The Bottom Line
Toothpaste usually contains fluoride. Swallowing it can cause stomach upset. Although fluoride can lead to more serious toxicity in very large amounts, it is unlikely to occur from small, unintentional ingestions of over-the-counter, fluoride-containing toothpaste.
The Full Story
A child who has eaten toothpaste is a common reason why parents call Poison Control. Kids find the flavors and sweetness of toothpaste irresistible. Usually, a child is caught sucking the paste out of the tube or is found in the bathroom with the paste smeared all over the counter (and the child!). This makes it difficult for parents to estimate the amount swallowed.
Most toothpaste is formulated with fluoride along with an abrasive (grit) and soap. Fluoride helps prevent tooth decay by keeping tooth enamel strong and inhibiting the growth of bacteria in plaque. Over-the-counter (nonprescription) toothpaste usually contains low concentrations of fluoride, just enough to provide a sufficient amount of fluoride during brushing. When fluoride is in the stomach, it can cause irritation leading to nausea, vomiting, and diarrhea. That’s why children who eat toothpaste may develop minor gastrointestinal symptoms.
It is unlikely for a child to have anything beyond short-term stomach upset from eating toothpaste. In rare cases, if an excessive amount of fluoridated toothpaste is swallowed, there can be more serious problems. Fluoride can lower the amount of calcium and magnesium in the body. Toothpaste formulated to help with sensitivity contains a second ingredient – a nitrate – that can also cause more serious problems if large amounts are ingested. This is unlikely to occur from unintentional ingestions by children, especially of over-the-counter toothpaste.
Giving the child a snack or beverage containing calcium (like milk or yogurt) will help prevent the stomach upset because calcium binds with fluoride.
Training toothpaste does not have fluoride. In order to get kids excited about brushing their teeth, it is often flavored with fruit or bubble-gum. The flavoring and the pictures of kids’ favorite cartoons on the package can make it irresistible for kids to eat. Training toothpaste is usually sweetened with sorbitol, which can have a mild laxative effect.
Despite its safety, toothpaste is considered medicine and should be treated and stored as such. If you are concerned because someone swallowed toothpaste, do not make them vomit. Call Poison Control for treatment advice. Poison Control will calculate the dose of fluoride or other ingredients possibly swallowed and tell you exactly what to do.
If you think someone might have swallowed toothpaste, call Poison Control right away at 1-800-222-1222 or use the webPOISONCONTROL® tool for online guidance.
Serkalem Mekonnen, RN, BSN, MPH
Certified Specialist in Poison Information
For More Information
Centers for Disease Control and Prevention. [Recommendations for using fluoride to prevent and control dental caries in the United States]. MMWR. 2001;50(RR-14):1-42.
Wong MC, Clarkson J, Glenny AM, et al. Cochrane reviews on the benefits/risks of fluoride toothpastes. J Dent Res. 2011;90:573-9.
- Teach children that toothpaste is “medicine”
- Observe children during brushing, reminding them not to swallow the toothpaste
- Store toothpaste out of reach and sight of children
- Use only the recommended amount for brushing
- For children under three years of age, only use a “smear” or the size of a grain of rice of fluoride toothpaste for brushing, starting when the first tooth appears
- For children between 3-6 years of age, use a pea-sized amount of fluoride toothpaste for brushing
This Really Happened
A mother of a 3-year-old girl called Poison Control after finding the child with a tube of fluoride-containing toothpaste in the bed with her. The girl was supposed to be napping. It looked like she had eaten some of the toothpaste.
The girl had no symptoms at the time of the call. Poison Control determined that the child would be able to tolerate the amount she might have swallowed. The mother was advised to give the child a calcium-containing snack or beverage and watch for stomach upset. She had some diarrhea a few hours later but did not have any further problems.
*Original article online at https://www.poison.org/articles/2015-dec/toothpaste