Fluoride in Dental Products
"If
you accidentally swallow more than used for brushing, seek professional help or
contact a poison control center immediately."
Toothpastes
Over
95% of the toothpaste sold in the U.S. now contains fluoride, with many grocery
stores carrying few if any non-fluoridated brands. The use of fluoride
toothpaste, particularly during early childhood, presents health risks. This is
why the FDA requires a poison warning on every tube of fluoride toothpaste now
sold in the US.
Risks
from ingesting fluoride toothpaste include permanent tooth discoloration
(dental fluorosis), stomach ailments, acute toxicity, skin rashes (perioral
dermatitis), and impairment in glucose metabolism. All of these risks have been
unnecessarily increased by the marketing practices of toothpaste manufacturers,
who use cartoon packaging and candy-flavors to target
*adult-strength* fluoride toothpaste to young *children.* The dental
community’s failure to educate the public about the dangers of swallowing too
much fluoride toothpaste has further exacerbated the problem.
A Major Source of Children’s Daily Fluoride Intake
Fluoride
toothpastes sold in the U.S. generally contain between 1,100 and 1,450 parts
per million (ppm) fluoride (the equivalent of over 1 mg of fluoride for each
gram of paste). Although the fine print on the back of the toothpaste tube
instructs users not to swallow and to use only a “pea-sized” amount,
advertisements continue to depict heaping swirls of paste on the brush, (Basch
2013), and manufacturers continue to market fluoride toothpastes in bubble-gum,
fruit, and candy-like flavors (Basch 2014). Using child-appealing flavors is
particularly dangerous because young children have poorly developed
swallowing reflexes, and invariably swallow large amounts of the paste they add
to the brush.
Not
surprisingly, 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.” (Levy 1999).
A Major Risk Factor for Dental Fluorosis
One
side effect from swallowing too much fluoride is dental
fluorosis. Dental fluorosis is a defect in tooth enamel caused by
excessive fluoride intake during the tooth-forming years (age 0 to 8). In its
mild forms, dental fluorosis presents as cloudy white splotches and streaks on the teeth, while
in its moderate and severe forms, fluorosis can cause extensive brown and black staining along with pitting and
crumbling of the enamel. Children who ingest a lot of toothpaste (whether
accidentally or purposefully), can develop the disfiguring brown and black
stains of advanced fluorosis, particularly if they also drink fluoridated
water. Fluorosis on the front teeth, even in its “mild” forms, but especially in its severe forms, can cause self-esteem problems for
a child, particularly when they reach adolescence.
Acute Poisoning
In
1997, the FDA ordered toothpaste manufacturers to add a poison warning on all fluoride toothpastes sold
in the U.S. The warning reads:
“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.”
The
FDA requires this warning because children who swallow too much fluoride
toothpaste can suffer acute poisoning, even death.
In fact, a single tube of bubble-gum flavored Colgate-for-Kids toothpaste
contains enough fluoride (143 mg) to kill a child
weighing less than 30 kg. (Whitford 1987a).
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. (Akiniwa 1997; Gessner 1994). A child
weighing 10 kg would only need to ingest 1 to 3 grams of paste (less than 3% of
a tube of Colgate-for-Kids) to experience one or more of these symptoms.
Although
it is believed that many poisoning incidents from fluoride toothpaste go
undiagnosed and unreported (Shulman 1997), the number of calls to Poison
Control Centers in the U.S. for fluoride poisonings from toothpaste has
skyrocketed since the FDA issued its poison warning. Indeed, in the early 1990s
(prior to the FDA’s warning), there were about 1,000 poisoning reports each
year from fluoride toothpaste. (Shulman 1997). Today, there are
over 23,000 reports a year, resulting in hundreds of emergency room
treatments.
Reports
to Poison Control Centers in U.S.
Due to Excessive Ingestion of Fluoride Toothpastes Data from: Brownstein (2009, 2010) & Watson (2003) |
||||||||
|
|
|
# Treated in
Emergency Room |
Medical Outcome*
|
||||
Year
|
Product
|
# Reports
|
None
|
Minor
|
Moderate
|
Major
|
Death
|
|
2009
|
F Toothpaste
|
24,547
|
378
|
4,781
|
1,146
|
42
|
2
|
0
|
2008
|
F Toothpaste
|
23,468
|
383
|
4,395
|
1,119
|
43
|
1
|
0
|
2002
|
F Toothpaste
|
24,087
|
411
|
4,852
|
1,218
|
40
|
1
|
1
|
* Minor
effect: Minimally bothersome signs or symptoms that generally
resolved without residual disability or disfigurement (e.g.
self-limiting gastrointestinal symptoms). Moderate effect: More
pronounced or prolonged signs or symptoms, or more of a systemic nature than
minor systems. While the symptoms are not life-threatening (e.g.,
disorientation or high fever that responds readily to treatment), some form
of treatment is indicated. Major effect: Signs and
symptoms that are life-threatening or result in significant residual
disability or disfigurement. (Shulman 1997)
|
Skin Rashes
Among
some individuals, the use of fluoride toothpaste may cause or aggravate perioral dermatitis (a rosacea-like skin
rash around the mouth). (McCaffery 2003; Mellette 1983, 1976). The condition
usually appears in women between the ages of 20 and 50. Where fluoride
toothpaste is the cause of the condition, significant improvement in symptoms
will be experienced within a few weeks of using a non-fluoridated toothpaste.
