Fluoride overdose

Fluoride can be harmful in large amounts. Acute exposure to dangerous amounts of fluoride is rare, and usually occurs in small children.

Fluoride is found in many over-the-counter and prescription products, including:

• Certain mouthwashes and toothpastes
• Certain vitamins (Tri-Vi-Flor, Poly-Vi-Flor, Vi-Daylin F)
• Water that has fluoride added to it
• Sodium fluoride liquid and tablets

Fluoride may also be found in other household items, including:

• Etching cream (also called acid cream, used to etch designs in drinking glasses)
• Roach powders

Other products may also contain fluoride.

Symptoms of a fluoride overdose include:

• Abdominal pain
• Abnormal taste in the mouth (salty or soapy taste)
• Diarrhea
• Drooling
• Eye irritation (if it gets in the eyes)
• Headache
• Abnormal levels of calcium and potassium in the blood
• Irregular or slow heartbeat
• Cardiac arrest (in severe cases)
• Nausea and vomiting
• Shallow breathing
• Tremors (rhythmic movements)
• Weakness

Have this information ready: 

• Person's age, weight, and condition (for example, is the person awake or alert?)
• Name of the product (ingredients and strength, if known)
• Time it was swallowed
• Amount swallowed
• If the medicine was prescribed for the person

Call for help even if you don't know this information.

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container to the hospital with you, if possible.

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may done include:

• Blood and urine tests
• Chest x-ray
• Electrocardiogram (ECG)

Treatment may include:

• Fluids through a vein (by IV)
• Medicines to treat symptoms
• Calcium or milk
• Laxatives
• Breathing support, including a tube through the mouth into the lungs and connected to a breathing machine (ventilator)

The above tests and treatments are more likely to be done if someone overdoses on fluoride from household products, such as hydrofluoric acid in rust remover. They are less likely to be done for an overdose of fluoride from toothpaste and other health products.

How well someone does depends on how much fluoride was swallowed and how quickly treatment is received. The faster a person gets medical help, the better the chance for recovery.

The amount of fluoride in toothpaste is usually not swallowed in large enough amounts to cause harm.

Aronson JK. Fluoride salts and derivatives. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:366-367.

Levine MD. Chemical injuries. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 55.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.