Major health organizations such as the Centers for Disease Control and Prevention and the American Academy of Pediatric Dentistry agree that fluoride offers significant benefit to oral health. In low concentrations, fluoride from drinking water, toothpaste and other sources strengthens tooth enamel, prevents cavities and helps build strong, healthy teeth. In higher concentrations, however, fluoride is essentially a highly toxic poison [sources: Danoff, Meyer].
Since 1997, the Food and Drug Administration (FDA) has required manufacturers to print warning labels on tubes of fluoride toothpaste sold in the U.S. [source: Fluoride Action Network]. These labels are designed to make parents aware of the potential for serious health risks in children who consume too much fluoride. Despite these warnings, most children still use too much toothpaste when they brush their teeth, and about half swallow the toothpaste rather than spitting or rinsing [source: Porterfield]. Even worse, curious children or those tempted by the fruity flavors of kids' toothpaste may decide to eat a large amount of the goo straight from the tube, exposing themselves to a possible fluoride overdose.
To protect kids from fluoride-related dangers, parents should treat toothpaste like any other harmful chemical and keep it locked up when not in use. Doctors recommend supervising children younger than age 6 while they brush and reminding them to spit out the paste rather than swallowing. Parents should also use this time to teach kids to use no more than a pea-sized amount of toothpaste. Children age 2 and younger shouldn't use fluoride toothpaste unless directed to by a dentist or doctor, and infants younger than 6 months should never be exposed to fluoride toothpaste [source: Danoff].
When used properly, fluoride toothpaste is unlikely to pose any serious risks to your child. However, swallowing more than a pea-sized amount each day increases a kid's risk for dental fluorosis, a condition that leads to brown spots and staining of the teeth [source: Wagner]. Your child faces an even greater chance of developing fluorosis if they consume fluoride from other sources, such as drinking water, food or mouthwash. While every child's tolerance to fluoride is different, eating small amounts of toothpaste has been linked to gastrointestinal problems ranging from vomiting to diarrhea [source: Ager]. Kids who eat small amounts every day can even develop chronic health issues, including problems with bone development [source: Oldenburg].
But what happens if you suspect your child has eaten a large amount of fluoride toothpaste? Read on to learn about lethal fluoride doses and when you should call poison control.
Fluoride Poisoning and Lethal Levels
With scary new labels on toothpaste, many parents are left wondering what to do when they catch their child eating toothpaste straight from the tube, but given the relatively low fluoride content in most brands, it's fairly difficult for a child to consume a lethal dose of fluoride at home.
For example, a pea-sized amount of toothpaste has about 0.24 milligrams of fluoride, about the same as a glass of tap water. According to the Columbia University College of Dental Medicine, the lethal dose for an 8-year old child weighing 45 pounds is 655 milligrams. Your child would have to consume more than four tubes of toothpaste to reach this level. For a 2-year-old, 22-pound child, the lethal dose is 320 milligrams, or more than two full tubes of toothpaste.
Of course, not all pastes are created equal. Most toothpaste contains between 1,000 and 1,500 parts per million of fluoride (ppm) [source: Wagner]. A standard 4.5-ounce tube of Colgate for Kids, at 1,100 ppm contains 143 milligrams of fluoride [source: Fluoride Action Network]. A 2-ounce tube of prescription ControlRX, at 5,000 ppm contains 282 milligrams of fluoride, a nearly-lethal dose for a 2-year old [source: NIH]. Parents should take extra care to lock up these types of prescription dental products, as well as any fluoride supplements, which can easily contain enough fluoride to kill a child.
Even doses as low as 0.1 milligrams of fluoride per kilogram of body weight, while unlikely to be fatal, can still cause acute poisoning symptoms, ranging from nausea to headaches. A 22-pound child can suffer from fluoride poisoning at doses as low as 1 milligram, while a 45-pound child would need to ingest 2 milligrams to experience similar symptoms. A single teaspoon of children's toothpaste contains about 5 milligrams of fluoride, making it more important than ever for parents to limit access to this product [source: Fluoride Action Network].
The National Institutes of Health (NIH) encourages parents to call the American Association of Poison Control Centers at 1-800-222-1222 any time they have a question about poisoning, whether or not it's an emergency situation. NIH also recommends that parents head to the emergency room if they suspect their child has consumed a tube of toothpaste or more [source: NIH].
While it's possible for a child to consume a lethal dose of toothpaste, it's also exceptionally rare. Between 1989 and 1994, Poison Control received more than 10,000 reports of potential fluoride overdose from toothpaste. Just two of these were life-threatening cases, and neither resulted in death [source: Fluoride Action Network].
More Great Links
- Ager, Susan. "Toothpaste Label Revs Up Some Anxiety." Detroit Free Press. January 13, 2005. (Sept. 7, 2011) http://fluoridealert.org/articles/toothpaste04/
- Columbia University College of Dental Medicine. "Fluoride Treatments and Supplements." 2011. (Sept. 7, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Checkups-and-Dental-Procedures/Fluoride/article/Flouride-Treatments-and-Supplements.cvsp
- Danoff, Dr. Robert. "A Little Fluoride Goes a Long Way." MSN. (Sept. 7, 2011) http://www.msn.com/en-us/health/nutrition/nutrient/21367/fluoride
- Fluoride Action Network. "Minimum Dose of Fluoride Producing Acute Toxicity." (Sept. 7, 2011) http://www.fluoridealert.org/health/accidents/acute.html#reports
- Fluoride Action Network. "Why Is There a Poison Warning On Toothpaste." January 2005. (Sept. 7, 2011) http://www.fluoridealert.org/toothpaste.html
- Meyer, John. "Conventional Insecticides." North Carolina State University. Nov. 4, 2003. (Sept. 6, 2011) http://cals.ncsu.edu/course/ent425/text19/insecticides.html
- National Institutes of Health (NIH). "ControlRX--Archived Drug Label." May 2010. (Sept. 7, 2011) http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=45335
- National Institutes of Health (NIH). "Toothpaste Overdose." July 20, 2009. (Sept. 7, 2011) http://www.nlm.nih.gov/medlineplus/ency/article/002745.htm
- Oldenburg, Don. "Toothpaste: How Safe?" The Washington Post. June 16, 1997. (Sept. 7, 2011) http://fluoridealert.org/articles/fda-toothpaste/
- Porterfield, Elaine. "Hazards Lurk in Toothpaste Tube." The Tacoma News Tribune. April 5, 1994. (Sept. 7, 2011) http://www.fluoridealert.org/health/accidents/toothpaste-illness.html
- U.S. Department of Agriculture. "USDA National Fluoride Database of Selected Beverages and Foods." Nutrient Data Laboratory. October 2004. (Sept. 12, 2011) http://www.nal.usda.gov/fnic/foodcomp/Data/Fluoride/fluoride.pdf
- Wagner, Holly. "Fluoride Toothpaste Linked to Teeth Discoloration in Children." Ohio State University. Nov. 23, 1998. (Sept. 7, 2011) http://researchnews.osu.edu/archive/flurosis.htm