Swallowing Toothpaste: Short & Long Term Effects (For Child)

Swallowing toothpaste? Not good. The main immediate effect that is worrying is due to fluoride. It is the main active ingredient in the regular toothpaste which American Dental Association (ADA) recommends.

Toothpaste is a cosmetic and, as such, is under the regulation of the Food and Drug Administration: Federal Food, Drug, and Cosmetic Act (FFD-CA) in the US. Most people assume that cosmetic and personal care products are tested for safety before being distributed and sold. In reality, this industry is one of the least regulated industries in the US. Under U.S. law, cosmetic products and ingredients do not need FDA approval before they go on the market.

In Malaysia, the cosmetic (including toothpaste) is regulated by National Pharmaceutical Regulatory Agency (NPRA). Regarding the fluoride content, Malaysian Dental Council sets the standards for labelling of fluoride concentration on the packaging [8] .

Even with the ones regulated by the FDA, it only tested their safety and efficacy based on the use of brushing. As the ingredients are not meant to be ingested, they can pose a health danger to the person who swallows them. The level of danger depends on the amount of ingestion and the duration.

This article will tell you about the effect of swallowing toothpaste in a large amount in a short time, or a small amount over a long time.

What will happen if my child swallowed toothpaste?

If the child swallows a large amount in a short time, the immediate toxic effect may arise which can be an emergency. The main agent that is causing this emergency is fluoride. This emergency is often referred to as fluoride poisoning.

An estimated concentration that can probably cause toxicity is 5mg/kg body weight (Probably Toxic Dose). This means that for a 6-year-old child that weighs 20kg, the child may experience the toxic effects if he or she swallows 75ml of regular toothpaste (1000ppm fluoride) [1].

That is equivalent to 70% of the toothpaste tube for “Colgate for Kids”.

You can refer to this website for more information about probably toxic dose of fluoride.

However, this does not mean that swallowing toothpaste of less than 70% of the tube will not cause toxicity. It is just a probably toxic dose suggested by researchers.

As you can see, it is also dangerous even if the child is swallowing kids toothpaste. In fact, the child may eat more kids toothpaste because it is tasty. You can read more about the Truth About Children Toothpaste here.

Swallowing a large amount of toothpaste in a short time: Symptoms

Swallowing toothpaste has different short term and long term effects on the body health.

Below are the symptoms that can happen to the child or anyone who swallowed a large amount of toothpaste in a short time.

#1 Stomach upset: vomiting and diarrhea

Fluoride could be the main culprit here. Swallowing fluoride in large amounts could cause nausea, abdominal pain, bloody vomiting and diarrhea. The child should receive medical attention immediately [1].

Other than fluoride, other ingredients also cause stomach and intestinal irritation, for example, sorbitol, sodium laurel sulfate, carrageenan, gluten, xanthan gum and citric acid. These are the ingredients that give the consumer a pleasant feeling of brushing because of the good taste and foaming effect [2,5,6].

#2 Dehydration: paleness, weakness, change in breathing pattern

If the child starts to have diarrhea and vomiting, he or she could lose a lot of water and electrolytes. If the water and electrolytes are not replenished, the child could be dehydrated and become extremely weak. You should send the child to the hospital immediately! [1]

#3 Muscle paralysis, muscle spasm

There could be a weakness in certain parts of the body muscle. Sometimes the muscles could be twitching or stiffening. Fluoride is the one that is causing these symptoms [1].

#4 Allergic reaction: skin itchiness, mouth rashes, lips peeling, swollen gums and abdominal discomfort

Some chemicals in the toothpaste are known to be irritants to the skin, lip, mouth, stomach and intestine of certain people [2,3,6]. The examples are polyethylene glycol (PEG), flavoring agents like cinnamon, and essential oils. Those people develop an allergic reaction towards these chemicals and result in

• skin itchiness and redness
• gum swelling
• lips peeling
• ulcers
• abdominal discomfort

#5 Dizziness and confusion

This is the result of excessive ingestion of sodium bicarbonate. It is an abrasive which helps to increase the cleaning efficiency of toothpaste. Although this condition is rare, some reported cases showed that it could cause disturbance to the brain function. [2]

If you start observing any of the signs mentioned above, immediately bring the child to seek medical attention. Usually, the medical team will support the body with water and electrolytes. The child body will slowly clears away the toxic chemicals in the body.

