Toothpaste - A close brush with poison

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 acknow ledges 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 be taking in many times more fluoride in his daily diet than is considered acceptable. The World Health Organization 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 average consumer. Fluoride toothpastes are also supposed to bear a warning about unsupervised toothbrushing 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 of the main outlets supermarkets and major chemists in a typical British city. He chose nearby Here ford 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 to 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 per cent sodium monofluorophosphate, which they haven't translated into parts per million on the packaging. (Our own calculation worked this out to be around 1118 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 per cent 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.

Printed on 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 BDHF, this product contains 0.32 per cent 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 there no warning about the dangers associated with ingesting too much fluoride, but it also emphasises that "children love the great taste" implying that 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 per cent sodium monofluorophosphate, which appears to be a standard amount of fluoride contained in kiddy 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 526 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 toothpastes 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 sodium monofluorophosphate (26 mg in a 50-ml tube), a dosage more than five times higher than Sainbury'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.

Lidl

Not only does this supermarket offer no fluoride free toothpastes, 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 and sodium fluoride 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 toothbrushing 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 is 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 ingested 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) aminopropyl-N-hydroxyethyl 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.

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.

!ATony Lees