The current issue of the journal Dermatology contains an interesting, albeit brief, case report of a suspected allergy to fluoride toothpaste.

The report, which I have posted in its entirety below, concludes that fluoridated toothpaste may be a cause of “Recurrent Aphthous Stomatitis”, a condition more commonly known as “canker sores.”

Aphthous Stomatitis (”Canker Sores”)

A quick review of research on the internet indicates that, while recurrent aphthous stomatitis is a common condition, its cause is poorly understood.

According to the University of Southern California’s School of Dentistry, “Recurrent aphthae or ‘canker sores’ is an extremely common and perplexing oral disease. Exact etiology continues to be obscure and treatment not particularly satisfactory.”

As noted by USC’s School of Dentistry, the canker sores associated with this condition are “characterized by an exquisitely painful lesion of the movable mucosa,” which “typically begin as an area of burning or sensitivity.”

According to emedicine.com, “Recurrent aphthous ulcers (RAUs), or canker sores, are among the most common oral mucosal lesions observed by physicians and dentists.”

Considering the common occurrence of this condition, coupled with its unknown origins, the finding that fluoride toothpaste may be one of the causative factors deserves careful attention, particularly considering the ubiquitous presence of fluoride in toothpastes.

Other Types of Allergy to Fluoridated Toothpaste

In addition to the possible link with canker sores, fluoride toothpaste has been linked to several other adverse reactions as well. In the September 2003 issue of the Journal of the American Dental Association, a US dentist, Karen McCaffery, made an interesting comment. According to McCaffery:

“It is my understanding that dermatologists frequently recommend that their patients with perioral dermatitis discontinue use of toothpastes with pyrophosphates and/or fluorides, citing that these are the most frequent causes.”

In response to McCaffery, another dentist, Steven S. Fuchs, wrote:

“Discontinuing use of strong topical steroid lotions, or toothpastes containing fluoride or pyrophosphates, seems to reduce the symptoms of perioral dermatitis. Dr. McCaffery is correct in that, if this is the case, these patients need to be educated about other preventive measures to prevent tooth decay.”

So what is “perioral dermatitis”? According to the American Academy of Dermatology:

“Perioral refers to the area around the mouth, and dermatitis indicates redness of the skin. In addition to redness, there are usually small red bumps or even pus bumps and mild peeling. Sometimes the bumps are the most obvious feature, and the disease can look a lot like acne. The areas most affected are within the borders of the lines from the nose to the sides of the lips, and the chin. There is frequent sparing of a small band of skin that borders the lips. Occasionally, the areas around the nose, eyes, and cheeks can be affected. Sometimes there is mild itching and/or burning.”

Interestingly, as with aphthous stomatitis, the American Academy of Dermatology notes that “The cause of perioral dermatitis is unknown.”

Meanwhile, according to a study published in the Archives of Dermatology (Mellette et al 1976), perioral dermatitis was first described in the medical literature in the late 1950s – which, incidentally, was the same period when fluoride toothpaste first hit the market. According to findings presented in the Archives of Dermatology, this may be more than a coincidence. To quote:

“Since its description in 1957… perioral dermmatitis (PD) has continued to be a perplexing entity. Many causes have been postulated, including sunlight sensitivity, birth control pills, emotional stress, fluorinated steroid creams, Candida albicans, and rosacea. We have gathered clinical and historical data implicating fluoride dentrifices as an important etiologic factor in this dermatosis… For the past eighteen months, we have been conducting a clinical study with the assumption that in some patients, fluoride dentrifices cause or aggravate perioral dermatitis. The clinical and historical evidence gathered has been impressive in support of this hypothesis”
SOURCE: Archives of Dermatology; Year 1976; Vol. 112; Pages 730-731.

Another paper, which was also published in Archives of Dermatology (Saunders 1975), presented evidence that fluoride toothpaste could cause acne-like eruptions around the mouth. To quote:

“Recognizing the fact that fluoride toothpastes are the prevalent type of dentrifice and that my findings could be a mere coincidence, I requested, nevertheless, that these patients switch, on a trial basis, from their fluoride toothpastes to a nonfluoride-containing toothpaste. Within a period varying from two to four weeks, approximately one half of the patients thus observed cleared of their previously persistent acne-like eruption… Several of the patients, who were concerned about the dental health factors relative to fluoride and its exclusion, requested to resume use of a fluoride toothpaste despite assurances that fluoride in water and dental treatments should be sufficient for good dental health and protection. These patients were then allowed to resume use of a fluoride toothpaste. Without exception, each developed the same distribution of acne-like eruption that had previously occurred”
SOURCE: Archives of Dermatology; Year 1975, Vol. 111, Page 793.

Unfortunately, despite the clearly important potential of these findings, and despite the latter author’s request that other dermatologists research the issue more thoroughly, there has been a notable lack of follow-up investigation, and a notable lack of published research.

I’m sure this lack of follow-up hasn’t upset the toothpaste companies too badly, but it has undoubtedly served to stunt our understanding of one potential causative and/or contributing factor to canker sores, perioral dermatitis, and acne-like skin eruptions around the mouth.

If you know anyone experiencing any of these conditions, you might try suggesting they switch to a non-fluoridated toothpaste and see what happens.

————————————

NEW REPORT:

Dermatology 
Year 2004; Volume 208; Page 181

Recurrent Benign Aphthous Stomatitis and Fluoride Allergy

By Robert Brun
Clinique Universitaire de Dermatologie, Genève, Suisse

Many years ago I consulted 2 patients suffering from recurrent aphthous ulceration to establish whether they had a toothpaste allergy. I thus proceeded to do many p-tests on the skin but without any positive results. However, replacement of the toothpaste with a simple soap quickly cured the ulcerations. A third case was referred to me with the same symptoms but in this case an unfortunate re-exposure caused a relapse of the ulcerations. At that time, it was unthinkable to speak of any kind of allergy in cases of aphthosis, and I forgot about these observations. I have been retired for a number of years, but 3 months ago, however, I was on a golf course when a competitor mentioned that she had been suffering from a painful aphthosis for many years and asked me how this condition could be ameliorated. I told her to replace her toothpaste with a simple soap. She seemed very skeptical at the time, but 10 days later she informed me that the ulcerations had disappeared.‘ Among the different specialists I consulted, why didn ’t anybody tell me this before?’ Research on the Internet reveals that numerous authors are always uncertain about the etiology of aphthosis, whilst others are beginning to suggest a possible allergy.

Finally, in a recent WHO monograph, we found that fluorides easily pass through the mouth ’s mucous membrane but do not cross the skin barrier. This would explain the lack of response of ordinary p-tests. Anyway, in cases of benign aphthosis, replacing toothpaste with normal soap is not such a difficult test. Of course, not all benign recurrent aphthoses respond favorably to this test, but because of its simplicity, it would be unwise not to try it. In cases of fluoride intolerance it would also be important to eliminate, among other items, salts and beverages enriched with fluoride compounds from the family diet and pay more attention to fish and shrimps for example, which concentrate fluorides in their skin.

Robert Brun,15,rue de l ’Athénée
CH –1206 Genève (Switzerland)
Tel.+41 22 346 4660, Fax +41 22 346 4684