NOTE: The following article provides an instructive example of the following statement from the scientific literature, and helps underscore the importance of the FDA-mandated poison label now required on all fluoride toothpastes sold in the US:

"Estimating the incidence of toxic fluoride exposures nationwide also is complicated by the existence of biases. Parents or caregivers may not notice the symptoms associated with mild fluoride toxicity or may attribute them to colic or gastroenteritis, particularly if they did not see the child ingest fluoride. Similarly, because of the nonspecific nature of mild to moderate symptoms, a physician's differential diagnosis is unlikely to include fluoride toxicity without a history of fluoride ingestion."
SOURCE: Shulman JD, Wells LM. (1997). Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. Journal of Public Health Dentistry 57: 150-8.

THE NEWS TRIBUNE (Tacoma, Washington)
April 5, 1994

Hazards lurk in toothpaste tube
Enumclaw sisters' illness traced at last to chemicals

By Elaine Porterfield

Doctors worked for weeks to find the source of 5-year-old Crystal Mustonen's nightly bouts of nausea and vomiting.

They gave the Enumclaw girl a complete series of gastrointestinal tests. She likewise endured a barium enema.

Then Crystal's 3-year-old sister Samantha started throwing up, too.

Finally, as he watched Samantha become ill after she brushed her teeth one night, it occurred to their father Wayne Mustonen that maybe it was his children's toothpaste.

Bubble gum-flavored toothpaste, to be exact.

The next night, after Crystal brusher her teeth, Mustonen's hunch was confirmed. His children were swallowing bits of toothpaste and becoming ill. The father, who'd been consumed by fear, was thrilled to find the cause was so simple.

"When they couldn't find anything, we got pretty worried," Morrrison said. "We have quite a bit of faith in God and we did of praying."

He immediately called the girls' doctor, "who said that could explain a lot," Mustonen said.

The specific is likely not to blame, said Terri Bonck, a Mary Bridge Children's Hospital pharmacist and poison control specialist. Rather, the culprit is fluoride.

"If the kids are sucking on the tube, that's enough to make them vomit," she said. "It's the fluoride itself - it's very 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, she said.

"This is pretty common, unfortunately, because of the amount of fluoride in the toothpaste," Bonck said. "In poison centers across the United States, it's a pretty common call."

Children likely vary in how sensitive they are to fluorride, she said.

In addition to fluoride, another ingredient in Sparkle toothpaste, sodium lauryl sulfate, likewise can make people ill if swallowed, said Jim Schwartz, spokesman for Cincinnati-based Proctor & Gamble, which makes Crest.

"They do cause stomach upset and will lead to vomiting if it's consumed," Schwartz said. "It's an effect of these ingredients."

But neither ingredient is added specifically to keep children from swallowing toothpaste, he said.

It's important parents watch children under 6 when they brush their teeth, Schwartz said. Just a pea-sized dab is needed, and children must be reminded to spit.

"An important safety message to parents is to urge them to supervise their children when they brush," he said. "It's something all parents should do when using over-the-counter medicine, like toothpaste."

Schwartz speaks from experience: One of his 3-year-old twin daughters recently suffered the same experience as Crystal Mustonen.

"Our own kid swallowed some toothpaste and threw up," he said.

Many parents might not know toothpaste can make children sick to their stomachs, said Chris Martin, spokesman for American Dental Association in Chicago.

"It's like everything, dosage is important," Martin said. "In small amounts, it's safe. You've got to make sure these products are treated carefully, locked away and kept out of the reach of kids.

"It's just not treated as you'd treat kitchen cleaner, but we wish parents would treat it like that."

May Mustonen, the girls' grandmother, lives with the family and cares for the children during the day. She said her grandchildren had been shown how to brush by a dentist and are carefully supervised.

She wishes Proctor & Gamble had labeled the enticing bubble-gum-flavored toothpaste with a warning that children can suffer nausea and vomiting from swallowing it.

That could have spared Crystal a battery of unpleasant medical tests, she said.

"We were so worried," she said. "I just want something put on the tube so other parents don't go through with their kids what we went through with ours."

See also:

• Toothpaste label revs up some anxiety

• Toothpaste: How Safe?