Safety and Toxicity

When used as directed, fluoride can improve the oral health of children. However, when used improperly it can produce chronic (fluorosis) and acute problems. Therefore, it is imperative that the practitioner instruct parents and patients about the proper storage and use of fluoride products.

Accidental ingestion of excessive amounts of fluoride can result in acute toxicity. Acute fluoride toxicity usually manifests itself as nausea and vomiting but death has been reported. The amount of ingested fluoride necessary to produce acute toxicity is in proportion to the child’s weight. For example, the lethal dose of fluoride for a 25 pound three year old is approximately 500mg but would be proportionately less for a child of lesser weight.

To reduce the possibility of ingestion of large amounts of fluoride, it is recommended that no more than 120 mg of supplemental fluoride be prescribed at any one time. Preparations of concentrated topical fluoride preparations (0.5% fluoride gels containing 5mg fluoride/ml) should be limited to 30 to 40 ml. The recommended treatment if a child ingests excessive amounts of fluoride is to call local poison control for verification, induce vomiting as quickly as possible and give milk every four hours to slow absorption.