Swallowing a small amount of toothpaste for a long time: Health effects

It is usually fine if the child unintentionally swallows the residual toothpaste after brushing as long as the amount used is as recommended.

However, some children may intentionally swallow toothpaste because of the tasty kid toothpaste. This should not be ignored as it poses some dangerous health effects in the long term.

Below are some of the negative health effects that the child may get if he or she has the habit of swallowing toothpaste during each brushing.

#1 Behavioral issues and mental growth disturbance

Few ingredients in toothpaste could affect the brain function, especially concerning the brain development of the child.

• Fluoride has been shown to have an association with reduced IQ in children [6].
• Artificial food dyes could affect children’s behavior and are likely to be linked to hyperactivity and ADHD (attention deficit hyperactive disorder) [6].

#2 Dental fluorosis

Dental fluorosis is the development disturbance of the outer layer of teeth during teeth formation. The outer layer, or enamel, will become whitish in color, rough, or even pitted and brown if severely affected.

This happens in children who ingest an excessive amount of fluoride during the first 8 years of life when the teeth are forming. The abnormal teeth have weak outer surfaces and often require dental treatment [1].

To avoid dental fluorosis, the child should use only the recommended amount of toothpaste. The recommendation is a smear layer at the age of three or below, and pea-size at the age of three to six [7].

#3 Skeletal fluorosis

Another concern of swallowing fluoridated toothpaste is its chronic effect on bones. Fluoride accumulates in bones, which can lead to a condition called skeletal fluorosis.

The affected people will have weak bones and problematic joints. The flexibility is often affected. There might be joint pain, joint degeneration and bone fracture if the condition is severe [2].

#4 Hormone disruption

The ingested chemicals can be consistently present in the body and affect the production of the hormones.

• One of the popular ingredients that received growing concerns is triclosan. It may cause hormonal disruption like early puberty and abnormal thyroid function [2,5,6].
• Fluoride has also been linked to abnormal thyroid hormone production.
• Parabens (preservatives) could also disrupt sex hormones [5].

#5 Immune system disturbance

Few studies showed that sodium benzoate, a preserving agent, could affect the function of the body’s immune system when consumed in large quantities. [2]

#6 Carcinogenic

• Parabens (preservatives) could increase the risk of developing breast and skin cancer. One of the examples is sodium methylparaben. Most toothpaste is replacing it with sodium benzoate which is a safer alternative.
• Studies also showed triclosan may promote breast cancer. FDA has banned its use in soaps in 2016. However, to the surprise, it is still allowed in toothpaste although most toothpaste companies have withdrawn it [5].

Conclusion

Toothpaste, a product that we put into our mouth, contains many ingredients that can be toxic.

If a large amount of toothpaste is swallowed in a short time, it is an emergency and the person should receive medical attention in a hospital or poison center.

On the other side, if you notice the child is swallowing a small amount each time he or she brushes, you should help the child to stop that action because it poses health danger in the long term.

Reference

1. Kanduti D, Sterbenk P, Artnik a. Fluoride: a Review of Use and Effects on Health. Materia Socio Medica. 2016;28(2):133.
2. Basch C, Kernan W. Ingredients in Children’s Fluoridated Toothpaste: A Literature Review. Global Journal of Health Science. 2016;9(3):1.
3. Zirwas M, Otto S. Toothpaste Allergy Diagnosis and Management. Journal of Clinical and Aesthetic Dermatology. 2010;3(5):42-47.
4. Grandjean P. Developmental fluoride neurotoxicity: an updated review. Environmental Health. 2019;18(1).
5. Thawani V, Mani A. Are all additives of toothpastes rational?. Journal of Mahatma Gandhi Institute of Medical Sciences. 2019;24(2):71.
6. Behind the Dazzling Smile: Toxic Ingredients in Your Toothpaste. Draft Horse Studio; 2016.
7. Wright J, Hanson N, Ristic H, Whall C, Estrich C, Zentz R. Fluoride toothpaste efficacy and safety in children younger than 6 years. The Journal of the American Dental Association. 2014;145(2):182-189.
8. Fluoride Content, Cost and Labelling of Commercially Available Toothpastes in Malaysia. URL http://www.dental.usm.my/aos/docs/Vol_14/aos-article-377.pdf