Brushing up on fluoride for kids and adults

What are the benefits of fluoride?

Fluoride is a naturally occurring mineral that can help prevent tooth decay by strengthening the enamel of your teeth. It is added to most types of toothpaste, as well as many other dental products, such as mouthwash. It is also added to the public water supply in many areas to help support dental health. Dentists sometimes prescribe fluoride supplements, such as tablets, especially for people who do not get fluoride from their water.

Should children use fluoride?

Fluoride is beneficial for dental health for people of all ages. As of 2014, both the American Dental Association and the American Academy of Pediatrics recommend using fluoride toothpaste beginning with a child’s first tooth. This will help prevent cavities, which is important for your child’s overall health and development.

Can fluoride be poisonous?

Fluoride is safe when used properly, and swallowing small amounts is not harmful.

Swallowing too much fluoride at once can irritate your stomach.

Regularly swallowing too much fluoride for a long time—such as having too much fluoride in your well water for several years—can lead to a condition called fluorosis. Dental fluorosis develops in children before their baby or adult teeth are fully formed, and causes streaks or spots on the teeth. It is usually not harmful to overall health. Skeletal fluorosis, which affects the bones, is not common in the United States.

A smear of toothpaste and a pea-sized amount
American Dental Association photo showing a smear of toothpaste for children under 3 years old (left) and a pea-sized amount for children 3-6 years (right).

How can I use fluoride safely?

For young children, follow the American Dental Association’s guidelines for tooth brushing:

  • For children up to 3 years old, use just a smear of fluoride toothpaste—about the size of a grain of rice.
  • For children age 3 to 6, use a pea-sized amount
  • Watch young children when they brush to make sure they spit out rather than swallow the toothpaste.

Store toothpaste and other dental products up high, out of the reach of young children. Keep them separate from medications and food to prevent accidental poisonings.

When using dental products, carefully follow the directions from your dentist or on the product label.

What about training toothpaste?

While some companies still make training toothpaste or other fluoride-free toothpaste for young children, the American Dental Association strongly recommends using small amounts of fluoride toothpaste as described above. Fluoride-free toothpaste will not help prevent cavities. Using a smear amount of fluoride toothpaste to brush your child’s teeth is safe, even if your child accidentally swallows the toothpaste.

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Why you should keep products in their original containers

“Keep products in their original containers.” Whether it’s a medication, a cleaner or an automotive product, this is one of our top tips for preventing poisonings, because mistakes are easy to make!

Windshield washer fluid and antifreeze
Keeping automotive products like windshield washer fluid and antifreeze in their original containers can help prevent poisonings. Photo by Paul Cooper, used under Creative Commons 2.0.

For example, every year we receive dozens of calls about people accidentally drinking automotive products that were placed in drink bottles. It’s a mistake that adults are just as likely to make as kids.

Maybe you were out of windshield washer fluid and your friend poured some of theirs into a sports drink bottle for you. Or perhaps you needed to drain off some antifreeze and collected it in a soda bottle. If they’re not in the original container, these products can easily end up in your mouth instead of your car!

If for some reason you have to keep a product in a drink bottle or some other container, peel off all the original drink labeling, make sure you clearly mark what is in the bottle, and store it up high, out of the reach of children and pets, with the cap on tight. Always store products in a separate area from any food or drink.

Always put products away as soon as you are done using them to prevent poisonings among young children. Remember that a bad smell is not enough to keep a kid from drinking something.

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Ways the poison center helps school nurses

The poison center is a great resource for school nurses. Not only does the poison center offer quick, expert treatment advice for possible poisonings of students and staff, it also can answer questions about a wide variety of medications and other products. The poison center provides educational materials and programming, as well as in-person education.

The Northern New England Poison Center receives about 500 calls a year from school nurses in Maine, New Hampshire and Vermont. Here are just a few of the situations the poison center helped school nurses with in the past couple years:

  • Photo of a school hallway by Henry de Saussure Copeland
    School hallway photo by Henry de Saussure Copeland. Creative Commons 2.0.

    A 6-year-old boy ate sumac berries found near the school.

  • Four students ages 7-10 all drank some hand sanitizer.
  • An 11-year-old boy was sprayed in the eye with a water-conditioning chemical by another student.
  • A 13-year-old girl got formaldehyde in her eye while dissecting a frog in science class.
  • A 16-year-old boy accidentally took a double dose of his ADHD medication.
  • A student’s cellphone caught on fire and released fumes in the cafeteria.
  • A school bus had a potential antifreeze leak into the passenger compartment.

The poison center also helps school nurses in cases where students have abused substances or tried to harm themselves.

