Fluoride Action Network

Excess fluoride in toothpaste unsafe for children

Source: Nigerian Tribune | September 10th, 2010 | By Sade Oguntola
Location: Nigeria
Industry type: Toothpaste

Dentists advise children to brush their teeth twice daily using toothpastes. However, different brands of toothpaste in Nigeria lack information on their proper usage as well as contain more than the required amount of fluoride that is safe for children below the age of six years, reports Sade Oguntola.

Sugar and starchy foods when left on teeth may turn to cavity-causing sugar if not promptly brushed clean. In addition, brushing the debris left behind from sugary snacks helps to eliminate the sugar turning into damaging acids, which may also be harmful to teeth and gums.

Although the single best way to remove harmful plaque, a thin, sticky film of bacteria, from teeth and gums is to brush teeth regularly and properly, the technique and frequency of teeth brushing, type of toothbrush and the content of the toothpaste, all affect the effectiveness of acheiving this harmful plaque.

Brushing with toothpaste (particularly toothpaste with fluoride) helps to remove plaque, resist decay, clean and polish teeth, remove teeth stains and freshen up breath.

However, irrespective of the brand or type (paste, gel or powder), fluoride is the most crucial ingredient in toothpaste.

Fluoride toothpaste is generally considered as the most important single factor in preventing cases of tooth decay found to be on the rise in high income countries. Fortunately, irrespective of the brand, consumer protection agencies recommended that toothpaste labels should carry messages that will ensure good oral health care, especially in children.

Apart from carrying labels of approval of these agencies on their container, which means that adequate evidence of safety and efficacy have been demonstrated in controlled, clinical trials, such labels should have information stating active ingredient, concentration of active ingredient, direction for use and instructions for children use.

However, contrary to the norm, the findings of a survey presented at the 2010 annual scientific conference of Nigerian Association of Paediatric Dentistry(NAPD) indicated that toothpastes from the United Kingdom had more labeling information in comparison to those from Nigeria.

This was an assessment carried out by Dr. Sola Ibiyemi of the Department of Periodontology and Community Dentistry in collaboration with Drs. V. Zohoori and A. Maguire from the Department of Child Dental health, School of Dental Sciences, New Castle University, United Kingdom.

A comparison of the labels of 10 most popular and locally available adult toothpastes from Nigeria and The United Kingdom found that four Nigerian toothpastes did not state their fluoride concentration on their labels while all the UK toothpastes provided this information.

According to the survey, only one Nigerian toothpaste had information on brushing thoroughly at least twice daily while nine UK toothpastes had this information. About half UK toothpastes had information on changing toothbrush every three months and visiting the dentist regularly.

In addition, none of the Nigeria toothpastes had information on what to do when there is an allergic reaction to toothpaste ingredients, storing toothpaste below 25 degree centigrade, not using toothpaste after expiration, flossing regularly and rinsing with mouthwash, unlike UK toothpastes. Also, majority of UK toothpastes had instructions about children use while very few Nigerian toothpastes had this information.

However disturbing was the fluoride content of most commercially available made-in –Nigeria toothpastes in the market found to be too high and so not healthy for children, especially those under six years of age.

An assessment of fluoride content of commercially available made-in-Nigeria toothpastes from a local market in Ibadan, which is representative of toothpastes available for sale in virtually all parts of Nigeria, found that the recorded percentage fluoride content on their package did not coincide with the measured fluoride content.

When the fluoride content of 10 brands of toothpastes purchased from the local market were assessed using the atomic absorption spectrophotometer, they contained more fluoride than is healthy for children under six years of age. Of the 10 brands, three of them were herbal toothpastes.

Professor Joseph Adenubi, a consultant paediatric dentist, Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, said Nigerian- made toothpastes are only accredited by Nigerian Dental Association (NDA) after it would have been undergone a blind test and ensured its fluoride content is within the recommended range.

However, a case where toothpastes contain a higher level of fluoride than was recommended for children, he explained could lead to the discolouration of newly formed teeth or those just forming about that period.

However, Professor Adenubi declared that NDA always insist that the fluoride content of toothpastes to be used by children be within the safe limit.

Already, cases of children vomiting after sucking on the tube of toothpaste had been reported due to its fluoride content, which could be irritating to the stomach. Probably just an ounce or so of toothpaste swallowed would be enough to make a 2- or 3-year-old vomit.

In addition to fluoride, another ingredient in toothpaste, sodium lauryl sulfate, likewise can make people ill if swallowed,. They cause stomach upset and lead to vomiting if it is consumed. But neither ingredient is added specifically to keep children from swallowing toothpaste.

Meanwhile, it is important parents watch children under six years when they brush their teeth. Just a pea-sized dab is needed, and children must be reminded to spit. Research has shown that because they are not yet in control of their swallowing reflex, children between the ages of four and six years typically swallow toothpaste when brushing.

A 1995 study at the Medical College of Georgia School of Dentistry found that about half the children this age don’t spit out or rinse out. They swallow the toothpaste instead. Making matters worse, they tend to use too much toothpaste on their own, especially when they use flavoured children’s toothpastes.

Many parents might not know toothpaste can make children sick to their stomachs. While the cavity-preventing effectiveness of fluoride has been demonstrated, too much fluoride not only can be dangerous, it can cause a condition known as fluorosis that discolours or spots developing teeth.

Research conducted by the School of Dental Medicine at the University of Connecticut Health Centre concluded that brushing with more than a pea-size amount of toothpaste more than once daily contributed to most of the fluorosis cases it observed in young children.

In areas where the drinking water contains fluoride, children who swallow even the pea-size amount of toothpaste are getting too much fluoride and are at risk for fluorosis.