Is it safe to swallow children toothpaste?
Over the decades, toothpaste has continuously been formulated to improve its effectiveness in preventing tooth decay and gum disease. Regular toothpaste often contains fluoride, which is the main agent in strengthening the teeth against decay. Fluoridated toothpaste has raised safety concerns, but when used correctly, it is safe when used for brushing. Some communities are concerned that it may harm the health of children if they ingest it accidentally. Swallowing toothpaste is not unlikely. Research showed that children under the age of six usually swallow between 25%-33% of toothpaste during each brushing [1].
In order to combat this issue, manufacturers produce toothpaste for children that contains small amounts of fluoride or does not contain any fluoride at all. Since children toothpaste is made for children, is it safer than regular toothpaste?
To get to the answer, we first look at the ingredients in children toothpaste and their effects on health.
Fluoride – The Main Active Ingredient in Toothpaste
Fluoride is added to toothpaste as it is effective in preventing tooth decay when used for brushing. The recommended concentration of fluoride in toothpaste is at least 1000ppm (parts per million) for decay prevention [2,3,4]. It has been proven safe for to be used for brushing, but it shouldn’t be swallowed.
It can be harmful to the child if he or she swallows toothpaste intentionally during brushing (of course, a very small amount of toothpaste accidentally swallowed is fine).
When a child swallows toothpaste, there are two potential harmful effects: the immediate emergency effect and the long-term health problem.
Immediate emergency effects of swallowing fluoride toothpaste
An immediate toxic effect may arise after swallowing a large amount of fluoride in a short period of time. This is called fluoride poisoning. This is seen as an emergency. In order to give an idea of that amount, it is estimated that a 6-year-old child weighing 20kg swallowing 75ml of “Colgate for Kids” toothpaste (about 70% of the tube) may experience toxic effects [5].
If someone swallows that much toothpaste, he or she may show the following alarming signs [5]:
- Stomach upset
- Diarrhoea
- Vomiting
- Weakness
At its most serious stage, fluoride poisoning could even lead to death for the child if it is not treated.
Your child should be taken to the hospital immediately if you notice that he or she has ingested a large amount of toothpaste, or if he or she exhibits any of the signs mentioned above.
Long-term health effects of swallowing toothpaste
If the child has the habit of swallowing some of the toothpaste intentionally while brushing, it can harm the body in the long run. Below are some of the possible health problems [6,7]:
- Behavioral issues
- Mental growth disturbance
- Dental fluorosis
- Skeletal fluorosis
- Physical growth disturbance
- Carcinogenic
You can read more about the Harmful Effects of Swallowing Toothpaste here.
Why Still use Fluoride Toothpaste?
Fluoride toothpaste is clearly harmful if it is swallowed intentionally. Nevertheless, without fluoride, children might not receive the same decay-prevention benefits that fluoride toothpaste offers. Global health organizations are still recommending fluoride toothpaste for children as fluoride has been proven long to be able to prevent tooth decay [2,3,4]. It is also safe for children to use if the amount used is appropriate. The scientific guidelines recommend the concentration of fluoride in toothpaste to be no less than 1000ppm (parts per million) fluoride to be effective in preventing tooth decay. The table below shows the appropriate amount of toothpaste that should be used for brushing in children [2,3,4]:
| Age (y/o) | Fluoride concentration (ppm F) | Amount of toothpaste used |
|---|---|---|
| 0-3 | 1000-1500 | A smear layer |
| 3-6 | 1000-1500 | A pea-sized amount |
| >6 | 1350-1500 | A 2cm ribbon |
Furthermore, a non-fluoride toothpaste may not mean that it is totally safe to be used for brushing in children. This is because there are some additives in toothpaste which can also harm the body if ingested in excessive amount.
Other Additives in Toothpaste and their Effects on Health
1. Sweeteners
Examples: sodium saccharin, sucralose and sorbitol.
Sodium saccharin and sucralose are artificial sweeteners have zero nutritional value and are only used to sweeten food or toothpaste. Their addition makes it easier for the child to accept and likely to like the taste. Sorbitol is a natural sweetener and is used as a sugar substitute.
Effects on health:
- Sodium saccharin is considered safe to be for consumption, but studies suggested it contributed to early decay. [8]
- Sorbitol could cause stomach discomfort and diarrhea because it is not absorbed in the gut.
