Your Dentist Australia

Important numbers

Toothpaste is intended to be used in the mouth as a topical agent only and to be spat out or rinsed out at the end of brushing. It should NEVER be deliberately swallowed in large amounts. Most mainstream brands of toothpaste contain fluoride, which helps strengthen the teeth. If toothpastes are swallowed in large quantities, this can cause illness from the detergents and other components, as well as from the fluoride.

Children’s toothpastes are low in fluoride levels to reduce the possibility of harm from accidental ingestion of small amounts. Adult toothpastes should be kept out of reach of young children, and parents should supervise toothbrushing for young children to prevent them ingesting large quantities of toothpaste.

If a small child ingests a large quantity of adult strength or high strength fluoride toothpaste, adverse effects will be expected at a fluoride dose level of 5 mg fluoride ion per kg body weight. This is known as the probably toxic dose (PTD), and is the minimum dose that should trigger immediate medical attention. Doses for children over 15 mg fluoride ion per kg body weight can potentially be fatal, while for an adult, over 32 mg fluoride ion per kg body weight would be required.

What do these dosage numbers mean in terms of toothpaste amounts? Normal adult strength toothpastes in Australia contain 1 mg of fluoride per mL, and the most common adult toothpaste tube size contains 100 mL, so the tube contains 100 mg fluoride in total. For a 1 year old child (body weight 10 kg) the PTD would be 50 mL (half the tube), and for a 5 year old (body weight 19 kg) the PTD would be 95 mL (the whole tube).

Child strength toothpaste is lower in fluoride concentration (0.4 mg/F per mL), and the tubes are deliberately made smaller, in the range of 50-75 mL, so the whole tube contains in the range of 20- 30 mg fluoride. For a 1 year old child (body weight 10 kg) the PTD of 50 mg would be much more than the whole tube. Actually swallowing a whole tube of toothpaste is difficult because severe nausea is caused by the detergent used in toothpaste.

What to do if my child swallows toothpaste

The recommended amount of toothpaste to be used in a child is less than a pea size amount (0.5 mL) of child strength toothpaste. As child strength toothpaste is weaker than adult toothpaste, 2.5 mL of toothpaste is needed to get 1 mg of fluoride ion. The amount of fluoride in the recommended pea size is only 0.25 mg. If this small amount if accidentally swallowed by the child, it is 200 times less than the PTD, and thus there will not be adverse symptoms from the fluoride content.

If your child swallows a large amount of adult fluoride toothpaste (for example if they decide to try to eat a tube of toothpaste), then immediately call the Poisons Information Centre on 13 11 26 or dial 000.

The symptoms of fluoride poisoning include:

• Nausea and vomiting
• Cramping and burning abdominal pains
• Excessive salivation and drooling
• Muscle spasms and convulsions
• Weakness
• Slower heart rate and abnormal heart rhythms
• Disorientation.

Before calling, determine the following information:

• The child's age, weight and condition;
• The name of the product (as well as the concentration of fluoride – which will be normally be marked in parts per million (ppm) – 1000 ppm is the same as 1 mg of fluoride per mL);
• The time it was swallowed; and
• An estimate of the amount swallowed.

Toothpaste and children

There are many proven benefits for children to use a toothpaste containing fluoride. Toothpastes specially formulated for children that contain low levels of fluoride (400 ppm) are available in supermarkets and pharmacies and these should be used instead of an adult strength toothpaste (1000 ppm). Deliberate swallowing of toothpastes should be discouraged, and children supervised when brushing and then encouraged to spit and rinse afterwards. Keep tubes of toothpaste out of reach of children.

Dental fluorosis

If your child ingests too much fluoride in a short period of time, particularly between the ages of 1 and 4, a condition known as dental fluorosis may result. In its mild form, which is the most common, fluorosis appears as tiny white streaks or specks on the tooth enamel that are often unnoticeable. In its severest form, which is also called mottling of dental enamel, it is characterized by brown stains and pitting of the enamel surface. The severity of dental fluorosis depends on the amount of fluoride exposure and the age of the child, as well as other factors including nutrition. Moderate fluorosis that is cosmetically significant can be reversed using dental treatments such as microabrasion and Tooth Mousse™, while severe fluorosis is often treated using dental bleaching followed by a veneer of tooth coloured adhesive filling material placed on the tooth surface.

What to do if an adult swallows toothpaste

The toxicity of fluoride is less in adults than in children. For a 70 kg adult, the lethal dose of 4-10 grams of fluoride would require swallowing at least 4 liters of toothpaste, or 20 whole 200 mL tubes of toothpaste, which is impossible not only because of the volume but because of the limiting effects of the detergents. Swallowing a large amount of adult strength toothpaste may cause stomach burning and cramping.

Further reading

Fluoride in dental products: safety considerations - Journal of Dental Research

The physiological and toxicological characteristics of fluoride - Journal of Dental Research

Contents of toothpaste - safety implications - Australian Prescriber

Toothpaste Overdose – MedlinePlus