Tooth Paste Poison!

This entry started out as a Bathroom Pet Peeve List then took an unexpected scary turn. Please supervise your young children when they are brushing with their fluoride toothpaste. This in no way means that your child does not need fluoride or should stop brushing their teeth.

When you were little did your mother tell you not to swallow the toothpaste when brushing your teeth? Mine did and apparently with good reason although no one told me the reason why. It was just recently while "trapped" in a bathroom at a hotel did I find the time to read the warning label on my daughter's Hello Kitty toothpaste!

"Keep out of reach of children under 6 years of age. If more than used for brushing is accidentally swallowed, get medical help or contact a Poison Control Center right away."


My first thought is how much is more than used for brushing? Is there a limit? I usually put a dime sized blob on Snow White's toothbrush due to most of it being run off when she holds it under the faucet before putting it in her mouth.

"Directions
* Adults and children 2 years of age and older" Brush teeth thoroughly, preferably after each meal or at least twice a day, or as directed by a dentist or physician.

* Instruct children under 6 years of age in good brushing and rinsing habits (to minimize swallowing).

* Use a pea-sized amount for children under 6.

* Supervise children as necessary until capable of using with out supervision.

* Children under 2 years of age: Consult a dentist or physician."

Logo at bottom "Zooth, Makes Healthy Fun." I kid you not!

Same warning on my Colgate toothpaste and every other fluoride toothpaste I later saw in the toothpaste isle. What if you thought your child was just exuberant about brushing their teeth and did so 5 or 6 times a day? Are they addicts? Should we call the Poison Center? Snow White has two new teeth and very excited about them. I am putting all toothpaste in a child safety cupboard out of her reach. If she wants to brush her teeth it will be under adult supervision and dispensed in lean measure. From now on no matter how much is rinsed off under the faucet before it reaches her mouth.

Here is what I found...

Last Updated: June 15, 2006

Editor(s): David C Lee, MD, Research Director, Assistant Professor, Department of Emergency Medicine, North Shore University Hospital and New York University Medical School; John T VanDeVoort, PharmD, Clinical Assistant Professor, College of Pharmacy, University of Minnesota; Michael J Burns, MD, Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center; John Halamka, MD, Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Asim Tarabar, MD, Assistant Clinical Professor of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

"Once absorbed, fluoride binds calcium ions and may lead to hypocalcemia. Fluoride has direct cytotoxic effects and interferes with a number of enzyme systems; it disrupts oxidative phosphorylation, glycolysis, coagulation, and neurotransmission (by binding calcium). Fluoride inhibits Na+/K+ -ATPase, which may lead to hyperkalemia by extracellular release of potassium. Fluoride inhibits acetylcholinesterase, which may be partly responsible for hypersalivation, vomiting, and diarrhea (cholinergic signs). Seizures may result from both hypomagnesemia and hypocalcemia. Severe fluoride toxicity will result in multiorgan failure. Central vasomotor depression as well as direct cardiotoxicity also may occur. Death usually results from respiratory paralysis, dysrhythmia, or cardiac failure.


Frequency:

In the US: In 2004, the American Association of Poison Control Centers reported 24,180 exposures involving toothpaste with fluoride.
Only 440 cases were actually treated in the emergency department.

Mortality/Morbidity: One death from ingestion of fluoride toothpaste was reported to the American Association of Poison Control Centers in 2002.

No deaths were reported in 2004.

Death may result from ingesting as little as 2 g of fluoride in an adult and 16 mg/kg in children. Symptoms may appear with 3-5 mg/kg of fluoride.
Estimated toxic dose for fluoride ingestion is 5-10 mg/kg.
Estimated lethal dose is 5-10 g (32-64 mg/kg) in adults and 500 mg in small children.
Age: Children younger than 6 years account for the vast majority of the cases. In 2004, this age group had a total 21,890 exposures, while adults 19 years and older had only 1213 exposures. "

Infants and children usually have accidental exposures.
I have to admit after having an onion bagel or the like for breakfast/snack at work, I brush my teeth then place a large dollop of toothpaste on my tongue and swallow it! I thought if it went all the way down the track and in to my stomach it would help mask the halitosis created by said breakfast/snack. My logic being the food was in my mouth, went down the track and resting in my stomach. This is not something I do frequently. It has been during instances such as when I was about to have a meeting and no mints available.

I thought my mother was telling me not to swallow the toothpaste due to any tartar or bacteria loosened during our in between dental visits would cause heart problems. Many people take prescriptions before going to the dentist to prevent bacteria from collecting on the heart.

For the full article go to: eMedicine - Toxicity, Fluoride : Article by Geofrey Nochimson, MD

Another useful link for all: www.aapcc.org/ American Association of Poison Control Centers