Toothpaste: A close brush with poison
What Doctors Don't Tell You,
Volume 11, No.4, July 2000.
Toothpaste can contain amounts of fluoride
damaging to adults and lethal to children. Yet, manufacturers are lax about
providing warnings or directions about a substance that is almost as toxic as
arsenic.
According to the government and the dental
association, you can't have too much of a good thing. We are being bombarded
from every direction by fluoride. Every last one of our dental products - from
toothpaste to floss and toothpicks to fluoride drops or pills - now contains
fluoride. This of course means that, with any and every means of dental hygiene,
we are ingesting some percentage (often unknown) of a substance that is more
toxic than lead and almost as toxic as arsenic - and still used in some quarters
to kill rats.
Although America acknowledges the potential
toxicity of fluoride with warnings on labels, Britain has the flimsiest of
controls over the claims made and warnings given about fluoride-containing
products. There is no control over daily consumption of fluoride and no
limits on the amount an individual can purchase.
If a person lives in an area with
fluoridated water and uses fluoridated dental products, he could he taking
in many times more fluoride in his daily diet than is considered acceptable.
The World Health Organisation warns that a chronic fluoride intake of
2.0-8.0 mg per day can lead to skeletal fluorosis, a debilitating and
sometimes crippling bone disease.
The quantity of fluoride in toothpastes for
children is even more of an issue as children, because of their smaller
size, naturally can be poisoned with far lower levels. Dental fluorosis,
where teeth are pitted and mottled because of too high an ingestion of
fluoride, is well known in areas of water fluoridation.
The most damning aspect concerns the types
of toothpaste being offered for children.. Many of these toothpastes use
enticing flavours such as orange, bubble fruit and strawberry - a practice
which only encourages them to swallow it. There is even a Barbie variety
with a tutti-frutti flavour.
Toothpaste and all over-the-counter dental
products are controlled under the cosmetics section of the Medicines Act and
administered by the Cosmetic, Toiletry and Perfumery Association, a trade
organisation which advises manufacturers on labelling for toothpaste,
mouthwash and dental floss.
Manufacturers are allowed to include fluoride up
to a concentration of 1500 ppm but, with no other information, this sort of
statistic is meaningless to the consumer.
Fluoride toothpastes are also supposed to bear
a warning about unsupervised tooth-brushing with a pea-sized amount of
toothpaste to minimise swallowing by children under seven.
It should also say that, if you are using
fluoride supplements (pills or drops) you should consult your dentist.
Mouthwashes also often include fluoride, but there seems to be no labelling
regulation to cover stating the amount of fluoride contained. But, these are
only recommendations and not hard-and-fast rules.
Since fluoride is not considered a drug
either, manufacturers do not need to specify the amount of fluoride
contained in their products or how much constitutes too high a daily dose.
They also don't need to specify if they have a product licence or not as
this is only required if some sort of therapeutic claim is made on the
packaging.
To examine the levels of fluoride in dental
products - mainly toothpastes - and the level of detail disclosed in the
labelling on all products containing fluoride, holistic dentist Tony Lees
conducted a survey of the products sold in most main outlets - supermarkets
and chemists - in a typical British city. He chose nearby Hereford and, in
late April 2000, went undercover, purchasing one of each product in all the
larger chain stores.
He was also interested in freedom of choice
-whether the store in question offered any non-fluoridated alternatives,
particularly for children. Finally, he wanted to see what types of warnings
there were concerning accidental overdose, particularly in children.
His findings make a chilling commentary on
the fact that toothpaste manufacturers, like most makers of toiletries, are
basically allowed to provide the flimsiest of detail about their products.
THE PRODUCTS
Boots
Boots offered two fluoride-free toothpastes - its
own brand and Kingfisher's non-fluoride. The rest of the toothpastes offered
contained fluoride, and no children's toothpastes were free of the stuff. Boots
also sells mouthwashes which contain fluoride, but offer no indication of
percentages, and dental floss which has been soaked in fluoride to the maximum
level permitted of 1500 parts per million.
At Boots, I was also able to purchase
orange-flavoured fluoride tablets (Endekay Fluotabs, for those ages four and
over) over the counter without prescription and with no verbal warnings given as
to their usage. This product contains 200 tablets of 2.2 mg sodium fluoride - a
level which certainly can cause fluoride intoxication, leading to dental
fluorosis or worse in children.
