The main toothpaste ingredient of concern is fluoride… first added to toothpastes in 1914; it was initially criticized by the American Dental Association (ADA) in 1937. Since 1991, the ADA began requiring that all toothpaste companies include the following words on all ADA-Accepted toothpastes:
Children 2 to 6 years: Use only a pea sized amount and supervise child’s brushing and rinsing (to minimize swallowing). Children under 2 years: Ask a dentist or physician.
I have also seen it worded as:
Do not swallow. To minimize swallowing use a pea-sized amount in children under 6. Supervise children’s brushing until good habits are established. Children under 2 years: ask a dentist.
This message was intended by the ADA to avoid cases of fluorosis*, but has been included in the directions rather than as a warning, with no explanation as to why the wording.
* The ADA wording was required in an attempt to reduce the risk of fluorosis, which is a permanent defect that develops most often while the teeth are still forming but which can effect any age teeth; and consists, in its mild form, of noticeable light spots or streaks on teeth and, in its severe forms, of black and brown stains and also cracking and pitting.
I think most people, as I did for many years, assume the wording exists to avoid gastrointestinal discomfort* associated with swallowing an otherwise harmless toothpaste.
* Whereas, in fact… it has been shown by a study on healthy adults that ingestion of fluoride toothpaste results in damage to the lining of the gastrointestinal tract, even in the absence of symptoms (e.g. nausea)… after a single ingestion of just 3 mg of fluoride; — [SOURCE: Spak CJ, et al. (1990). Studies of human gastric mucosa after application of 0.42% fluoride gel. Journal of Dental Research 69:426-9.].
As far as toothpaste is concerned, children often ingest 3 mg of fluoride, even when not brushing… especially if the toothpaste is bubble-gum flavored or otherwise marketed towards children.
More recently, in 1997, the Food and Drug Administration (FDA) decided to shed some light on the dangers of fluoride in toothpaste, by mandating the following warning on all fluoride toothpastes:
Warning — Keep out of the 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.
The FDA considers fluoride to be a ‘poison’ and an ‘unapproved new drug’.
Fluoride is more toxic than lead and only slightly less toxic than arsenic.
This image is based on LD50 data from Robert E. Gosselin et al, Clinical Toxicology of Commercial Products 5th ed., 1984.
So diverse are fluoride containing compounds, that it is impossible to generalize on their toxicity, which depends on their reactivity and structure… in the case of fluoride salts (of which sodium fluoride [commonly found in toothpastes and many other consumer foods, beverages {including tap water}, and drugs] is the most common)… their solubility and ability to release fluoride ions.
Soluble fluoride salts, of which sodium fluoride (commonly found in toothpaste) is the most common, are toxic and have resulted in human deaths. The absolute minimum fatal dose in humans is not known. The average fatal dose for adults is estimated as 5 to 10 grams (32 to 64 mg elemental fluoride per kg body weight) and 500mg in children, with a documented case of a fatal poisoning of an adult with 4 g of sodium fluoride, while a dose of 120 g sodium fluoride has been survived. Death may result from ingesting as little as 2 g of fluoride in an adult and 16 mg/kg in children… a toxic dose leading to adverse health effects is estimated at 3 to 5 mg/kg of elemental fluoride; — [SOURCES: Gosselin, RE; Smith RP, Hodge HC (1984). Clinical toxicology of commercial products. Baltimore (MD): Williams & Wilkins. pp. III-185–93. / Baselt, RC (2008). Disposition of toxic drugs and chemicals in man. Foster City (CA): Biomedical Publications. pp. 636–40. / IPCS (2002). Environmental health criteria 227 (Fluoride). Geneva: International Programme on Chemical Safety, World Health Organization. pp. 100. / I. M. Rabinowitch. “Acute Fluoride Poisoning”. Can Med Assoc J. 1945, 52, 345–349. / Abukurah AR, Moser AM Jr, Baird CL, Randall RE Jr, Setter JG, Blanke RV (1972). “Acute sodium fluoride poisoning”. JAMA 222 (7): 816–7.].
One death from ingestion of fluoride toothpaste was reported to the American Association of Poison Control Centers in 2002.
It has been long known that the acute effects of fluoride are such that it
combines with the calcium of the tissues and becomes, therefore, a proto-plasmic poison
sodium-fluoride produces disorders of the calcium metabolism similar to those which occur after removal of the para-thyroid glands, the general effects appear to be due to the withdrawal of calcium from the fluids and tissues of the body; [SOURCE FOR BOTH QUOTES: I. M. Rabinowitch, M.D., C.M., D.Sc., F.R.C.P.[C.]. Acute Fluoride Poisoning, From the Department of Metabolism, the Montreal General Hospital. Can Med Assoc J. 1945, 52, 345–349.].
