By Dr Senani Wijesena 29/07/2016
Despite some benefits of topical fluoride application on reducing dental caries, caution must be exercised and benefit and harm must be weighed. Toothpaste contains toxic levels of fluoride if ingested by a child and care must be taken to avoid swallowing (40% young children swallow toothpaste due to poor gag reflex). Poison warnings are placed on many fluoridated toothpastes and is mandatory for example in the USA by law (1997, FDA). The 1984 issue of Clinical toxicology of commercial products lists fluoride as “more poisonous than lead and slightly less poisonous than arsenic. The FDA requires toxicity warnings on toothpaste tubes because children who swallow too much fluoride toothpaste can suffer acute poisoning, even death. While fatalities from fluoride ingestion are rare (the last reported death occurred in 2002), bouts of acute fluoride poisoning are not. Acute fluoride poisoning, which occurs at doses as low as 0.1 to 0.3 mg per kg of bodyweight, generally presents in the form of gastric pain, nausea, vomiting, headache, dizziness and flu-like symptoms. Risks from ingesting fluoride toothpaste include permanent tooth discoloration (dental fluorosis), stomach ailments, acute toxicity, skin rashes (perioral dermatitis), and impairment in glucose metabolism.
Fluoride toothpastes sold in Australia generally contain between 1,000 and 1,100 parts per million (ppm) fluoride (the equivalent of over 1 mg of fluoride for each gram of paste). A child weighing 10kg would only need to ingest 1 to 3gms of paste (less than 3% of a tube of Colgate- for –Kids) to experience one or more of the above symptoms. Numerous studies have found that many children ingest a significant amount of fluoride each day from toothpaste alone. According to the Journal of Public Health Dentistry: “Virtually all authors have noted that some children could ingest more fluoride from [toothpaste] alone than is recommended as a total daily fluoride ingestion.”