The trouble with toothpaste and other dental products



Introduction You think toothpaste can’t hurt you because you don’t swallow it? Wrong!
Death by toothpaste
Reader stories

  • KB’s story:  severe chronic Insomnia caused by red gel toothpaste
  • Runny nose from toothpaste, I never considered it could cause such suffering
  • Bedwetting due to salicylates in mint toothpaste
  • Irritability and major temper outburst in 8 yo due to toothpaste provided by school nurse
  • 4 yo back to pre-diet behaviour due to strong mint toothpaste
  • Insomnia and restless legs due to tooth mousse
  • 2 years of behaviour problems related to unlisted artificial colour in fluoride tablets


Q. What does colour/color CI 77891 mean?
Q. My 2yo daughter is addicted to salicylates - she loves breaking into the bathroom and sucking on her minty Wiggles baby paste. Is there a low fluoride plain toothpaste for kids?
Q. Why doesn’t the government protect consumers by insisting on better labelling?
Q. Surely they don’t use artificial colours in European toothpaste?
Q. What’s wrong with artificial sweeteners in toothpaste?
Q. We use Colgate's toothpaste. That wouldn't have artificial colours, would it?
Q. What about SLS sodium lauryl sulphate in some toothpastes?

Failsafe toothpastes in Australia, online, USA, for children, for sensitive teeth
Scientific references
More information

Keywords: toothpaste, dental, floride, fluoride, sensitive teeth, teeth




Artificial colours - many that are not even permitted in foods -  are now so prevalent in toothpaste I would think there are few children or adults who do not ingest artificial colours on a daily basis. Some of these additives are known to cause a wide range of problems. Most people will never know they are affected until they stop ingesting them for 3 weeks.

  • additives can be absorbed through the oral mucosa (the mucous membrane lining the inside of the mouth)
  • colours, flavours and sulphite preservatives are the most likely to cause reactions
  • effects include: asthma, anaphylaxis, insomnia, irritability, hayfever, skin irritation, mouth ulcers, bedwetting and more…
  • artificial colours in toothpaste are listed as CI numbers to confuse consumers
  • there are now many artificial colours in toothpastes that are not permitted in foods, for some we have no idea what their effects are
  • it is possible to buy plain toothpaste without colours and flavours
  • all brands contain some preservative to prevent furry mould
  • minimise the risk by using only small amounts
  • NEVER swallow your toothpaste
  • NEVER allow your children to suck on their toothpaste tube

        Death by toothpaste

An English teenager died after suffering an extreme allergic reaction to toothpaste, according to her family. In the days before her death Francesca Sanna, 19, had complained her gums were sore. She collapsed and died from anaphylactic shock minutes after brushing her teeth while preparing for a night out with friends. Francesca had suffered from asthma and severe allergies all her life. Although the inquest was inconclusive, her parents believed the newly repackaged Aquafresh toothpaste was the most likely cause of the fatal reaction.

Francesca was using Aquafresh Mild & Minty toothpaste. I couldn't find the ingredients for that version, but I found 7 others (Extra Fresh, White & Shine, Kids, Advanced, Sensitive, Extreme Clean, Cavity Protection).  The additives in those toothpastes that would be most likely to cause a reaction like Francesca's include:

Preservative -  sodium sulphite (E221)  in the White & Shine. Sulphite preservatives are well known as the additives most likely to affect asthmatics and the reaction can occur within minutes, see FDA warning While all toothpastes contain preservatives (otherwise they will develop serious furry mould), most contain sodium benzoate (E211), not good, but not as dangerous to asthmatics. I was surprised to encounter sodium sulfite - I can't recall ever seeing sulphite preservatives in a toothpaste.

Flavours - range from extra fresh minty sensation flavour in the White & Shine to icy mint in the Advanced and Bubble Mint in the Kids version. Strong mint and menthol flavours can be dangerous for people with salicylate-induced asthma. Reactions are dose related, the stronger the flavour, the more the risk. Intake could also depend on whether Francesca was cleaning her teeth more frequently due to her sore gums.

