Don’t Swallow Your Toothpaste
As of April 7th, 1997, the United States FDA (Food & Drug Administration) has required that all fluoride toothpastes sold in the U.S. carry a poison warning on the label. The warning cautions toothpaste users to:
“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.”
Why the Need for a Warning?
One of the little-known facts about fluoride toothpaste, is that each tube of toothpaste – even those specifically marketed for children – contains enough fluoride to kill a child.
As detailed below, most “Colgate for Kids” toothpastes – with flavors ranging from bubble gum to watermelon – contain 143 milligrams (mg) of fluoride in each tube. This dose of fluoride is more than double the dose (60 mg) that could kill the average-weighing 2 year old child. It is also greater than the dose capable of killing all average weighing children under the age of 9.
Fortunately, however, toothpaste-induced fatalities have been rarely reported in the US. In a review of Poison Center Control reports between 1989 and 1994, 12,571 reports were found from people who had ingested excess toothpaste. Of these calls, 2 people – probably both children – experienced “major medical outcomes”, defined as “signs or symptoms that are life-threatening or result in significant residual disability or disfigurement” (SOURCE: Shulman 1997).
Other problems with fluoride toothpaste
As common sense might indicate, death is not the only concern with fluoride toothpaste. Other potential problems with fluoride toothpaste include:
Ingestion of fluoride has been documented to produce symptoms of gastrointestinal discomfort at doses at least 15 to 20 times lower (0.2-0.3 mg/kg) than the doses which can kill (SOURCE: Gessner 1994; Akiniwa 1997). Thus, a 2 year old child may experience gastrointestinal ailments if they ingest a mere 2 to 3 percent of the bubble-gum flavored paste.
Between 1989 and 1994, over 628 people – mostly children – were treated at health care facilities after ingesting too much fluoride from their toothpaste. Gastrointestinal symptoms appear to be the most common problem reported (SOURCE: Shulman 1997).
Moreover, ingestion of fluoride toothpaste may damage the lining of the gastrointestinal tract – even in the absence of symptoms (e.g. nausea). This was revealed by a carefully conducted study on healthy adult volunteers which found that damage to the gastrointestinal wall occurred – in the absence of symptoms – after a single ingestion of just 3 mg of fluoride (SOURCE: Spak 1990). Undoubtedly, some children will periodically ingest 3 mg of fluoride, or more, from toothpaste in single sittings, especially if they have access to the bubble-gum flavored varieties (which are still being heavily marketed for children).
One of the most visible and well-recognized side-effects of ingesting fluoride toothpaste is a discoloration of teeth called dental fluorosis. Fluoride produces dental fluorosis by damaging the cells (ameloblasts) which produce the tooth’s enamel. The resulting discoloration of teeth can range from white spots in the mild forms of the disorder to brownish and black stains in the the moderate and severe forms.
Children with dental fluorosis – particularly those with the moderate or severe kinds – can experience significant esteem problems from the perceived unattractiveness of their teeth. As one young girl with dental fluorosis told British television:
“When I first saw that my teeth were discolored, I was teased quite a lot, especially in the middle school by people. They used to say, ‘oh you don’t clean your teeth or anything’ and they used to call me ‘shit teeth’ which did upset me, even though I knew it was fluorosis.”
Being that dental fluorosis is such a visible and tangible effect of over-exposure to fluoride, toothpaste companies are becoming increasingly vulnerable to litigation as public awareness of dental fluorosis increases. As a possible harbinger of what lies ahead for the industry, a family in England won a settlement from Colgate to pay for the costs of treating the dental fluorosis which their toothpaste caused.
Increasing Children’s Daily Intake of Fluoride beyond Recommended Levels
Since young children do not have well-developed swallowing reflexes, they tend to swallow a large percentage of the toothpaste placed on their brush. In fact, one of the more consistent findings in the recent dental literature, is that some children – even children living in unfluoridated communities – ingest more fluoride from toothbrushing alone than is recommended as the total daily exposure. As noted by Dr. Steven Levy, of the University of Iowa:
“Virtually all authors have noted that some children could ingest more fluoride from dentrifice alone than is recommended as a total daily fluoride ingestion” (SOURCE: Levy 1999).
