The next time you buy toothpaste, make sure to read the fineprint on the box, particularly if you have children below 12 years at home. This is because toothpaste, though it seems quite harmless, carries a health warning for children.
A reading of the fineprint will reveal that most toothpaste brands are not meant for children below six years of age and some are not recommended for children up to 12 years. It is better to choose toothpastes exclusively meant for children, but even these caution that they are not meant for children below five years.
“We take it for granted that toothpaste is for the entire family. But in most cases it is not so. The type of toothpaste we choose should depend on the quantum of the dental problem we suffer. Certain toothpastes are not meant for children who do not know how to spit out the excess paste and tend to swallow it. Toothpastes containing chemicals cause mineralisation and they are absorbed by body. There should always be adult supervision if toothpaste is used for small children,” says Dr M. Rahmatullah, chairman of the Indian Academy for Advanced Dental Education.
According to him, children below six years may be given a “pea size” quantity of toothpaste and not the usual “two centimetre” quantity. Moreover, brushing should always be under adult supervision and the children should be made to spit out the toothpaste.
Dr Rahmatullah also cautions that toothpaste containing fluoride and meant for sensitive teeth or whitening teeth should not be given to children. Television commercials often feature school children, suggesting that all types of toothpaste are good for youngsters. While the “benefits” are published in big letters and prominently on the toothpaste tube and box, the warning, “not meant for children below six or 12 years” is mostly in fine print, which parents generally fail to read.
Dr K. Sasikiran, general physician at Yashoda Hospitals, recommends that parents should be selective about the toothpaste they choose for their kids.
“If there are small children at home, ordinary toothpaste without chemical additives, foaming agents or abrasives should be preferred. Adults may use special types of toothpaste depending on the problem they suffer from,” he says. He cautions parents against using toothpaste with high fluoride content. “Though fluoride is known to fight dental caries, it actually causes dental caries in small children if used in excess. Different brands of toothpaste have varying content of fluoride. If a child swallows toothpaste with high content of fluoride, it may lead to spinal deformities. Whitening or bleaching agents added to toothpaste cause gastritis in children. In a few cases, it may even lead to cancer, Dr Sasikiran warns. Fluoride is good if taken in small quantities, but toothpastes with a high fluoride content cause concern.
Just imagine this. Everyone knows that Nalgonda district is notorious for the high fluoride content of its water. One can see people with deformed teeth, curved spines and bent limbs in several villages in the district.
The content of fluoride in ground water in Nalgonda’s villages ranges between 0.4 ppm and 20 ppm (parts per million). The upper limit considered safe is 0.5 ppm of fluoride in drinking water. The average fluoride toothpaste contains 1100 ppm.
This in other words means your toothpaste contains 55 times more fluoride content that the upper limit (20 ppm) found in ground water in Nalgonda, which is notorious for fluorosis.
If a child swallows fluoride toothpaste regularly, he or she is 55 times more prone to fluorosis than a villager living in fluoride-hit Nalgonda. The total intake of fluoride through all sources of food and water should not exceed 8 ppm perday for an adult. For children it is much lower. In the case of children, if the fluoride content exceeds 1.5 ppm it will lead to dental fluorosis.
Senior dentist Dr K. Satyendra Kumar argues that fluoride and other chemicals present in toothpaste are harmful for children as the enamel of their teeth is porous. “Fluoride toothpaste contains between 1100 and 1600 ppm of fluoride content. Certain toothpastes contain harmful abrasive agents. Anti-tartar toothpastes are meant for those over 18 years while toothpastes for sensitive teeth are recommended for middle aged and older persons,” he adds.
Most permanent teeth start erupting when a child turns 12 years. At this stage care should be taken against rampant use of toothpaste containing harmful chemicals. Whitening agents, for instance, observes Dr Satyendra Kumar, bleaches the tooth and produces “nascent oxygen”, which is not good for children. “Normal toothpaste can be used from the time of the first tooth eruption. Half the pea sizecan be used up to six years. Between six and 15 years, toothpaste with low fluoride content can be used,” he suggests.
Apart from fluoride, toothpastes often contain triclosan, which is said to produce chloroform when it reacts with chlorinated water supplied by municipal bodies. Foaming agents like sodium lauryl sulphate, hydrated silica and saccharin are also added to toothpaste. Fluoride is generally added in the form of sodium fluoride, which is one of the main ingredients in poison meant to kill rodents.
Surfactant, originally a detergent, is also added in some types of toothpaste. Regular intake of surfactant is like eating your washing soap. While more grown up children can develop dental fluorosis, little children in the age of tooth development run the risk of enamel fluorosis if the intake of fluoride through toothpaste is high. This could cause discoloration of the teeth, white teeth turn brownish or black.
According to a report by the Centres for Disease Control and Prevention (CDC) of the USA, fluoride in toothpaste is taken up directly by the dental plaque and demineralised enamel and also increases the concentration of fluoride in saliva.
Can a toothpaste kill a child if he swallows the entire tube? Dr Sharmila Asthana, consultant paediatrician, Apollo Hospitals, warns that it is “theoretically possible” for a small child to have serious health consequences if he/she consumes a whole tube of toothpaste depending on the size of the toothpaste tube and the weight of the child.
“If ingested, fluoride reacts with gastric acid in the stomach to produce hydrofluoric acid. Acute exposure to high concentrations can result in immediate effects of abdominal pain, excess salivation and vomiting. Seizures and muscle spasms can also occur. Death due to respiratory paralysis is also a possibility although I doubt that concentrations in toothpaste are high enough to do this,” Dr Sharmila says.
She has a warning for parents: “If a child accidentally does consume an entire tu be of toothpaste, parents should regard it as any other acute poisoning and rush the child to the nearest emergency room.” Senior prosthodontist Dr M. Sirajur Rahman of King Kothi Government Area Hospital, warns that toothpaste containing phosphoric acid, potassium nitrate and fluoride content should not be given to small children.
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