Use of the amber teething necklace by the child population: risks <i>versus</i> benefits

Cota, Ana Lídia Soares; Silva, Emilly Alves da; Freitas, Nicole Beatriz Barros de Sá; Bisneto, José Sarmento Lins Irmão; Buriti, Gabriella Marinho; Valente, Júlia Quintella Lessa Maia; Nemezio, Mariana Alencar

doi:10.1590/1984-0462/2022/40/2020412IN

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Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 40 • 2022 • https://doi.org/10.1590/1984-0462/2022/40/2020412IN copy

Use of the amber teething necklace by the child population: risks versus benefits

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

Based on scientific evidence, the objective of the present study is to report the possible risks and benefits of the amber teething necklace for children who use it.

Data source:

This is an integrative literature review, carried out based on the following guiding question: “Does the amber teething necklace have therapeutic properties that justify its usage during tooth eruption?”. The consulted databases were LILACS (Latin American and Caribbean Health Sciences Literature) and PubMed (National Center for Biotechnology Information), with the following descriptors: “Amber,” “Deciduous teeth,” “Strangulation,” and “Local symptoms.”

Data synthesis:

A total of five scientific articles were selected, which indicates an insufficient basis regarding the benefits associated with the use of the amber teething necklace. Conversely, there is a convergence regarding the possibility of health risks such as strangulation, asphyxiation, and swallowing of beads.

Conclusions:

Health professionals should discourage the use of the amber teething necklace by children insofar more studies on the topic are carried out.

Keywords:
Amber; Deciduous teeth; Strangulation; Local symptoms

Authors (year)^reference	Objective	Main results	Conclusion
Machet et al. (2016)¹⁰10. Abdulsatar F, Matsui D, Miller M, Taheri, S. Teething necklaces and bracelets pose significant danger to infants and toddlers. Paediatr Child Health. 2019;24:132-3. https://doi.org/10.1093/pch/pxy155. https://doi.org/10.1093/pch/pxy155...	To analyze the bacterial colonization on amber necklaces used by children during hospital appointments.	All necklaces analyzed had bacterial colonization. 32 different species were found, the most frequent being coagulase-negative staphylococci. In addition, 70.4% of parents consider risky using this necklace on their children.	Amber necklaces can be highly colonized, being contraindicated, as they are susceptible to bacterial infections.
Cox et al. (2017)¹1. Cox C, Petrie N, Hurley F. Infant strangulation from an amber teething necklace. CJEM. 2017;19:400-3. https://doi.org/10.1017/cem.2016.342 https://doi.org/10.1017/cem.2016.342...	To report an accidental infant strangulation case caused by the use of amber teething necklace.	A 4-month-old patient used an amber teething necklace while sleeping to decrease the discomfort caused by tooth eruption and woke up with petechiae on the face and neck, compatible signs with the diagnosis of accidental strangulation.	It is extremely important that health professionals who work with children make safe recommendations for those responsible, considering that amber teething necklaces present strangulation risks.
Soudek and McLaughlin (2018)¹¹11. Soudek L, McLaughlin R. Fad over fatality? The hazards of amber teething necklaces. Paediatr Child Health. 2018;23:106-10. https://doi.org/10.1093/pch/pxx158 https://doi.org/10.1093/pch/pxx158...	To analyze the strength required to break amber necklaces, in accordance with the Standard Specification of the American Society for Testing and Materials.	Of the 15 collars tested, seven did not break until the strength of 15 pounds, and eight out of ten did not break at a force of 1.6 pounds (standardized by the ASTM – American Society of Tests and Materials).	The amber teething necklaces present risk of strangulation in young children, as they cannot open so easily with the minimum strength applied.
Nissen et al. (2019)⁵5. Nissen MD, Lau ET, Cabot PJ, Steadman KJ. Baltic amber teething necklaces: Could succinic acid leaching from beads provide anti-inflammatory effects? BMC Complement Altern Med. 2019;19:1-9. https://doi.org/10.1186/s12906-019-2574-9 https://doi.org/10.1186/s12906-019-2574-...	To evaluate the efficiency of the amber teething necklace in treating symptoms of tooth eruption.	All amber stones submerged in saline buffered with pH 5.5 octanol phosphate did not release measurable succinic acid, except for light-colored spheres, which were divided into small fragments. In addition, treatment of macrophages with succinic acid did not reduce the release of any measured inflammatory cytokines and exhibited toxicity to cells in high concentrations.	There is no evidence that the active ingredient, succinic acid, contains anti-inflammatory properties and can be released from amber stones onto human skin.
Strieder et al. (2019)⁸8. Strieder AP, Aguirre PE, Lotto M, Cruvinel AF, Cruvinel T. Digital behavior surveillance for monitoring the interests of google users in amber necklace in different countries. Int J Paediatr Dent. 2019;29:603-14. https://doi.org/10.1111/ipd.12500 https://doi.org/10.1111/ipd.12500...	To determine Google users’ interest in information about the use of amber necklace in different countries over the years.	There has been an increase in interest from users, particularly since the year 2004, without the influence of monthly or quarterly seasonality. Most searches were about information to reduce discomfort, which demonstrates the perpetuation of beliefs associated with tooth eruption.	There is great interest of Google users regarding the use of the amber necklace as a solution for the relief of tooth eruption symptoms in several countries.

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[1] *Corresponding author. E-mail: emillyalves06@gmail.com (E. A. Silva).