It is clear therefore that fluoride toothpaste represents a very important source of ingested fluoride for children. The use of fluoride toothpaste may thereby contribute to the various health risks (e.g. dental fluorosis, bone fractures, bone cancer, neurotoxicity) associated with systemic fluoride exposure.
Among some ‘hypersensitive‘ individuals, the use of fluoride toothpaste may produce canker sores and skin rashes in and around the mouth. The evidence pointing to this possibility is compelling, but has received scant attention from the dental community.
Another potential side effect of fluoride toothpaste has only recently come to light. Research conducted in the 1990s from the US pharmaceutical company Sepracor indicated that the levels of fluoride in toothpaste may be sufficient to cause or contribute to periodontal bone loss. Sepracor’s finding is serious because periodontal bone loss is the #1 cause of tooth loss among adults. According to the scientists at Sepracor who conducted the study:
“We have found that fluoride, in the concentration range in which it is employed for the prevention of dental caries, stimulates the production of prostaglandins and thereby exacerbates the inflammatory response in gingivitis and periodontitis…. Thus, the inclusion of fluoride in toothpastes and mouthwashes for the purpose of inhibiting the development of caries [cavities] may, at the same time, accelerate the process of chronic, destructive periodontitis.”
Europe: Taking a More Cautious Approach than U.S.
As with water fluoridation, continental western Europe has taken a more precautionary approach with fluoride toothpaste than has so far been the case in the United States.
Due to concerns about children ingesting too much fluoride from toothpaste, many European countries are now utilizing children’s toothpastes with significantly lower levels of fluoride (250 – 500 ppm) than adult brands (1,000 ppm+). In the US, meanwhile, the vast majority of children’s toothpastes continue to have the same concentration of fluoride (1,000 ppm+) as adult toothpastes (1,000 ppm+).
Interestingly, “despite” the fact that the vast majority of western Europe does not fluoridate its water, and despite the fact that children’s toothpaste with lower fluoride levels are more common, Europe’s tooth decay rates are as low – if not lower – than the tooth decay rates in the heavily fluoridated United States.
FLUORIDE HEALTH EFFECTS DATABASE – OVERVIEW PAGE
“Over the past ten years a large body of peer-reviewed science has raised concerns that fluoride may present unreasonable health risks, particularly among children, at levels routinely added to tap water in American cities.”
ENVIRONMENTAL WORKING GROUP, July 2005.
“In summary, we hold that fluoridation is an unreasonable risk.”
US ENVIRONMENTAL PROTECTION AGENCY HEADQUARTERS’ UNION, 2001.
“Carefully conducted studies of exposure to fluoride and emerging health parameters of interest (e.g., endocrine effects and brain function) should be performed in populations in the United States exposed to various concentrations of fluoride.”
US NATIONAL RESEARCH COUNCIL, 2006
“I am quite convinced that water fluoridation, in a not-too-distant future, will be consigned to medical history.”
Dr. ARVID CARLSSON, Pharmacologist, Nobel Laureate in Physiology and Medicine, 2000.
FLUORIDE ACCIDENTS & POISONINGS (Click for more detail)
Fluoride, the active ingredient in many pesticides and rodenticides, is a powerful poison – more acutely poisonous than lead. Because of this, accidental over-ingestion of fluoride can cause serious toxic symptoms.
Each year there are thousands of reports to Poison Control centers in the United States related to excessive ingestion of fluoride toothpastes, mouthrinses, and supplements.
FLUORIDE & DENTAL FLUOROSIS (Click for more detail)
According to the Centers for Disease Control, 32% of American children now have some form of dental fluorosis, with 2 to 4% of children having the moderate to severe stages (CDC 2005).
According to Dr. Hardy Limeback, Head of Preventive Dentistry at the University of Toronto, “it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion.