Here is an excerpt from Acute Fluoride Poisoning, sourced in the above paragraph, which… while an extreme case… may shed some more factual light on the actual dangers of fluoride in the human body and the nature of its toxicity:
The patient was moribund and died before calcium gluconate could be administered. The case is, however, instructive because of (a) the extremely low blood calcium and (b) the slight degree of corrosion of the stomach, which clearly indicated that death was not due to the corrosive action of the poison but largely to the reduction of the calcium content of the blood. The following are, briefly, the facts of the case.
A man, aged 39, was admitted to the outdoor department of the Montreal General Hospital with a history of having attempted suicide by ingestion of sodium fluoride. Though, in “shock”, he was able to tell the intern on duty what he had taken and when he had taken it. He also stated that, soon after he had taken the poison, he began to have “muscle spasms'” in the feet and hands. He did not vomit. When the intern saw him, the striking features were salivation, low blood pressure and “spasm of the hands resembling the carpal spasm of tetany”. The stomach was washed thoroughly and about 15 gm. of calcium lactate were left in the stomach. He lost consciousness rapidly and died from respiratory failure three hours and five minutes after ingestion of the poison. A sample of blood, taken a few minutes before he died, showed 2.6 mgm. only of calcium per 100 c.c. of serum, which, as far as I have been able to ascertain, is the lowest value ever found in a human being.
(Normal = 9 to 11.5 mgm. per 100 c.c.)
At the autopsy (by the coroner) the only evidence that a corrosive poison had been taken was a small area of swelling of the mucosa of the stomach near the duodenum, which fitted in with the complete absence of vomiting both before and after his admission to the hospital. A case with no gastro-intestinal symptoms has been reported by McNally.
Before describing treatment recommended in such cases, an attempt will be made to summarize briefly the essential facts about fluorine and fluorine-containing compounds and their toxicology, in view of the increasing use of these compounds in industries.
Fluorine is widely distributed in nature. It is, therefore, a constituent of normal body tissues, particularly teeth and bone; but, like lead, it is present in minute traces and probably as a contamination rather than for physiological needs. Sodium fluoride is a corrosive and a general protoplasmic poison. It is poisonous to plants and bacteria and inhibits enzyme action (urease, lipase, etc.). It combines with calcium in an ionic state to form insoluble calcium fluoride. Calcium, as is well known, is indispensable for the functional integrity of the voluntary and autonomic nervous systems; but only calcium in ionic form is physiologically active, and it is precisely such calcium which is attacked by fluorides. Sodium fluoride thus lowers the available calcium of the blood and thus produces low-calcium tetany. For the same reason, sodium fluoride is an anticoagulant, but also probably by an effect upon thrombin formation and also injury to the liver. Normal coagulation, for example, is not restored by replacing the calcium lost by precipitation but only if thrombin is also added.
Sodium fluoride is not very soluble (a saturated solution contains, approximately, 4 grams per 100 c.c.) but, when in solution, it is rapidly absorbed from the stomach. Destruction of the mucous membrane lining of the stomach increases the absorption. Unlike the other halogens (chlorine, bromine and iodine), however, it is slowly excreted and thus tends to accumulate in the body tissues
as insoluble calcium fluoride, which tends to deposit in the liver, kidneys and other tissues, as readily recognizable crystals. When deposited in bone, the calcium fluoride makes the latter white, harder and more brittle. Unlike oxalic acid, which also combines with, and thus lowers, the available calcium in the blood, sodium fluoride also exerts an alkaloid-like reaction. In lower organisms, for example, which do not require calcium, the fluorides still exert this action; whereas, oxalic acid does not.
Fatal dose. — The minimum lethal dose is not known. About 4 gm. have caused death in an adult. In general, the more soluble the fluoride the greater is its toxicity; but fluorine content is an equally important factor. Sodium fluosilicate (Na2SiF6) for example, used widely as a rat poison, is much less soluble than sodium fluoride, but, when adjusted to fluorine content, the toxicity is approximately the same. As little as 0.2 to 0.7 gm. of sodium fluosilicate have caused death in adults.
Fatal period. — Though the salts tend to act more slowly than hydrofluoric acid, death has resulted within 5, 10 and 15 minutes, but periods of 10 to 12 hours have been noted. In the case cited above, death occurred in three hours. The average is about eight hours.
