Toothpaste: A close brush with poison

[joeblow]

http://www.awaywolf.com/fluoridationfac ... poison.htm

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.

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.

    *

      Kingfisher Fennel
    *

      Weleda Plant toothpaste (gel and cream) NB. Weleda also produce a non-fluoride mouthwash.
    *

      Boots Non-fluoride
    *

      Sainsburys Non-fluoride
    *

      Aloedent Whitening Aloe Vera
    *

      Euthymol
    *

      lgydium
    *

      Green People Herbal Fresh (Fenel / Citrus / Mint)
    *

      Sensodyne Sensitive
    *

      Sarakan

Fluoride accumulates over time

While it has long been believed that fluoride has a half life of 3.5 hours (time to clear it from the body), experience of victims of fluoride poisoning suggests that the chemical's half-life is much longer. When a community in Alaska was poisoned with fluoride due to a malfunction of the fluoridation equipment system, researchers noted that blood fluoride levels did not return to normal within 24 hours as would be expected. Nineteen days after the poisoning, mean blood levels of fluoride were 0.092 mg / L - nearly three times the levels in the few non-poisoned individuals residing in the same community (Fluoride, 1994; 27: 32-6).

Studies now show that, far from clearing quickly from the body, fluoride accumulates over time, reaching toxic levels as a person ages.

Fluoride has a particular affinity for bones and has been widely linked to the development of osteoporosis and a high rate of hip fractures (JAMA, 1992; 268: 746-8: JAMA, 1990; 264: 500-2: JAMA, 1991; 285: 513).

Accumulation of fluoride, which begins in infancy, can reach the lower levels of toxicity needed to produce bone damage after only 38 years. In fluoridated communities where the leveI of fluoride in the water is 4 pmm (the maximum allowable in water and far below that of toothpaste), many people will reach mid-to-high dose accumulation by this age.

As a general rule, approximately half of each days fluoride intake is retained. Healthy kidneys can eliminate only about 50 per cent of daily fluoride intake. The rest gets absorbed into calcified tissues such as bones and teeth as weII as some organs. And remember: you get fluoride from other sources like food. To our horror, we discovered that even meal replacements intended for ill patients contain as much as 0.15 mg of sodium fluoride per 100 ml.

Who to call in an emergency (NB. fluoride.org.uk does NOT guarantee that these numbers will remain as published)

The UK National Poisons Information Service (NPIS) is made up of six centres throughout the UK, with links to the the poisons unit of Beaumont Hospital in Dublin, and the wider toxicology community through the European Association of Poisons Centres and Clinical Toxicologists and the American Academy of Clinical Toxicology.

In cases of toothpaste ingestion, vomiting should be induced if it is not spontaneous; fluoride-binding liquids such as as milk should be administered , and the patient taken to the nearest hospital for emergency care.

If your child has swallowed toothpaste (or any other toxin) you can also phone the following numbers for help and advice:

National single telephone number: 0870 600 6266

(This will route you to the centre nearest you and can be used for all poison enquiries.)

Local Numbers

Belfast: 01232 240 503

Birmingham: 0121 507 5588/9

Cardiff: 01222 709 901

Dublin: 00353 1 837 9964

Edinburgh: 0131 536 2300

London: 020 7635 9191