I was particularly amazed to find at Boots
a Denture Toothpaste specifically designed in clean dentures which, for some
reason, contained 0.24 per cent sodium fluoride. Another inexplicable touch
was the addition of the artificial sweetener saccharine. As it also contains
bromochlorophene, a disinfectant, it is obviously not designed to be used
like a normal toothpaste.
Boots also sells Theramed 2 in 1, a
toothpaste and mouthwash combination. This product gives no indication of
the amount of sodium fluoride it contains. It also doesn't warn against
unsupervised brushing for children or provide an advisory that anyone taking
fluoride supplements consult their dentist as some of the other products do.
Safeway
There was a very limited choice of
non-fluoride toothpastes available - only Sensodyne Sensitive tooth formula
with strontium chloride (a heavy metal used to alleviate the pain of
age-related receding gums and Euthymol, which contains antiseptics with a
strong taste that children are not likely to find pleasant. There were no
fluoride-free children's toothpastes on offer. Safeway also sells
mouthwashes, again containing unspecified amounts of sodium fluoride.
Safeway's own brand, Savers toothpaste
contains a whopping 0.85% sodium monofluorophosphate which they haven't
translated into parts per million on the packaging (our own calculation
worked this out to be around 1121 ppm of fluoride or 140 mg in a 125 ml
tube.). It makes a number of therapeutic claims - "helps prevent tooth decay
and strengthens tooth enamel" - but does not display a product licence (PL)
number to substantiate them.
Another Safeway's own-brand toothpaste is
Oracle for Kids Strawberry Flavour Gel, with the word 'Kids' in giant
letters on the tube. This strawberry flavoured gel contains 0.4% sodium
monofluorophosphate ( 525 ppm or 39 mg in a 75-ml tube). The worry of a
product with such a 'fun taste' as strawberry is that, although it might
"encourage kids to clean their teeth", as the manufacturer says, it may also
encourage them to swallow it.
Lidl
Not only does this supermarket offer no
fluoride-free toothpaste, but it sells some toothpastes with no amount
specified for fluoride content. There are no child warnings, not even about
minimising swallowing.
Dentalux Med 3 asserts on the packaging,
"The combination of sodium monofluorophosphate strengthens the gums and
therefore helps to protect the teeth from decay". This is an untenable
therapeutic claim as there is no evidence that sodium fluoride strengthens
the gums. Furthermore, this toothpaste offers no advice on children's
tooth-brushing or about the quantities of fluoride added to the toothpaste.
Needless to say, there is no PL number given.
Lidl's Dentalux 2 in 1, a mouthwash and
toothpaste combination, doesn't specify the levels of fluoride it contains.
There's also no swallowing warnings, no brushing advice and, despite
therapeutic claims, there is no PL number stated on the packaging.
Lidl's Unodent Plus toothpaste contains
1450 ppm of fluoride, which is an extremely poisonous level - 145 mg in a
100-ml tube - enough to kill a child if swallowed in quantity. Nevertheless,
there are no warnings about the use of this product by children.
kingfisher
Dentalux in family size (125 ml) makes the
claim that "the latest research shows that the active ingredients in
Dentalux help to prevent tooth decay and gum disease". The product contains
"Olafluor", a proprietary combination of
"bis(hydroxyethyl) amino-propyl-N-hydroxy-ethyl
octadecyclamin-dihdydrofluoride". Whatever this substance is - and I have
never heard of it before - it is included in an unspecified quantity. There
are no warnings whatsoever about accidental swallowing by children under
seven and no advisory about using a pea-sized amount of paste to minimise
swallowing. No PL number is displayed.
Printed oil the packaging was the following: "The
performance claims made on Oracle for Kids Strawberry Flavour Gel are approved
by the British Dental Health Foundation". The British Dental Health Foundation,
for the uninitiated, is a self-appointed body consisting, in the main, of dental
manufacturers plus some dentists.
Another worrying aspect of the packaging is
that, although therapeutic claims are made, no PL number appears on the
packaging.
The other brand I was able to purchase at
Safeway was Signal Family protection toothpaste. Also 'accredited' by the
BDH, this product contains 0.32% sodium fluoride (1450 ppm or 145 mg in a
100-ml tube). This is enough to kill a child if a sufficiently large
quantity is consumed. Not only is these no warning about the dangers
associated with ingesting too much fluoride, but it also emphasises that
"children love the great taste" - implying they may use it as much as
possible. Despite claims about hardening tooth enamel, again no PL number is
displayed.