Post-mortem appearances. — Depending upon the degree of irritation and corrosion, the appearance of the mucosa of the stomach may vary from that of slight inflammation only to dark crimson discoloration of the rugae, marked oedema, haemorrhage and necrosis with marked blackening. Changes in the muscularis are, however, rare. If death has not occurred for some time, similar changes may be noted in the duodenum and jejunum. The liver and kidneys may show extensive and severe parenchymatous changes and, as stated, may contain crystalline deposits of calcium fluoride. As much as 1.6 mgm. of CaF2 per 100 gm. of soft tissue has been found in a fatal case, compared with the “normal” 20 to 80 micrograms.
Signs and symptoms. — As a rule, the initial signs and symptoms are produced by the corrosive action of the poison-burning sensation in the mouth, dysphagia, great thirst, salivation, abdominal pain, nausea, and vomiting. As the corrosive effects become more marked, there is diarrhoea; the vomitus and faeces may contain blood, and death may result from shock; but, as in the case cited above, the dominant signs and symptoms may be those of a lowered blood calcium-stiffness of muscles, paralysis of the facial muscles, inability to talk, inability to walk, classical low-calcium tetany of the hands and feet, epileptiform convulsions, etc. Death may then occur from asphyxia due to fixation of the respiratory muscles. In a series of 34 cases, convulsions occurred in 11, approximately 33%. Fluorides also have a direct toxic action on heart muscle and thus may reduce the blood pressure, independent of shock, and cause death from heart failure.
TOTAL COMBINED FLUORIDE INTAKE
Add to the fluoride in toothpaste that enters the body by being swallowed or sublingually, the amount of elemental fluoride naturally occuring in food and water, plus the amount added to many food and drink products, plus the amount added to the water by the government… and consider whether or not there is a reliable way of determining if you are being poisoned… and also consider if there is enough scientific data to safely say that fluoride doesn’t accumulate permanently in the body… and you begin to see why people are beginning to understand the dangers associated with fluoride.
Besides the danger of swallowing toothpaste, fluoride is absorbed sublingually in the mouth, so even if no toothpaste is swallowed, brushing with fluoride toothpaste puts fluoride in the bloodstream. We know that fluoride is a toxin, but is there enough data to safely say with certainty that fluoride is not retained in the body and that it does not accumulate irreversibly, in a similar manner as some other toxins do?
SOME EYE OPENING QUOTES ABOUT FLUORIDE:
Fluoride is a persistent bioaccumulator, and is entering into human food-and-beverage chains in increasing amounts. – Marier J, Rose D. (1977). Environmental Fluoride. National Research Council of Canada. Associate Committe on Scientific Criteria for Environmental Quality. NRCC No. 16081.
Based on this review, we conclude that fluoride intakes of infants and children have shown a rather steady increase since 1930, are likely to continue to increase, and will be associated with further increase in the prevalence of enamel fluorosis unless intervention measures are instituted. – Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60(3):131-9.
The prevalence of dental fluorosis in the United States has increased during the last 30 years, both in communities with fluoridated water and in communities with nonfluoridated water. – Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60(3):131-9.
The increase in [dental fluorosis] suggests that the total systemic fluoride exposure for children during dental development has changed since the 1940s. – Pang D, et al. (1992). Fluoride intake from beverage consumption in a sample of North Carolina children. Journal of Dental Research 71: 1382-1388.
A few cases of more severe fluorosis can be found now in some communities. Because the prevalence of fluorosis is now higher than 50 years ago, we can conclude that fluoride availability… has increased in North American children. – Rozier RG. (1999). The prevalence and severity of enamel fluorosis in North American children. Journal of Public Health Dentistry 59(4):239-46.
My reasons for choosing the above toothpaste are because, of course, that it is fluoride and SLS free… but also that Tom’s of Maine uses all natural ingredients, they are a charitable company, and their products are made in the U.S.A (quality control is important to me).
I do not have sensitive teeth, so I cannot make an honest recommendation to those who do.
The only real way to know which is the best toothpaste for you is to try a few according to your needs and discover which one(s) you prefer. Have a few different kinds of toothpaste and use them in series or alternatively, so your teeth and overall wellbeing get the benefit and do not have to rely too heavily on only one list of ingredients… and besides, it is enjoyable to brush with different toothpastes… sort of like not chewing the same flavor gum every time.
What do you think about fluoride in toothpaste or otherwise?
This image is based on LD50 data from Robert E. Gosselin et al, Clinical Toxicology of Commercial Products 5th ed., 1984.
About me… 
Leave a Reply