Colours - Red 30 -  an artificial coal tar dye not permitted in foods, therefore no one knows what happens when it is absorbed into the body. And Blue 1 (E133) - an artificial coal tar dye.

Over the years, we have received two reports of dramatic reactions requiring hospitalisation as a possible reaction to brilliant blue (E133), e.g. " I had two sips from a bottle of the new Pepsi Blue (with Allura red 129 and Brilliant Blue 133, Blue #1) and within 30-40 seconds I became violently ill. I was taken to hospital and it took me approximately ten days to recover fully."  The other was a similar reaction to a blue coloured icecream with no other colours.

Japanese doctors have reported the case of a five year old girl who developed multiple chemical sensitivity after an initial severe reaction to brilliant blue (133) and tartrazine (102) artificial colours in sweets and repeated exposure to food additives in foods and medication. Doctors commented that azo dyes in foods and drugs might play important roles as elicitors of paediatric MCS. Naoko Inomata and others, Multiple chemical sensitivities following intolerance to azo dye in sweets in a 5-year-old girl, Allergology International. 2006; 55(2):203-205. Free full text

Brilliant blue was one of the artificial colours found to cause a greater adverse effects when used in a mixture of commonly used additives. Researchers found the additive mixtures stunted the growth of nerve cells in mice, interfering with proper signalling functions. (Lau K and others, Synergistic Interactions between Commonly Used Food Additives in a Developmental Neurotoxicity Test

Further reading: Story from

        Reader stories

[1293] KB's story: severe chronic Insomnia caused by red gel toothpaste (December 2014)

In October 2104, Howard and I embarked on a long, high, difficult six week trek in the remote Dolpo region of Nepal. Our guide, KB, was brilliant - young, fit, strong and clever, he spoke excellent English and we enjoyed his company. However, on the 14th day of the trek, KB admitted he was having terrible trouble sleeping at night. The problem had started on the first night of the trek and was getting worse. He had also become extremely sensitive to night noises such as barking dogs. He didn't have to tell us that because we’d already noticed that he would spend his nights throwing rocks at noisy dogs and even, rather bizarrely, ask mule train and pack horse drivers to remove the bells from their animals' necks.

This was a puzzle. Insomnia and hyperacusis – an increased sensitivity to everyday sounds - are commonly associated with some food additives and natural food chemicals, but I knew what KB ate because we were eating the same: additive free local foods mostly roasted barley flour porridge and two big serves a day of rice, lentils and vegetables. I checked that his drinks were okay, mostly water and weak milky tea, and that he wasn't using chewing gum.

Then I asked about toothpaste. You have to consider everything that people put in their mouths because additives can be absorbed through skin, whether you swallow the toothpaste or not. KB looked stunned. We read the label on his toothpaste. Bingo. It contained five colours, but even I couldn’t tell what they were, because toothpaste labelling is not covered by the same rules as food. It is one of the dirty tricks that manufacturers use to hide nasty additives from concerned consumers: they use Colour Index numbers. So the list read “colours mica/CI 77019, CI 16255, CI 17200, CI 177491, CI 77891”.


I usually look those numbers up on our website, but here we were in one of the most remote places on the planet and I didn’t have access. We could see the toothpaste was red. Get rid of it, I suggested. “But it is recommended by the World Dental Federation”, KB said.

Out went the toothpaste and KB’s problem disappeared overnight. I later confirmed that one of those numbers is artificial colour E124. When used in European food, it has to carry a warning about adverse effects on children's behaviour and attention, Another one - naphthalene red - isn’t even permitted in food, so no one knows what the side effects might be.  I was furious with toothpaste manufacturers, governments and therapeutic goods regulations for permitting this confusing labelling, and with the dentists in the World Dental Federation for endorsing such a product.