FLUORIDE & ALLERGY/HYPERSENSITIVITY (Click for more detail)
As acknowledged by the Physicians’ Desk Reference, some individuals are allergic/hypersensitive to fluoride. The largest, government-funded, clinical trial found that 1% of individuals exposed to 1 mg/day of fluoride exhibited allergic/hypersensitive reactions, including skin reactions, gastric distress, and headache.
FLUORIDE & the KIDNEYS(Click for more detail)
The kidneys play a vital role in preventing the build-up of excessive fluoride in the body. Among healthy individuals, the kidneys excrete approximately 50% of the daily fluoride intake. However, among individuals with kidney disease, the kidneys’ ability to excrete becomes markedly impaired, resulting in a build-up of fluoride within the body.
It is well recognized that individuals with kidney disease have a heightened susceptibility to the cumulative toxic effects of fluoride.
Of particular concern is the potential for fluoride, when accumulated in the skeletal system, to cause, or exacerbate, renal osteodystrophy – a bone disease commonly found among people with advanced kidney disease.
In addition, fluoride has been definitively shown to poison kidney function at high doses over short-term exposures in both animals and humans. The impact of low doses of fluoride, given over long periods of time, has been inadequately studied. A recent animal study, conducted by scientists at the US Environmental Protection Agency (Varner 1998), reported that exposure to just 1 ppm fluoride caused kidney damage in rats if they drank the water for an extended period of time, while a new study from China found an increased rate of kidney disease among humans consuming more than 2 ppm (Liu 2005). Hence, the adverse effects to kidney function that fluoride causes at high doses over short periods of time, may also be replicated with small doses if consumed over long periods of time.
FLUORIDE & the BRAIN (Click for more detail)
Fluoride’s ability to damage the brain represents one of the most active areas of research on fluoride toxicity today.
Concern about fluoride’s impact on the brain has been fueled by 18 human studies (from China, Mexico, India, and Iran) reporting IQ deficits among children exposed to excess fluoride, by 4 human studies indicating that fluoride can enter, and damage, the fetal brain; and by a growing number of animal studies finding damage to brain tissue (at levels as low as 1 ppm) and impairment of learning and memory among fluoride-treated groups.
According to the US National Research Council, “it is apparent that fluorides have the ability to interfere with the functions of the brain.”
FLUORIDE & the PINEAL GLAND (Click for more detail)
In the 1990s, it was discovered that the pineal gland is a major site of fluoride accumulation within the body – with higher concentrations of fluoride than either teeth or bone.
Subsequent animal studies indicate that the accumulation of fluoride in the pineal gland can reduce the gland’s synthesis of melatonin, a hormone that helps regulate the onset of puberty. Fluoride-treated animals were found to have reduced levels of circulating melatonin and an earlier onset of puberty than untreated animals. The scientist who conducted the research concluded:
“The safety of the use of fluorides ultimately rests on the assumption that the developing enamel organ is most sensitive to the toxic effects of fluoride. The results from this study suggest that the pinealocytes may be as susceptible to fluoride as the developing enamel organ” (Luke 1997).
The fact that fluoride’s impact on the pineal gland was never studied, or even considered, before the 1990s, highlights amajor gap in knowledge underpinning current policies on fluoride and health.
According to the US National Research Council, “any agent that affects pineal function could affect human health in a variety of ways, including effects on sexual maturation, calcium metabolism, parathyroid function, postmenopausal osteoporosis, cancer, and psychiatric disease.”
FLUORIDE & the THYROID GLAND (Click for more detail)
According to the US National Research Council, “several lines of information indicate an effect of fluoride exposure on thyroid function” – particularly among individuals with an iodine deficiency.
Fluoride’s potential to impair thyroid function is most clearly illustrated by the fact that — up until the 1970s — European doctors used fluoride as a thyroid-suppressing medication for patients with hyperthyroidism (over-active thyroid). Fluoride was utilized because it was found effective at reducing the activity of the thyroid gland – even at doses as low as 2 mg/day.
Today, many people living in fluoridated communities are ingesting doses of fluoride (1.6-6.6 mg/day) that fall within the range of doses (2 to 10 mg/day) once used by doctors to reduce thyroid activity in hyperthyroid patients. This is of particular concern considering the widespread problem of hypothyroidism (under-active thyroid) in the United States. Symptoms of hypothyroidism include obesity, lethargy, depression, and heart disease.