In addition to dermatitis, fluoride toothpaste may also cause stomatitis (i.e., mouth ulcers, “canker
sores”). (Brun 2004; Douglas 1957).
Impaired Glucose Metabolism
Perhaps
the most important, yet most overlooked, risk from excessive ingestion of
fluoride toothpaste, is the impact it can have on blood glucose and insulin
levels. In the 1980s, researchers at the University of Indiana reported that
rats receiving acute, but relatively small, doses (0.5 mg/kg) of fluoride, had
significantly higher glucose levels in their blood, and decreased levels of
insulin. (Shahed 1986; Whitford 1987b). Since that time, numerous studies have
repeated this finding (in both animals and humans) at doses which many children
routinely ingest from fluoride toothpaste. It is now estimated, for example,
that blood fluoride levels of just 95 ppb produce an increase in glucose levels
and a decrease in insulin. (Menoyo 2005). Strikingly, this level is routinely
exceeded by about 5 to 10% of children using fluoride toothpaste (particularly
those living in fluoridated communities).
This
finding raises the obvious question of whether the widespread use and ingestion
of fluoride toothpaste is contributing to, or exacerbating, the rising
prevalence of diabetes in children. Diabetes is a condition
caused by persistently high glucose levels. A chemical that can simultaneously
increase glucose levels and decrease insulin (insulin is a hormone that helps
clear glucose from the blood) should be handled very carefully, particularly
among those who already have diabetes. Indeed, several researchers have already
begun suggesting that diabetic children should use toothpastes with
low-fluoride content. As noted by the authors in a recent study from the
Journal of Fluoride Chemistry:
“[K]nowing
that chronic [fluoride] intake is capable of decreasing insulin signal and
causing insulin resistance, the use of dentifrices with lower F content
is recommended, especially for diabetic children, for whom
excessive F consumption may lead to health implications.” (Chiba 2012).
References:
- Akiniwa, K. (1997). Re-examination of acute toxicity of fluoride. Fluoride 30: 89-104.
- Basch CH, Rajan S. (2014). Marketing strategies and warning labels on fluoride toothpaste. Journal of Dental Hygiene 88(5):316-9.
- Basch CH, et al. (2013). Advertising of toothpaste in Parenting Magazines. Journal of Community Health 38(5):911-4.
- Bronstein AC, et al. (2010). 2009 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 27th Annual Report. Clinical Toxicology 48:979-1178.
- Bronstein AC, et al. (2009). 2008 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th Annual Report. Clinical Toxicology 47:911-1084.
- Brun R. (2004). Recurrent Benign Aphthous Stomatitis and Fluoride Allergy. Dermatology 208: 181.
- Chiba FY, et al. (2012). NaF treatment increases TNF-a and resistin concentrations and reduces insulin signal in rats. Journal of Fluorine Chemistry 136:3-7.
- Gessner BD, et al. (1994). Acute fluoride poisoning from a public water system. New England Journal of Medicine 330:95-9.
- Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23.
- McCaffery K. (2003). Fluoride and dermatitis. Journal of the American Dental Association 134: 1166.
- Mellette JR, et al. (1983). Perioral dermatitis. Journal of the Association of Military Dermatologists 9: 3-8.
- Mellette JR, et al. (1976). Fluoride tooth paste: A cause of perioral dermatitis. Archives of Dermatology 112: 730-731.
- Menoyo I, Rigalli A, Puche RC. 2005. Effect of fluoride on the secretion of insulin in the rat. Drug Res 55(5):455-60.
- Shahed AR, et al. (1986). Effect of F on rat serum insulin levels in vivo. Journal of Dental Research 65:756.
- Shulman JD, Wells LM. (1997). Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. Journal of Public Health Dentistry 57: 150-8.
- Watson WA, et al. (2003). 2002 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. American Journal of Emergency Medicine 21:353-421.
- Whitford GM. (1987a). Fluoride in dental products: safety considerations. Journal of Dental Research 66: 1056-60.
- Whitford GM, et al. (1987b). Topical fluorides: effects on physiologic and biochemical processes. Journal of Dental Research 66(5):1072-8.
Being a middle child from a big family(at least by today's standards) one is often on the lookout for trouble. Fluoride is trouble with a capital F. Many wonder who put the F in fluoride. This song may help answer that question SingAlong
ReplyDeleteAnother very good folk song with a message everyone should listen to. I would never want a parent to make a baby's formula with the drinking water from town water with fluoride added. The very worse part is that many people may not be aware that there is fluoride in it. The best thing the Water Department could do for the people in our town on town water would be to take the fluoride out, but seeing they won't do it, they could at least put a warning on the water bills, so parents can make up their own minds. Bev.
DeleteThere have been references to a man named John Taylor Gatto the author of The Underground History of American Education here on Pauly's Blog, by myself. My research has found that fluoride has been added to our water supply by big corporations that may not have our best interest in mind. These same corporations as mentioned in Bryson's book The Fluoride Deception are controlled by wealthy interests who may not share our common values. Insight on this matter can be enhanced by spending some time watching Gatto's excellent interview with Tragedy and Hope founder Richard Grove called The Ultimate History Lesson, you will not be disappointed. UltimateHIstoryLesson
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