There was one fact I wanted to look up when we got back. What exactly is the World Dental Federation? Turns out it’s a professional group that runs congresses for dentists, and it is funded by …  wait for it … the same multinational company that makes KB's toothpaste - Sue Dengate



Three years ago I started the RPAH elimination diet and discovered I was suffering intolerance to dairy as well as other food chemicals. Although other symptoms cleared up, there were a few niggling things, particularly the blocked and running nose, always having my sleeve or back pocket loaded with tissues, ready for the inevitable moment. I had always suffered this morning and evening ritual of a running nose so 'just lived with it'. Trying the diet again 3 years later, after a week of full elimination, the runny nose persisted. I read and re-read through your checklist of common mistakes and decided to try plain toothpaste which I never did 3 years ago as my dietician at the time said, 'oh you don't have to give up toothpaste if you don't want to - everything else though' and I never really considered it could cause me such suffering. Well well well. A truly amazing change has occurred for me. No more nose blowing at breakfast time or when I'm settling into bed at night. The tap has officially been turned off! – from story [815]

Bedwetting due to salicylates in mint toothpaste

I have a 10 yo who is hyperactive and an 8 yo who wets the bed. I recently browsed your website and was astounded with what I found … I recently changed their toothpaste to a mint one and couldn't understand why one of my children was off this planet with behavioural problems and the other was wetting the bed a lot more. I would never have linked the problems to the toothpaste. I read about salicylates in the mint toothpaste and stopped immediately. The bed wetter has improved already. We have cut additives out of our diet and it seems that as long as we limit the amount of salicylates in fruit and vegetables that he eats, he doesn't wet the bed. – Tania, by email, story [975]

My 6 yr old daughter has been hyperactive, aggressive, throws mega tantrums. She reacts badly almost immediately after eating anything that has blue food colouring in it including toothpaste. I also found with colouring that I had to watch out for green as it is made up of blue and yellow. –  by email

Insomnia and restless legs due to tooth mousse

I have tried the "plain" GC Tooth Mousse [with benzoates, you have to leave it on for a few minutes] 3 times and have reacted each time. It appears to stay in my system for 2 days. I react with insomnia, then my body gets the "jumps".  I have even gone back to having the jumps in my legs and arms during the day (2 days after taking the tooth mousse)! – Di, by email

High salicylate mint flavoured blue Savacol mouthwash causes eczema, behaviour problems

My salicylate sensitive daughter had a tooth removed under general and we were told to use Savacol mouthwash 3 times daily for a week post surgery to keep the stitches infection free.

I've noticed her eczema has returned with a vengeance and a red anus ring as well as deplorable behaviour. Savacol is marketed as an antiseptic and alcohol free, with no other ingredients listed than the main ingredient chlorhexidine gluconate.  It reeks of mint and is bright blue coloured liquid. Although she is only gargling with this mouthwash and not drinking it per se, I am wondering if this could be the culprit. - J

Sue's comment: you don't have to swallow mouthwash to be affected by additives and strong flavours. They can be absorbed through the mucous membranes lining the mouth. It's the same problem as toothpaste.

I hate the way the  pharmaceutical industry has stopped listing nasty additives. Putting profits ahead of consumer safety as usual. It's best to follow RPAH advice at all times: "Avoid unnecessary medication". Consider home remedies first. When I had a wisdom tooth removed recently, I was told to gargle with salt water and use icepacks for pain. Both worked really well and were failsafe.

Irritability and major temper outburst due to toothpaste provided by school nurse

My 8 yo son experienced irritability and a major temper outburst after using highly coloured and flavoured fluoro blue fruit-tasting toothpaste provided at school by the school dental nurse. – by email


Our 4 yo son improved beautifully for the first two weeks on the elimination diet, then slowly started to get worse. By the end of three weeks he was back to pre-diet behaviour.  What caused it? We started to a new, strong mint flavoured toothpaste at the start of week 3. – by email














Q.What does colour/color CI 77891 mean?

