Welcome to our guide on fluoride in dental products. Here, we provide insight into the presence of fluoride in various dental products and its potential health implications.

“>Dental products are a major source of fluoride exposure, particularly for children. Fluoridated dental products include toothpastes, mouth rinses, fluoride gels and foams, fluoride varnishes, and fluoride supplements. Many dental products contain dangerously high levels of fluoride. For years, manufacturers and dentists failed to warn consumers about the risks from ingesting these products. Although the FDA now requires manufacturers to warn consumers that fluoride products are poisonous when swallowed, manufacturers and dentists are still using these products in ways that expose consumers and patients to potentially toxic levels of fluoride.

[image – toothpaste warning label]  

“>Fluoride Toothpastes (1,000 to 1,500 ppm)

  • Approximately 95% of toothpastes now contain fluoride.
  • A single strip of toothpaste covering the length of a child’s brush contains between 0.75 to 1.5 mg of fluoride. This exceeds the amount of fluoride in most prescription fluoride supplements (0.25 to 1.0 mg).
  • Although research suggests adult-strength fluoride toothpaste with 1,000-1,500 parts per million (ppm) fluoride can reduce tooth decay, this potential benefit comes with the risk of disfigured teeth.
  • Ingesting toothpaste during childhood is a major risk factor for dental fluorosis, particularly for children who brush before the age of three and who live in areas with fluoridated water, and can also cause symptoms of acute fluoride toxicity (e.g., stomach pain, etc).
  • Dentists now recommend that children only use “a pea-sized amount” of toothpaste, but many young children swallow over 50% of the paste added to their brush, particularly if they use candy-flavored varieties and if they are not supervised during brushing to ensure they spit and fully rinse. Research has shown that some children swallow more fluoride from toothpaste alone than is recommended from all sources combined.
  • Children who swallow fluoride toothpaste can reach fluoride levels in their blood that exceed the levels that have been found to inhibit insulin secretion and increase blood glucose in animals and humans.
  • All fluoride toothpastes sold in the U.S. must now include a poison label that warns users to “contact a poison control center immediately” if they swallow more than used for brushing.
  • Just 1 gram of fluoride toothpaste (a full strip of paste on a regular-sized brush) is sufficient to cause acute fluoride toxicity in two-year old children (e.g., nausea, vomiting, headache, diarrhea).
  • In 2009, U.S. poison control centers received over 25,000 calls related to excessive ingestion of fluoride toothpaste, with over 378 users requiring emergency room treatment.  
  • In adults, fluoride toothpaste can cause skin rashes around the mouth known as perioral dermatitis as well as canker sores.

Fluoride Mouth Rinses (230 ppm)

  • Many mouth rinses now contain fluoride.
  • A single mL of fluoride mouth rinse contains roughly 0.25 mg of fluoride.
  • Between 5 to 15 mL are generally used per rinse, which equates to 1.25 to 3.75 mg of fluoride.
  • Little data is available to show how much of the rinse is ingested.

Fluoride Varnish (22,600 ppm)

  • A fluoride varnish is a liquid, or in some cases a gel, that is applied in a thin layer to the teeth. Fluoride varnishes are designed to bond fluoride to the surface of the teeth for days or weeks at a time. It will harden and release fluoride during that time period.
  • Dentists apply varnishes up to 4 times a year in children with high risk for cavities.
  • Most fluoride varnishes contain 5% sodium fluoride, or 22.6 milligrams of fluoride for each milliliter of varnish that is applied.
  • Since the varnish eventually wears off the teeth, all of the fluoride that is applied is ingested.
  • While this is twice the concentration used in professionally applied fluoride gels (12.3 mg per milliliter), less varnish is used per treatment. With fluoride gels, dentists generally apply about 4 to 8 mL of gel per treatment (48 to 96 mg of fluoride). With varnishes, dentists apply about 0.5 to 1.0 mL of varnish (11.3 to 22.6 mg of fluoride). Fluoride varnishes, therefore, introduce less fluoride into the mouth than fluoride gels, and because of their slow-release, they do not cause the same severe spike in blood fluoride levels that gels create.

