Have you ever noticed the bold statement on the label of your toothpaste tube: “WARNING: Keep out of reach of children under 6 years of age. If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately?” Pretty scary, huh? Especially when this stuff is supposed to do such wonderful things like prevent cavities and gum disease, freshen breath, and give you that dazzling bright smile.
A report published on January 7th 2011, by the Secretary of Health and Human Services prompted us to give you a quick review of both the potential for chronic or acute fluoride poisoning, especially in children.
When you call the Illinois Poison Center about a child who has accidentally swallowed toothpaste, we have two concerns: fluoride and fluorosis. Too much fluoride consumed all at once is, in fact, an overdose. Symptoms of a very large ingestion of fluoride may include stomach pain, vomiting, diarrhea, and lowering of essential minerals in the blood, especially calcium and magnesium. In 2009, U.S. poison centers reported 21,755 cases of toothpaste with fluoride ingestions and 4,617 fluoride containing mouthwash ingestions in children under 5 years of age.
We all know fluoride to be an effective preventative against tooth decay. Since the early 1950s, fluoride has been added to municipal drinking water systems, over-the-counter toothpastes, mouthwashes, and some prescription multivitamin/fluoride supplements. Yet, you may not know that recent studies have demonstrated that too much daily intake of fluoride by children 0-8 years of age may cause a condition called “fluorosis.” For the most part, fluorosis is a cosmetic problem associated with discoloration or mottling of the tooth enamel.
Int he past, after a visit with the dentist, you probably said “look mom, no cavities!” But now your kids may be saying “look mom, spotted teeth!”
In 1986 the incidence of dental fluorosis in children ages 12-15 was estimated to be 23%. This number nearly doubled to 41% in 1999. Although uncommon, more severe cases of fluorosis are associated with brittle bones, calcified ligaments and bone breakage. To reduce the incidence of fluorosis, please view the proposed recommendations by the American Dental Association.
Of course, you can imagine that both problems can happen easily because many of these products come in tempting flavors (e.g. bubblegum) and attractive cartoon shaped containers.
Here are a few simple measures to prevent an accidental overdose of fluoride or excess chronic intake of fluoride derived from Center for Disease Control (CDC) resources:
- Parents should discourage swallowing of toothpaste after brushing to avoid the risk of fluorosis.
- When your infant’s first tooth appears, brush without toothpaste, using plain water and a small soft bristled toothbrush after each meal.
- You may start using fluoride toothpaste no more than twice daily once your child reaches 2 years of age.
- Under your supervision, apply a pea-sized amount of toothpaste to the toothbrush (again, discourage swallowing the toothpaste while brushing).
- Do not use prescription fluoride supplements if your tap water is treated with fluoride. You can check to see if your water is fluoridated by going to the CDC’s “My Water’s Fluoride” program. When in doubt ask your pediatrician or dentist.
- You may use fluoridated water to prepare baby formula. Since there is a risk of mild fluorosis, however, when using fluoridated water exclusively to mix baby formulas, you may wish to use a low-fluoride bottled water.
Additionally, we advise all parents and caregivers to keep all toothpastes and mouthwashes well out of the reach of small children when not in use. If you have any questions about an accidental ingestion or safe use of any dental hygiene product please call the IPC at 1-800-222-1222. Keep showing off those pearly whites!
Don’t forget to check out the “My Child Ate…” resource center which gives toxicity level and treatment information for the most common substances/products ingested by children.
By Cassandra Lancki and Tony Burda