A. Colour Index or color index numbers, used in dental products, e.g.:

CI 77019 mica, a colourless silicate that provides lustre, failsafe
CI 16255 also known as *E124, ponceau 4R, brilliant scarlet, banned in the US, European food with this must display warning “may have an  adverse effect on behaviour and attention in children”, not failsafe
CI 17200 D&C Red 33 also known as naphthalene red, azo grenadine and azo magenta, not permitted in food, used in cosmetics, hair dyes, dentifrices, side effects when ingested unknown but  likely to cause the same problems as other azo dyes: irritability, restlessness, inattention, sleep disturbance and more
CI 77491 also known as E172 iron oxide, red, yellow, orange, brown black colour, failsafe
CI 77891 also known as E171 titanium dioxide, white colour, failsafe
CI 42051,also known as E131, patent blue, artificial colour, not failsafe, not permitted in food, known to cause urticarial and allergies
CI 15985, also known as E110, sunset yellow, artificial colour, European food with this must display warning “may have an adverse effect on behaviour and attention in children”, not failsafe
*E stands for Europe. For Australian and NZ numbers, ignore the E

See more CI numbers for colours to avoid

Q. My 2 year old daughter is addicted to salicylates - she loves breaking into the bathroom and sucking on her minty Wiggles baby paste. Is there a low fluoride plain toothpaste for kids?

A. Young children shouldn't swallow fluoride toothpaste, because too much fluoride can affect the formation of permanent teeth and possibly other health problems. An advantage of plain toothpaste - other than lack of salicylates - is that children aren't tempted to eat it. Normal toothpastes contains about 1 mg of fluoride per gram of toothpaste and low fluoride toothpaste contains about half that. I don't know of any low fluoride children's toothpastes that are free of both flavours and artificial colours but you can use small amounts - “a smear” - of plain adult toothpaste. Or if living in an area with fluoridated water, you may want to choose plain non-fluoridated toothpaste. Ask your dentist.




A. The short answer to this is that multinational corporations are too powerful and decisions are now made for profit instead of health. It is up to consumers to protect themselves by being better informed. If you can’t understand what’s in a product, don’t buy it. Read Nicholas Freudenberg’s 2014 book Lethal but legal or see

Q. What’s wrong with artificial sweeteners in toothpaste?

A. A new study has shown that artificial sweeteners aspartame, saccharin and sucralose can encourage obesity by altering beneficial gut bugs. Can your toothpaste make you fat? We don’t know but maybe you don’t want to find out.

Q. Surely they don’t use artificial colours in European toothpaste?

A. Yes they do! Since 2008, Europeans have been required to display the warning "may have an adverse effect on activity and attention in children" on foods containing any of the six artificial colours used in Southampton University studies. These colours have mostly been removed from foods but artificial colours such as E133 brilliant blue that were not included in the Southampton University study are still used. And Europeans need to be looking at their pharmaceuticals because the ban doesn’t apply to those, for example, toothpaste commonly contains patent blue CI 42051, another name for artificial blue E131.



A. You need to read labels:  Titanium dioxide CI 77891 is white and considered failsafe. Other than that, you could have problems. For example, Colgate's My First Infant & Toddler toothpaste for children aged 0 to 6 years contains FD&C Blue No.1 (otherwise known as brilliant blue, E133). Can kids be affected by blue colour? YES. This is what some of our readers say about reactions to blue colour:

*"...someone shared a packets of lollies and she came home proudly saying that blue is OK ... 5pm that night blue was not OK" - from story [003]

*" ... Oh and the canteen why oh why do they make lemonade slushies blue it's so unnecessary it's infuriating" - from story [1211]

Another example - for adults (remember that adults with Alzheimers can be affected at least as badly as the most sensitive children yet no one ever thinks of this) - Colgate Max White One contains: 

CI 42051 not permitted in food, patent blue (to be avoided by those with a history of allergy, severe reactions including shock and breathing problems can occur, ref Hanssen's Additive Code Breaker)
CI 17200 not permitted in food, naphthalene red, see KB's story above
CI 77891 titanium dioxide - failsafe
CI 74160 not permitted in food, phthalocyanine blue (exposure to phthalocyanines may cause serious birth defects, see Wikipedia)
CI 73360 not permitted in food, red 30

Q. What about SLS sodium lauryl sulphate in some toothpastes?

A. There is a lot of controversy about this chemical, which is to be found in some of the items recommended below. It is considered to be failsafe, but some extra sensitive failsafers find they can't tolerate it.

