Toothpaste may be harmful; read the warning on the toothpaste box; many toothpaste brands are not for children below 6 years

Syed Akbar
Hyderabad: The next time you buy toothpaste make it sure to read the fine print on the box particularly if you have children below 12 years at home. This is because toothpaste, though seems quite harmless, 
may prove to be detrimental to the health of your little sons and daughters if you fail to follow the 
warning.
Most of us fail to read the fine print on toothpaste tube and box. If we read it carefully, most of the toothpaste brands we use at home are not meant for children below six years of age; and some are not 
recommended for children up to 12 years. The toothpaste adults use need not necessarily be good for young children, warn city doctors. There are some toothpaste exclusively meant for children, but even they carry the caution that it is not meant for children below five years.
"We take 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 toothpaste 
are not meant for children as they do not know how to spit the excess paste and tend to swallow it. Toothpaste containing chemicals cause mineralisation and they are absorbed into the 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" and not the usual two centimetre quantity but it should be under adult supervision and the children should be made to spit it out. "But 
toothpaste containing fluoride and meant for sensitive teeth should not be given to children," he adds.
Fluoride toothpaste as also those meant for "whitening" of teeth and fighting "sensitivity" or tartar should be avoided for children. That toothpaste manufacturers hide the fact that most of the brands are not meant for small children is clear from the television commercials which mostly depict schoolchildren, as if all types of toothpaste are good from the youngsters. While the "benefits" are published in big letters and prominently on 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.
"One should not pick whatever type of toothpaste one lays hands on in a super market. If there are small children at home, ordinary toothpaste without chemical additives, foaming agents or abrasives should 
be preferred for them. Adults may use special types of toothpaste depending on the problem they suffer from,"  observes Dr K Sasikiran, general physician of Yashoda Hospitals.
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 fluoride is in excess quantity. 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.
Is fluoride so bad for children? Doctors point out that fluoride is good if it is taken in small quantities, but it is the high content of fluoride in toothpaste that causes concerns. Just imagine this. Everyone 
knows that Nalgonda district is notorious for its "high" fluoride content. One can see "live example" of people with deformed teeth, curved spines and bent limbs moving in scores of villages of Nalgonda.
And what is the content of fluoride in ground water in Nalgonda villages?  It ranges between 0.4 to 20 ppm (parts per million). This is in contrast to the upper limit of 0.5 ppm of fluoride in drinking water. But an average fluoride toothpaste contains 1100 ppm.
This in other words means your toothpaste contains 55 times more fluoride content that the highest 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 - food and water - should not exceed 8 ppm per day for an adult. For children it is much lower. In 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 toothpaste contain harmful abrasive agents. Anti-tarter toothpaste are meant for those over 18 years while toothpaste for sensitive teeth are recommended for middle and old age persons," he adds.
Permanent teeth just 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 firth tooth eruption. Half the pea size can be used up to six years.  Between six and 15 years toothpaste with low fluoride content can be used," he suggests.
Apart from fluoride, toothpaste 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 means eating your washing soap.
While grown up children 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 will cause discoloration of the tooth. White teeth will give way to brownish or black teeth.
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 tube 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. "Such toothpaste causes haemolysis in children and hampers the growth of teeth. They should not be used for children up to 12 years. For children below six years there's should always be adult supervision while using toothpaste meant for little kids," he suggests.

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Fact box
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* Always read the fine print and warning if any on toothpaste tube and box before using it, particularly if there are children below six years at home. Certain types of toothpaste are not meant for children 
up to the age of 12.

* Do not go by TV commercials. Decide the type of toothpaste for your children after consulting a dentist or physician.

* For children below six years use toothpaste of the size of half pea. Do not use two centimetres of toothpaste for children as many families generally do. Use a pea size as the child grows older. Teach 
children not to swallow toothpaste.

* Toothpaste can kill a child if he swallows the entire tube. The severity of the problem depends on the content consumed and the age and weight of the child.

*  Till the child learns to brush, rinse and spit out toothpaste, give only the brush to the child without the toothpaste, as the child will end up sucking on the toothpaste and swallowing it. Parents should 
brush in the child's presence so that the child learns to brush by seeing them do it.

* If you are using fluoride toothpaste for your child, take advice from a doctor.