Acute Poisoning

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 childweighing 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)