Last week we took our baby to his 8 month developmental check. The health visitor told us that we should start brushing our baby’s teeth as soon as they appeared. She went on to say that some government dentist recommends the use of the Colgate brand toothpaste shown on the left. We were given a big tube of this toothpaste and a Colgate toothbrush for 0-2 year olds.
I was surprised to hear that the NHS health visitor was recommending toothpaste containing fluoride. The mums were clearly distracted by their babies when given both the toothpaste and the advice about how to use it. The health visitor pointed out that although a pea-sized amount is often recommended, a smear would be enough.
Despite the fact that my wife uses fluoride toothpaste, she went off to Whole Foods in search of a more baby friendly alternative. She found a fluoride-free Green people toothpaste. We let the baby try it. He loved putting the toothbrush in his mouth. It soon occurred to us that although it was pretty easy to get the toothpaste into his mouth, it would be impossible to get it out again. The toothpaste would be swallowed. We were glad that we had not tried it with the Colgate!
I could not stop thinking about this Colgate toothpaste and started looking at the ingredients on the box, looking on the Internet to see what other parents thought, tried and failed to figure out who exactly was recommending Colgate toothpaste for babies in Hackney.
Have a look at the ingredients in the toothpaste that our local health authority has recommended that you and I give to our babies:
Dicalcium Phosphate Dihydrate – Used for remineralisation of enamel.
Aqua – water
Glycerin – A chemical produced by combining water and fat. Found in soaps and also a lot of hand creams.
Sodium Lauryl Sulfate – an inexpensive foaming agent often found in shampoo and engine degreasers. It breaks down oils.
Cellulose Gum – a ‘cost-effective’ thickening agent which is found in many foods and toiletries.
Aroma – Impossible to know what this is or where it comes from.
Sodium Monofluorophosphate (1000 ppm) – The concentration is interesting to note. It is 1000 times, that is not a typo, 10oo times what would be considered optimum for fluoride levels in drinking water.
Tetrasodium Pyrophosphate – Twice as toxic as salt. Used to prevent plaque build up by removing calcium and magnesium from saliva. Also used in laundry detergents.
Sodium Saccharin – Also known as saccharin the once banned, but now considered safe, artificial sweetener.
Sodium Fluoride (450 ppm) – Another source of fluoride. US toothpastes contain about 1000 ppm of fluoride but UK ones contain up to 1450 ppm as in the Colgate example.
Calcium Glycerophosphate – Plaque inhibitor
Limonene – responsible for the aroma of citrus, a by product of the production of orange juice and considered a natural degreaser.
When you consider that the brush is responsible for more of the cleaning than the toothpaste, is it necessary? I am willing to accept that fluoride can prevent decay, tooth enamel can be re-mineralised in the presence of fluoride and saliva. Is is really necessary for a child with a couple of baby teeth to use fluoridated toothpaste? Does the risk of swallowing fluoride and the other ingredients in toothpaste outweigh any benefits?
How much is enough?
If you think that some fluoride is necessary for oral health, it might be worth considering how much is necessary. Infant formula milk prepared with tap water is a high source of fluoride especially for babies who are exclusively formula fed. In the US the RDI (recommended daily intake) is 0.05 mg / kg body weight / day. This means that a 1 year-old boy does not need more than 0.5 mg / day. If you brush his teeth twice a day, that is 0.25 mg of fluoride per brushing. I estimate that you can find 0.25 mg in 0.17 g or 130 microlitres of Colgate’s fluoride toothpaste. Do you think that you could measure such a small amount on to a toothbrush while holding a baby? Remember the pea-sized amount? The volume of a pea is 200 microlitres so even that is more than what is necessary.
How much is too much?
A tube of fluoride toothpaste contains enough fluoride to kill a one year old child. In practice, this doesn’t happen because the fluoride would cause nausea and vomiting before they could eat that much of it. The ‘probably toxic’ dose for a 10kg infant is 50mg. A 100 ml tube of Colgate contains about 188.5 mg of fluoride, more than three times a lethal dose for a one year old yet no where on the packaging are there any warnings that this product might be harmful to your child. Toothpaste tubes don’t even have child-proof caps. If you have fluoridated toothpaste in your house, make sure that you keep it out of reach of your children. The American Association of Poison Control Centers reported 24,547 (21,775 were under five years old) incidents involving excess fluoride ingestion in 2009. Of these, 378 had to be treated in emergency departments and two cases had ‘severe’ outcomes. No deaths were reported in that year but a death was reported in 2002. It should be noted that 3-5 mg / kg of body weight can make your child very ill. For a 10 kg infant that means 30 mg – 50 mg, less than a quarter of the tube.
In the US, the Food and Drug Administration (FDA) started requiring warning labels on toothpastes in 1997:
“If you accidentally swallow more than used for brushing, seek professional help or contact a poison control center immediately”
By contrast, our UK tube of Colgate says:
“Children of 6 years and younger: Use a pea sized amount for supervised brushing to minimize swallowing. In case of intake of fluoride from other sources consult a dentist or doctor.”
If we lived in the US, we might have been given My First Colgate, a toothpaste designed for infants and toddlers that is safe to swallow. It contains no fluoride. My First Colgate is available here but it is quite expensive as it is probably imported from the U.S.
I decided to ring Colgate on their customer advice line (00800 – 321-321-32 in the UK and Ireland) to ask what toothpaste they would recommend for a child not yet 1 year old. They said that they do not have a product for children under 1 and that their advice was to use either a soft cloth moistened with water or a soft bristled brush also just with water. When asked why there was no fluoride free option in the UK, the Colgate rep told me that it was because most people in the UK do not have access to fluoridated water.
I called my local GP surgery where we attended the baby clinic and was told (correctly) that the Health Visitors do not come under their jurisdiction but the practice manager told me that they would not recommend toothpaste for a 39 week old baby.
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