Tesco
Tesco's own brand, Total Care Kids,
contains 0.4% sodium monofluorophosphate, which appears to be a standard
amount of fluoride contained in kids toothpastes. Like most other products,
it doesn't display any evidence of a PL number despite making
therapeutic claims. It boasts that the product is ''not tested on animals",
which is a good thing for the laboratory monkeys and rats of the world as it
contains around 527 ppm of fluoride (26 mg in a 50-ml tube) - which can lead
to mottling or cavitation of children's teeth if accidentally swallowed.
Tesco also sells Pearl Drops Smokers
toothpaste. The manufacturer has not even bothered to give the percentage of
fluoride contained in Pearl Drops - presumably because it figures that
smokers are already engaging in slow-motion self- poisoning. Again, there is
no warning about accidental overdosing and no PL number displayed
The only fluoride-free toothpaste available
at Tesco were Euthymol and Sensodyne Sensitive. There were no fluoride-free
brands for children.
Sainsbury's
This supermarket gives the widest choice.
For those wishing to avoid fluoride, Sainsbury's offers both Kingfisher and
its own-brand fluoride-free toothpaste. It also offers its own-brand
'low-fluoride' Baby Tooth Gel, which contains 0.025 per cent sodium fluoride
(110 ppm or 5.5 mg in a 50-ml tube).
Although Sainsbury's labels this more fully
than any other baby-tooth toothpaste in the survey, it still fails to match
the poison warnings required by the US Food and Drug Administration on
American brands of fluoridated toothpaste.
Sainsbury's also sells a Milk Teeth gel
toothpaste for children aged 0-6, made by Macleans (SmithKline Beecham).
This contains 525 ppm of fluoride (26 mg in
a 50-ml tube), a dosage more than five times higher than Sainsbury's
own-brand label. Macleans' product, available with a strawberry flavour, has
the so-called accreditation of the British Dental Association, the UK
dentists' trade union. Again, no PL number is displayed.
Kwik-Save (owned by Somerfield)
Kwik-Save offered no choice of any
fluoride-free toothpastes. Somerfield's Freshmint fluoride toothpaste
contains 0.22 per cent sodium fluoride (995 ppm or 100 mg in a 100-ml
tube) - enough to seriously injure a child.
Fluoride toothpastes in the US are
required to show a poison label. The American consumer is warned about
swallowing the product and a toll-free Poisons Bureau telephone number is
given in case the toothpaste is accidentally swallowed.
In the UK, the labelling of fluoride
toothpaste and other fluoridated products is nothing short of haphazard.
Fluorides in dental over-the-counter products carry a potent risk of acute
and chronic fluoride poisoning. There is no question that easy availability
of these products and the poor labelling pose a serious threat to health,
particularly in children.
Fluoride - a lethal dose
Much of what we know about the efforts of
fluoride poisoning has come from research into the fluoridation of water.
What is certain from this research is that, taken in sufficient quantity,
fluoride will kill you.
Since the 1950s, proponents of fluoridation
have maintained that fluoridation of water at 1 ppm represented a minimal
risk - between 2250 and 4500 times less than would be required to kill an
adult, and 250 to 500 times less than would be required to kill a child.
However, several more recent reports show
that what is known as the 'probably toxic dose' (PTD) of fluoride - that is,
ingestion which would require therapeutic intervention and hospitalisation -
is actually much lower, between 32 and 64 mg of fluoride per kg of body
weight administered in one dose (J Rent Res, 1987; 66: 1056-60).
Acute poisonings have occurred at doses of 0.1 to 0.8 mg / kg of body weight
- or 6 to 48 mg for a 60 kg (130 lb) adult in the USA (Fluoride,
1997; 30: 89-104).