Environmental chemical exposure is a major concern for consumers of packaged goods. The complexity of chemical nomenclature and wide availability of scientific research provide detailed information but lends itself to misinterpretation by the lay person. For the surfactant sodium lauryl sulfate (SLS), this has resulted in a misunderstanding of the environmental health impact of the chemical and statements in the media that are not scientifically supported. This review demonstrates how scientific works can be misinterpreted and used in a manner that was not intended by the authors, while simultaneously providing insight into the true environmental health impact of SLS. SLS is an anionic surfactant commonly used in consumer household cleaning products. For decades, this chemical has been developing a negative reputation with consumers because of inaccurate interpretations of the scientific literature and confusion between SLS and chemicals with similar names. Here, we review the human and environmental toxicity profiles of SLS and demonstrate that it is safe for use in consumer household cleaning products.

Environ Health Insights. 2015 Nov 17;9:27-32. doi: 10.4137/EHI.S31765. eCollection 2015. Human and Environmental Toxicity of Sodium Lauryl Sulfate (SLS): Evidence for Safe Use in Household Cleaning Products. Bondi CA, Marks JL, Wroblewski LB, Raatikainen HS, Lenox SR, Gebhardt KE.

See also Sue's blog on sodium lauryl sulphate SLS

        Failsafe toothpastes

You can brush with salt on a wet toothbrush OR buy a failsafe toothpaste

Avoid toothpastes with artificial colours and/or mint/fruit/herbal flavouring because they contain salicylates and/or amines, not permitted on the elimination diet. The following toothpastes are recommended:

Alfree Plain Toothpaste* available from pharmacies. This toothpaste is non-fluoride, which may be what you want if you live in an area with fluoridated water, see more below

Pharmacy Health Plain Toothpaste* (formerly Soul Pattinson's Plain toothpaste) contains fluoride, from Soul Pattinson pharmacies or online from

Plain Toothpaste* from Oral Hygiene Solutions, contains fluoride, by mail order 


Priceline Plain toothpaste is easily available, but does contain SLS - see Sue's blog on sodium lauryl sulphate SLS

Also available: failsafe whitening toothpastes

We have heard from a failsafe dentist that your local pharmacy will stock this brand on request. (in the Newcastle area at Charlestown and Belmont but not Kotara, $3 a tube), thanks to Nat

* WARNING: toothpastes usually contains benzoate preservative, otherwise they get a 'serious furry mould' within 6 months. Minimise the risk by using only small amounts. Both contain fluoride at 0.76% - thanks to Jenni. These brands are suitable for both adults and children.

USA Failsafers have recommended the following toothpastes:

Cleure Original (no flavour) - thanks to Emma

Xlear Spry Tooth Gel with Xylitol, Original Flavor - Ingredients: Purified water, Xylitol, Calcium glycerophosphate, Cellulose gum (thickening agent), and Grapefruit seed extract (as a preservative). - thanks to Elise

Fluoride and children

The current medical recommendation for children under six in Australia is to use only a pea size amount of low fluoride toothpaste or a smear of regular fluoride toothpaste twice a day.

Children shouldn't swallow fluoride toothpaste because too much fluoride can affect the formation of permanent teeth and possibly other health problem. In Jan 2011, US authorities took the unprecedented step of lowering the amount of fluoride permitted in water supplies, due to signs of fluorosis (too much fluoride) in 40% of American teenagers. A big advantage of plain toothpaste - other than lack of salicylates - is that children aren't tempted to eat it. Normal toothpastes contains about 1 mg of fluoride per gram of toothpaste and low fluoride toothpaste contains about half that.

