Aug 2, 2004: “How toxic is an ingestion of toothpaste containing fluoride in a child?”

Background:  Email communication has increased the visibility of “urban legends”. Recently an email circulated addressing the risk of toothpaste purchased at dollar store chains such as Dollar Tree Ô, 99 centsÔ, and other “everything is a dollar” chains (NOT Dollar General stores). The email states that the toothpaste is manufactured in South Africa and has a higher fluoride content than is allowable in the U.S. 


Findings:  This story, as do many urban legends, has some truth in it.  The toothpaste sold in many dollar store chains is manufactured in South Africa.  I purchased a tube of Close-Up toothpaste at the Dollar TreeÔ in Nashville and it indeed was made in South Africa.


The amount of fluoride in toothpaste is listed as a salt form.  There are three common fluoride salt forms used in toothpaste manufacturing.  These salt forms and the amount of fluoride ion in each are as follows:


There is 1mg Fluoride in à   2.2 mg of Sodium Fluoride (NaF)

                                                4.1 mg of Stannous Fluoride (SnF2)

                                                7.6 mg of Sodium Monofluorophosphate (MFP)


The amount of fluoride in the South African Close-UpÒ toothpaste purchased at Dollar Tree is listed as 0.81% Sodium Monofluorophosphate.  This is exactly the same as the American Close-UpÒ toothpaste formulation.  However if one compares it to CrestÒ    toothpaste, which is 0.243% Sodium Fluoride, it may appear that the Close-Up has four times the amount of fluoride.  However, due to the different fluoride concentrations in the different salts, the fluoride concentration in the two tubes of toothpaste is basically the same.  The average of amount of fluoride in toothpaste is 1mg fluoride/gram toothpaste.


Toxicity of Toothpaste:  While toothpaste does contain fluoride, most pediatric ingestions are of sub-toxic quantities. The amount of fluoride considered toxic is 5-10mg/kg.  Assuming an ingestion of 1 ounce of toothpaste in a 10kg toddler, the amount of fluoride ingested would be 3mg/kg.  While this may produce mild nausea, the administration of a calcium containing product (milk, yogurt, ice cream) may help alleviate the nausea by decreasing the fluoride concentration due to calcium binding. The sorbitol in toothpaste may cause diarrhea following ingestion.


As with any potentially toxic ingestion the Tennessee Poison Center can assist with any questions regarding potential toxicity.


I am interested in any questions that you would like answered in “Question of the Week.”  Please e-mail me with any suggestions at


Donna Seger, M.D

Medical Director

Tennessee Poison Center