the reach of children.

• use benzocaine gels and liquids sparingly and only when needed. Do not use them more than 4 times a day.

• read the label to see if benzocaine is an active ingredient when buying OTC products. Labels on OTC prod­ucts containing benzocaine are not currently required to carry warn­ings about the risk of methemoglo­binemia. If you have any concerns, talk to your health care professional before using them.

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com

Is there a relationship between oral bacteria and arthritis or failing joints?

Is Oral Bacteria Responsible For Your Failing Joints?

Dentists have been well aware for several decades that patients that have a prosthetic joint need special precautions¹.  A consultation with the orthopedic surgeon usually results in a recommendation for prophylactic coverage with a large dose of an antibiotic taken one hour before the procedure, and only one dose is necessary².

The precautionary antibiotic prior to the procedure is given in order to protect the patient from transient bacteremia (bacteria in the bloodstream) as a result of the instrumentation, since the mouth harbors many bacteria, and these bacteria can travel through the circulatory system and end up in the joints.  The high level of antibiotic present in the bloodstream reduces the chance of seeding the joints (bacteria creating an infection that will cause damage to the joint that could result in prosthetic joint failure).

A similar recommendation for antibiotic prophylaxis has been used for prevention of bacterial endocarditis³ for decades, but anatomy, microorganisms and mechanisms of infection are different.

Also joints with plates, pins and screws do not need antibiotic prophylaxis, only orthopedic hardware that is bathed by synovial fluid is at risk of developing an infection.

Bacteremias can occur during the course of our daily lives, in the presence of acute infections of the oral cavity, gastrointestinal, urogenital and other systems, and may happen during dental and medical procedures such as dental extractions, colonoscopies, and some urologic and endoscopic procedures.

A recent study shows a possible relation between patients with arthritis and failed prosthetic joints and bacteria found in the oral cavity using sophisticated DNA tests⁴.  The authors conclude that patients with arthritis or failed prosthetic joints should be examined for the presence of periodontal disease and given appropriate treatment if necessary.  The results of this article and others like it give support to the increasing evidence of a relationship between oral bacteria in periodontal disease and systemic disease.

It is our responsibility as dentists to make sure that we do not get so involved in the technical and mechanical aspects of our profession that we forget to look at the health status of our patients.

Bibliography:

1 Ching DW, Gould IM, Rennie JA, Gibson PH: Prevention of late haematogenous infection in

major prosthetic joints. J Antimicrob Chemother 1989;23:676-680.

2 Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements. Information statement. http://www.aaos.org/about/papers/advistmt/1033.asp.

3 Guidelines for the prevention of endocarditis with valvular disease. http://circ.ahajournals.org/content/118/8/887.full.pdf.

4  Identification of Oral Bacterial DNA in Synovial Fluid of Patients With Arthritis With Native and Failed Prosthetic Joints. Journal of Clinical Rheumatology: April 2012 - Volume 18 - Issue 3 - p 117–121

doi: 10.1097/RHU.0b013e3182500c95

Carlos Boudet, DDS DICOI
1840 Forest Hill Blvd Suite 204
West Palm Beach, Florida. 33406
Phone: (561) 968 6022
Website: http://www.boudetdds.com
Implant Blog: http://www.palm-beach-implants.com
Spanish Website: http://www.palmbeachdentist.net/