Fluoride “Supplements”

  • Fluoride “supplements” are tablets, drops, or lozenges that are designed to provide a substitute fluoride exposure for children living in areas where fluoride is not added to water. Unlike other dietary supplements, fluoride supplements cannot be purchased over the counter. They are only available by prescription.
  • Supplements contain between 0.25 to 1 mg of fluoride per drop, tablet, or lozenge. The amount depends on the age of the child.
  • Fluoride supplements were introduced in the 1950s on two incorrect assumptions: (1) fluoride is a nutrient and (2) fluoride is effective when swallowed.
  • Despite being prescribed by pediatricians and dentists for over 60 years, fluoride supplements have never been approved as either safe or effective by the FDA.
  • As conceded by a pro-fluoride researcher, “virtually none of the early fluoride supplement studies would be published today, because of methodological and other shortcomings.” (Riordan 1999).
  • Modern research has consistently shown that children who use fluoride supplements have a much higher rate of dental fluorosis than children who do not. By contrast, the evidence that supplements reduce tooth decay has recently been described by pro-fluoride researchers as “poor,” “inconsistent,” and “weak.”
  • Even the American Dental Association (ADA) and other pro-fluoride organizations no longer recommend fluoride supplements for most children. The ADA does not recommend fluoride supplements for infants under six months of age. After six months of age, the ADA only recommends supplements for children who are at “high risk” for cavities.
  • Some children who take fluoride supplements can develop allergic reactions, including skin rashes, gastric distress, vomiting, and headache.
  • Although fluoride supplements were only intended for children living in non-fluoridated areas, surveys have shown that some dentists prescribe supplements to children living in fluoridated areas as well. This places children at risk for the most severe forms of dental fluorosis.

Fluoride Gels

Professionally Applied Gels (12,300 ppm)
  • “Fluoride Gels” are acidic, highly concentrated fluoride products that dentists topically apply to a patient’s teeth about two times a year. Of all the fluoride products currently used in dentistry, fluoride gels are – without question – the most hazardous.
  • Although dental researchers only recommend topical fluoride gels for patients with high risk for cavities, surveys have shown that dentists routinely apply gels to most of their patients.
  • A single mL of gel contains 12.3 mg of fluoride.
  • While fluoride gels are designed to be applied “topically” (i.e., directly to teeth), very large quantities of fluoride are absorbed into the body during the treatment. The highly acidic nature of the gel greatly increases saliva flow, which makes it largely impossible to avoid swallowing large amounts of it. While few measures were used in the past to limit the amount of fluoride ingested, dentists are now advised to use suction devices and to encourage the child to fully rinse and spit at the end of the treatment.
  • Even when precautionary measures are taken, children swallow an average of 7.7 mg per treatment.
  • Adults swallow an average of 10.3 mg per treatment.
  • Due to this large systemic exposure, many patients – particularly children – experience symptoms of acute fluoride toxicity (e.g., nausea and vomiting) within an hour of the treatment.
  • Gastric distress is not the only side effect. Fluoride gels produce an enormous spike in blood fluoride levels for up to 14 hours, exposing every tissue in the body to fluoride concentrations that have been can damage, in short-term exposures, the kidney, the male reproductive system, and glucose metabolism.
  • Although the dental community has taken steps to reduce the amount of fluoride that gets into the blood from fluoride gels, the extent of fluoride exposure from these gels continues to remain excessive and toxic. Due to the conspicuous absence of safety studies, however, the public health consequences from the dental community’s 40-year experiment with fluoride gels remains a disturbing mystery. Read More.
  • Dentists are now recommended to apply no more than 4 mL when treating children (=49 mg of fluoride), and no more than 8 mL when treating adults (=98 mg of fluoride).
Self-Applied Fluoride Gels (5,000 ppm)  
  • Dentists prescribe self-applied gels to those at high-risk of tooth decay.
  • Each mL of gel contains 5 mg of fluoride.
  • Without taking extraordinary precaution to limit the amount of gel that is applied and reduce the amount of gel that is ingested, self-application can result in dangerously high fluoride exposures.