Fluoride toothpastes, mouthwash marketed to kids in dangerous ways, lawsuit says

Companies making fluoride-containing toothpastes and mouthrinses are improperly marketing their products as harmless and pleasant-tasting to very young children despite scientific research showing ingestion of the products could be dangerous to their health, according to allegations in a group of proposed class action lawsuits filed earlier this month.

There is a scientific consensus that fluoride primarily acts topically and reduces tooth decay when used properly in toothpaste, but ingestion of concentrated fluoride products can be dangerous across the board — especially for young children.

Many fluoride products lack easy-to-read warning labels and are flavored to taste like fruit or candy, and bear bright colors, cartoon characters, and illustrations of misleadingly large quantities of toothpastes on toothbrushes, according to the lawsuits, which bear many similar claims.

“The qualities they imbue these products with very much entice children to use more and ingest more than they should,” said Michael Connett, a partner at New York-based firm Siri & Glimstad, which is bringing the suits.

“Kids are swallowing so much of this stuff. I’ve always been disturbed by how reckless and deceptive the marketing is.”

Six lawsuits from total of 34 lead plaintiffs were filed Jan. 13 against Colgate and Tom’s of Maine (part of Colgate-Palmolive), Crest (part of Procter & Gamble), Hello Products, the Perrigo Company, and Chattem, Inc. Four were filed in circuit courts in northern Illinois and two in California.

One of the products being litigated is “Firefly” mouth rinse, owned by Perrigo Company. This product’s packaging looks like a toy and showcases cartoon characters popular with preschoolers such as Paw Patrol and Buzz Lightyear. The mouthwash itself comes in sweet candy flavors and colored pink, purple, or blue.

“Firefly’s toylike appearance, and candy-like nature, conveys the false impression to parents and caregivers that this is a product that is meant for and safe for young children,” the suit against Perrigo argues.

Most of the other products use similar marketing tactics.

None of the manufacturers immediately responded to requests for comments about the litigation.

“Unreasonable risk”

In 2023, America’s Poison Centers received more than 9,000 calls about fluoride toothpastes that year, more than 80 percent of which involved children 5 years of age or younger, according to the organization’s 2023 annual report. There are also 3,750 calls about fluoride mouthwash, the majority involving young kids. There were 262 visits to a hospital or urgent care clinic, related to ingestion of these products, the report found.

Exposure to fluoride has been linked with lowered IQ, according to a large meta-analysis of studies on the subject produced by researchers with the National Institutes of Health and published January 6 in JAMA Pediatrics.

The study also identified a dose-response effect, bolstering the idea that the relationship between fluoride exposure and IQ decrements is causal and linear, even at low levels, said Bruce Lanphear, an expert on environmental neurotoxins and a health sciences professor at Simon Fraser University in Vancouver.

Connett is also a consultant with the Fluoride Action Network, which has campaigned to end water fluoridation, the intentional addition of fluoride to public water supplies for the purpose of reducing cavities. A seven-year long court case, led by Connett, concluded in September 2024 with a judge ordering the Environmental Protection Agency to re-evaluate the safety of the practice as it “poses an unreasonable risk of reduced IQ in children.”

Corey Basch, a public health researcher at William Paterson University who is not involved in the suit, has studied the marketing of kids’ fluoride products, said the “marketing of toothpaste to young children… poses risks due to the potential for excessive ingestion of toothpaste, which can lead to fluoride toxicity, given that young children are more likely to swallow toothpaste.”

A 2014 study by Basch of 26 US products found that every toothpaste displayed at least one children’s animated character, half had one or more pictures of a food item, 92% stated they were flavored, and 27% depicted a full swirl of toothpaste — directly contradicting dentist recommendations for young children.

“Misleading marketing strategies are regularly used in selling children’s toothpaste as if it is a food product, while warnings regarding overconsumption among youth are minimized,” the study concluded.

Other dental health professionals have warned against the use of candy-like flavors in toothpastes. As long ago as 1992, the Journal of Public Health Dentistry published a consensus statement from dental researchers stating that “the use of flavors that may increase the ingestion of fluoridated dentifrices by young children should be strongly discouraged.”

Misleading marketing

According to the Food and Drug Administration (FDA), fluoride mouthwashes “are not indicated for use in children under 6 years of age” and “should not be within easy reach of any children.”

Mouthwashes are especially dangerous because they can be accidentally swallowed more easily than toothpaste.

A single 10 ml dose of Firefly mouthwash contains 2.4 milligrams of fluoride, the quantity of fluoride in over three liters of “optimally” fluoridated water in the US. Connett calculated that if a young child drank more than half a bottle of Firefly, it could be fatal.

The FDA requires fluoride-containing products to bear a warning label that says: “Keep out of reach of children under 6 years of age. If more than used for brushing [or rinsing] is accidentally swallowed, get medical help or contact a Poison Control Center right away.”

Connett said the words in the warning on the Firefly bottle “are so small, I cannot even read them,” which entails, in his view, “a flagrant violation” of the law.

Toothpastes are not supposed to be used by children under 2 years old, should be kept out of reach of children under 6 years of age, and caregivers who purchase fluoride toothpaste for children under 6 need to supervise the child’s brushing in order “to minimize swallowing,” according to the FDA.

The FDA and other health authorities agree that if children aged 3 to 6 use fluoride toothpaste, it should be no more than a “pea-size” amount. If kids aged 2 to 3 use toothpaste, it’s only supposed to be a tiny, rice-grain-sized smear.

Some of the products being litigated against, like Crest Kids color-changing toothpaste, contain visual illustrations on the packaging of a full strip of toothpaste being used, Connett said, which is misleading and potentially dangerous.

“When you see a product with crayon fonts and rainbow colors and it has fruit and candy flavors and smiling cartoons, most parents look at that and say, ‘this is a safe product for my kid,’” which is a false impression, he added.

“I’m hoping these companies stop these reckless marketing practices, that are causing excess fluoride exposure for millions of kids in the country,” Connett said.

(Featured image by Joshua Hoehne via Unsplash.)