- Because of the pleasant taste, the child may intentionally swallow the toothpaste and get the harmful effects from other ingredients.
2. Artificial coloring
Examples: D&C Red 30 Lake, D&C Red 38, FD&C Blue 1 Lake.
You may not find these code names on the label because it does not make any sense to the customer. Therefore, manufacturers simply display the word “artificial colorings” on the labels.
Effects on health:
- Some studies showed that exposure to these coloring agents results in allergic reactions. [9]
- They could irritate the skin, eyes, and airway lining if they are coming in contact. [9]
- The colorings are known to affect children’s behavior and are likely to be linked to hyperactivity and attention deficit hyperactive disorder (ADHD). [7]
3. Flavorings
Examples: strawberries, oranges, cinnamon, menthol. They can be natural or synthetic.
Flavorings are different from sweeteners since flavorings add a range of tastes that are not just sweet.
Effects on health:
- Generally, the flavorings are not found to cause a health problem.
- There are reports that certain flavorings like cinnamon cause an allergic reaction which appears as skin peeling in the mouth and gum inflammation. [7]
4. Foam Booster
Examples: sodium laurel sulfate (SLS), Cocamidopropyl betaine.
In addition to SLS which is a widely used foam-forming agent, some children toothpaste is even added with Cocamidopropyl betaine to further increase the foam during brushing. This could improve the pleasant experience of brushing for children, which can be seen as double-edged sword.
Effects on health:
- Though rare, some research mentioned that it could cause allergic reactions. [10]
Fluoride-free Toothpaste: Is it safe to be swallowed?
Due to the concern of potential harms brought by fluoride toothpaste to children, manufacturers have begun producing toothpaste with little or no fluoride. Moreover, to make toothpaste appealing to children, it is often added with variety of flavors and colorings [2]. In one sense, it can benefit children by making them more motivated to brush their teeth. On the other hand, if the child swallows toothpaste purposefully because of the overly pleasant taste, those additives could be harmful to their health, as discussed above.
Since children toothpaste is made for children, is it safer than regular toothpaste? Children toothpaste is safe to use for brushing. However, just like regular toothpaste, children’s toothpaste contains some ingredients that can be harmful if ingested, so swallowing it is never a good idea.
Summary
Children’s toothpaste is suitable for use by children since it increases the motivation of children to brush. We should remember, however, children toothpaste also contains additives which can be present in higher concentration than regular toothpaste. Therefore, children toothpaste does not make it safer to be ingested. In fact, just like any toothpaste, we should be careful when letting children brush their teeth with children toothpaste since they may swallow it if they find it tasty.
When deciding between fluoride toothpaste or non-fluoride toothpaste, one should be reminded that the current recommendation from scientific communities is to use fluoride toothpaste with a minimum of 1000ppm fluoride level for children, with an appropriate amount of toothpaste used each time for brushing.
In conclusion, the general consensus among scientific researchers is to advise caregivers to stop children from intentionally swallowing toothpaste during brushing, regardless of its fluoride content. Regular toothpaste is not safe for children to swallow, and children’s toothpaste is not better, especially when it contains additives that make them swallow more.
Click here to find out more about the right toothpaste and toothbrush for children.
Reference
- Dincer E. Why do I have white spots on my front teeth?. N Y State Dent J. 2008;74(1):58-60. (Link)
- Basch CH, Kernan WD. Ingredients in children’s fluoridated toothpaste: A literature review. Global journal of health science. 2016 Jul 12;9(3):1. (Link)
- Giacaman RA, Campos P, Munoz-Sandoval C, Castro RJ. Cariogenic potential of commercial sweeteners in an experimental biofilm caries model on enamel. Archives of oral biology. 2013 Sep 1;58(9):1116-22. (Link)
- Kobylewski S, Jacobson MF. Food dyes: A rainbow of risks. Center for Science in the Public Interest; 2010. (Link)
- Behind the Dazzling Smile: Toxic Ingredients in Your Toothpaste. Draft Horse Studio; 2016. (Link)
- Schnuch A, Lessmann H, Geier J, Uter W. Is cocamidopropyl betaine a contact allergen? Analysis of network data and short review of the literature. Contact Dermatitis. 2011 Apr;64(4):203-11. (Link)
- Kanduti D, Sterbenk P, Artnik B. Fluoride: a Review of Use and Effects on Health. Materia Socio Medica. 2016;28(2):133. (Link)