These figures refer to pure fluoride so
they do not reflect ingestion of toothpaste, which contains compounds of
fluoride. Sodium fluoride is a mixture of sodium and fluoride. The amount of
pure fluoride is around half of a given quantity of sodium fluoride and
around one-eighth of sodium monofluorophosphate. Nevertheless, current
toothpaste formulations do contain sufficient fluoride to exceed the PTD for
young children. For instance, a 10-kg child who ingests 50 mg fluoride
(roughly equivalent to 1/3 of a 100-ml tube of 1500 ppm toothpaste or 1/2 of
a 100-ml tube of 1000 ppm toothpaste) will probably have ingested a toxic
dose (J Public Health Dent, 1997; 57: 150-8)
What do the percentages and parts per
million on toothpaste labels actually mean?
In our survey, labelling information was
not consistent. Some companies listed the amount of fluoride in ppm and
some in percentages, some in both and some not at all. The British
Dental Association (BDA) have recommended that all toothpastes should
list their fluoride content in ppm as this is the easiest way to make
the total amount of fluoride in any given product clear.
Choosing a low ppm toothpaste for your
child is essential for limiting the amount of fluoride he or she ingests.
Not long ago, researchers in Manchester set cut to determine how much
fluoride was being retained in children s mouths after brushing with
toothpastes with different ppms. They tested toothpastes with 400 to 1450
ppm.
The average amount of fluoride ingested per
brushing was 0.42 mg when using the 1450 ppm toothpaste and 0.10 mg where
using the 400 ppm toothpaste. If using the 400 ppm toothpaste twice daily,
children of average weight would not ingest in excess of 0.05 mg / kg body
weight (considered a 'safe' level). But using the 1450 ppm toothpaste would
certainly exceed this level (Br Dent J, 1999; 186: 460-2).
Unfortunately, not all toothpaste tubes
show fluoride content in ppm. Some manufacturers include percentages, which
are not helpful because they do not refer directly to the amount of fluoride
in the tube. In fact, these percentages refer to the chemical compound of
which fluoride is a part. Sodium fluoride, for example, is a compound
containing sodium and fluoride whereas sodium monofluorophosphate comprises
sodium, fluoride and phosphate.
To figure cut the amount of fluoride in
your toothpaste. you need to look for the ppm. If your toothpaste tube only
lists percentages, there is a way to translate this to arrive at the amount
of fluoride in the tube.
The
following chart will help you work out the approximate ppm of your tooth
paste (To find out how many milligrams of fluoride are in the tube, divide
the ppm by 1000, then multiply that by the number of millilitres in the
tube. Thus: 1500 ppm ÷ 1000 x 125 ml = 187.5 mg):
| ppm |
*mg / 100 ml |
Sodium fluoride |
Sodium monofluoro-
phosphate
|
| 1500 |
150 |
0.33% |
1.14% |
| 1000 |
100 |
0.22% |
0.76% |
| 500 |
50 |
0.11% |
0.38% |
*As a rough guide, in each 100-ml tube
of toothpaste, there are these amounts of fluoride (NB. Given as a separate
table in original article).
Why is there so much fluoride in toothpaste
and mouthwash? Because these products are meant to be rinsed out of the
mouth, so it is thought that we only retain a proportion of the fluoride.
That idea, of course, is only relevant to the laboratory. In the real world,
children don't always spit toothpaste out. They may be too young to control
their swallowing or it may simply be that sweet flavours and pretty colours
make toothpaste as appealing as candy to swallow.
Also, fluoride can be unstable. Depending
on the formulation, the amount of fluoride in toothpaste can deteriorate
rapidly. When sodium fluoride is combined with aluminium- and / or
calcium-containing abrasives, the mixture will lose between 60 lo 90 per
cent of the added fluoride after one week's storage at room temperature (J
Dent, 1989; 17: 47-54). Manufacturers may add more of it to overcome
this problem.
Believe it or not, you can buy several
toothpastes which are free from fluoride. Look out for these brands,
many of which are widely available in health food shops. Make sure to
read the labels carefully, as some brands have both a fluoride and
fluoride-flee version.
Tom's of Maine (Cinnamint / Fennel /
Spearmint)
NB. Tom's also produce a children's
toothpaste, though this can be difficult to find in the UK, as well as
fluoride-free mouthwash in two flavours. (SOME ADDITIONS AND LINKS MADE -MR. BEARDO)
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Boots Non-fluoride (No longer listed on their site)
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Sainsburys Non-fluoride (No longer listed on their site)
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Euthymol (No longer listed on their site, discontinued Until 2014, may not be Fluoride free by then)
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Sensodyne Sensitive (Fluoride Free toothpaste no longer listed on their site)
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