Since the introduction of fluoride toothpaste in the 1970s, there have been large declines in tooth decay in most countries. This trend has occurred regardless of the concentration of fluoride in water or the use of fluoridated salt, and it probably reflects use of fluoridated toothpastes and other factors, including perhaps aspects of nutrition, whether fluoridated water is used or not. Fluoridated water schemes have been withdrawn in Germany, Finland, Japan, the Netherlands, Sweden, and Switzerland, apparently because of the effectiveness of other measures such as fluoridated toothpaste - although in some places fluoridated table salt is used. In 2011, US authorities took the unprecedented step of lowering the amount of fluoride permitted in water supplies, due to signs of fluorosis (too much fluoride) in 40% of American teenagers:

Hint for children - Tell your child that regular toothpaste is not acceptable, "so you will have to clean your teeth with salt from now on". Next day, announce "I managed to get you some special toothpaste!" so the child compares the new taste to salt, not mint.

Sensitive teeth - Toothpastes for sensitive teeth often contain artificial colours and the active ingredient in most is potassium nitrate (preservative 252: NOT failsafe). In recent years, studies have suggested a link between nitrates and cancer, heart disease, diabetes and Alzheimers.

In 2003, Oral Hygiene Solutions launched a plain toothpaste for sensitive teeth that contains strontium acetate as the active ingredient, which is failsafe


        Scientific references

Skaare A et al, Skin reactions and irritation potential of four commercial toothpastes. Acta Odontol Scand. 1997 Apr;55(2):133-6.  Reactions to 4 toothpastes were tested in 19 healthy dental students in a double-blind study …. The toothpastes tested were A) Zendium (non-ionic detergent), B) Solidox F (SLS/polyethylene glycol), C) Colgate Total (triclosan/copolymer/SLS/propylene glycol), and D) Solidox G (triclosan/zinc citrate/SLS/polyethylene glycol). Toothpaste C was the greatest irritant, causing skin erythema in 16 of the 19 subjects, whereas toothpaste D gave no reactions. Toothpaste B provoked three reactions (two severe), whereas toothpaste A caused only one mild reaction. Although this study was carried out on skin and hence not directly applicable to the oral cavity, these and previous results may indicate that a toothpaste without propylene glycol and SLS may be preferred by susceptible persons.

dos Santos MA et al, Menthol-induced asthma: a case report, J Investig Allergol Clin Immunol. 2001;11(1):56-8. A case of asthma due to menthol is reported in a 40-year-old woman with no history of asthma or any other allergy. During the last two years, the patient had presented dyspnea, wheezing and nasal symptoms when exposed to mentholated products such as toothpaste and candies …. The patient achieved control of symptoms by avoiding menthol and its derivatives.

Bayat R, Borici-Mazi R. A case of anaphylaxis to peppermint  Allergy Asthma Clin Immunol. 2014 Jan 28;10(1):6. A 69 year old male who suffered anaphylaxis to peppermint candy reported recent onset of mouth itchiness and mild tongue and lip swelling after using Colgate peppermint toothpaste.

Andersson M, Hindsen M. Rhinitis because of toothpaste and other menthol-containing products. Allergy. 2007;62:336–337. Described in:

Spurlock BW, Dailey TM. Shortness of (fresh) breath-toothpaste-induced bronchospasm. N Engl J Med. 1990;323:1845–1846. Described in:

Paiva M, Piedade S, Gaspar A. Toothpaste-induced anaphylaxis caused by mint (Mentha) allergy. Allergy. 2010;65:1201. Described in

Rietschel RL, Contact urticaria from synthetic cassia oil and sorbic acid limited to the face.  Contact Dermatitis 1978;4(6): 347-9. A patient with contact urticaria with skin and respiratory symptoms was found to be sensitive to both sorbic acid and synthetic oil of cassia … The source of the patient's contactants was her shampoo and toothpaste


        More information

Introduction to food intolerance

See also teeth grinding (bruxism)


© Sue Dengate update February 2019