FLUORIDE & BONE DISEASE (Click for more detail)
Excessive exposure to fluoride is well known to cause a bone disease called skeletal fluorosis.
In its advanced stages, fluorosis can resemble a multitude of bone/joint diseases.
In individuals with kidney disease, fluoride exposure can contribute to, and/or exacerbate, renal osteodystrophy.
FLUORIDE & BONE FRACTURE(Click for more detail)
The majority of animal studies investigating fluoride’s effect on bone strength, have found fluoride to either have no effect or a negative effect on strength. According to the US National Research Council, “The weight of evidence indicates that, although fluoride might increase bone volume, there is less strength per unit volume.”
Studies on human populations consuming fluoride in drinking water have found an association between dental fluorosis and increased bone fracture in children; and between long-term consumption of fluoridated water and increased hip fracture in the elderly.
Carefully conducted human clinical trials – including two “double-blind trials” – have found that fluoride (at doses of 18-34 mg/day for just 1-4 years) increases the rate of bone fracture, particularly hip fracture, among osteoporosis patients.
FLUORIDE & CANCER (Click for more detail)
According to the National Toxicology Program, “the preponderance of evidence” from laboratory ‘in vitro’studies indicates that fluoride is a mutagenic compound. Many substances which cause mutagenic damage also cause cancer.
While the concentrations of fluoride causing mutagenic damage in laboratory studies are higher than the concentrations found in human blood, there are certain “microenvironments” in the body (e.g. the bonesand the bladder) where the concentrations of fluoride can accumulate to levels comparable to, or in excess of, those causing mutagenic effects in the laboratory.
Fluoride has been found to cause bone cancer (osteosarcoma) in government animal studies and rates of osteosarcoma among young males living in fluoridated areas have been found to be higher than young males living in unfluoridated areas. Osteosarcoma, while rare, is a very serious cancer. Children who develop osteosarcoma face a high probability of death (usually within 3 years) or amputation.
Fluoride exposure has also been linked to bladder cancer – particularly among workers exposed to excess fluoride in the workplace. According to the US National Research Council, “further research on a possible effect of fluoride on bladder cancer risk should be conducted.”
FLUORIDE & the GASTROINTESTINAL TRACT (Click for more detail)
Among people hypersensitive to fluoride, gastrointestinal ailments have been produced following ingestion of 1 mg tablets of fluoride or consumption of 1 ppm fluoridated water.
A single ingestion of as little as 3 mg of fluoride, in carefully controlled clinical trials, has been found to produce damage to the gastric mucosa in healthy adult volunteers. No research on the gastric mucosa has ever been conducted to determine the effect of lower doses with repeated exposure.
FLUORIDE & TOOTH DECAY (Caries)(Click for more detail)
According to the current consensus view of the dental research community, fluoride’s primary – if not sole – benefit to teeth comes from TOPICAL application to the exterior surface of teeth, not from ingestion.
Perhaps not surprisingly, therefore, tooth decay rates have declined at similar rates in all western countries in the latter half of the 20th century – irrespective of whether the country fluoridates its water or not. Today, tooth decay rates throughout continental western Europe are as low as the tooth decay rates in the United States – despite a profound disparity in water fluoridationprevalence in the two regions.
Within countries that fluoridate their water, recent large-scale surveys of dental health – utilizing modern scientific methods not employed in the early surveys from the 1930s-1950s – have foundlittle difference in tooth decay, including “baby bottle tooth decay”, between fluoridated and unfluoridated communities.
Akiniwa, K. (1997). Re-examination of acute toxicity of fluoride. Fluoride 30: 89-104.
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.
Spak CJ, et al. (1990). Studies of human gastric mucosa after application of 0.42% fluoride gel. Journal of Dental Research 69:426-9.
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.
Whitford GM. (1987). Fluoride in dental products: safety considerations. Journal of Dental Research 66: 1056-60.
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