Besides cases of possible poisoning, the NNEPC, answers questions for school nurses about products used in the school, medications, trends in substance abuse and more. It offers lessons for use in the classroom on topics such as electronic cigarettes and caffeine, and trainings for school nurses on current poisoning topics, such as opioids and synthetic drugs of abuse.

The poison center is here for school nurses and everybody else, 24 hours a day, 365 days a year. Just call 1-800-222-1222, chat online or text POISON to 85511.

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Choosing Wisely: Toxicology

Choosing Wisely logoThe Choosing Wisely campaign, conceived by the National Physicians Alliance, provides evidenced-based and practical recommendations in a number of clinical disciplines to help patients and physicians make good decisions. The campaign focuses on clearing up misconceptions and avoiding unnecessary and costly interventions.

The American College of Medical Toxicology and the American Academy of Clinical Toxicology have created a list of 10 items that are relevant to primary, emergency, and specialty care providers regarding specific toxicological treatment and evaluation.

The Northern New England Poison Center has nurses, physicians and pharmacists ready to assist you 24/7. Let us help you choose wisely when a toxicology-related question arises, or even if you are unsure if it’s toxicology related. Call 1-800-222-1222.

Choosing Wisely, Toxicology: Ten Things Physicians and Patients Should Question
American College of Medical Toxicology and American Academy of Clinical Toxicology

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Stay safe this Halloween

Jack-O’-Lantern by William Warby. Creative Commons.

For many of us October means Halloween—picking out costumes, carving pumpkins, and maybe dipping into the candy stash a little too early!

While a little spookiness is part of the fun, none of us want anything actually scary to happen. Follow these tips for a fun and safe Halloween:

  • Dress trick-or-treaters in brightly colored costumes made of flame-resistant materials. Add reflective tape to costumes or trick-or-treat bags to make sure your child is visible after it gets dark.
  • If you use makeup, test it on a small area of skin first. Keep an eye out for skin irritation or an allergic reaction, such as a rash or itching. If this happens, remove the makeup right away with soap and water. Remove all makeup before bedtime to prevent skin and eye irritation.
  • Keep an eye on kids playing with glow sticks. They can break and sometimes children chew them open. The insides of a glow stick can irritate the skin and eyes and cause an upset stomach.
  • Bring along your own candy to give your children while trick-or-treating so they will not eat candy you have not inspected from their bags.
  • Inspect all treats before kids eat them. Only eat treats that are in their original, unopened wrappers. Throw out candies with wrappers that are faded, have holes, tears or signs of rewrapping.
  • Keep candy, such as chocolate, away from dogs and other pets. It can be poisonous to them.
  • Keep candle-lit jack-o-lanterns off doorsteps and out of the way of foot traffic. They can be a fire hazard for trick-or-treaters with long or flowing costumes.
  • Keep dry ice out of drinking glasses. Dry ice can cause frostbite if it touches your skin or mouth.

Most importantly, always supervise your child, and remember you can call the poison center at any hour at 1-800-222-1222 or chat online if your child chews on or swallows something that may be harmful.

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Make poison prevention part of your emergency preparedness plan

The right preparation can help you get through an emergency. For a poisoning, that includes having the poison center help line, 1-800-222-1222 saved in your phone.

For other emergencies, such as natural disasters, it’s important to be prepared to take care of yourself and your family for at least three days. Follow these three steps from the Federal Emergency Management Agency:

  1. Family prepares for emergencies
    Every September is National Preparedness Month. Photo from

    Make a kit

    • Pull together items your family will need during a disaster. Visit for a list.
    • Make sure your kit includes at least a three-day supply of any medications you need.
    • Keep the kit out of the reach of children.
  2. Make a plan
    • Choose someone you know in a different town that you can have your family call if you are separated.
    • Set up a meeting place for your family to gather.
    • Check with your workplace and your children’s schools to find out what their emergency plans are.
  3. Be informed
    • Learn about different types of emergencies and how they can affect your family. This will help you make quick changes to your family plan. Visit for a list of possible dangers you could face.                                                                        

You can be prepared for personal emergencies by saving other important help lines in your phone. Visit the NNEPC’s R U Prepared program page for more information.

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Fentanyl and carfentanil exposures in first responders

Download this as a printable fact sheet


The risk of significant opioid exposure is minimal for first responders who encounter fentanyl, carfentanil or other fentanyl analogs in the field. The evidence suggests that limited precautions, such as nitrile gloves, provide sufficient protection from harm. Use of excessive protective equipment could delay patient care and prevent first responders from performing their duties well.


Fentanyl and fentanyl analogs, such as carfentanil, are very powerful opioid drugs sometimes found in or sold as heroin, leading to accidental overdoses. First responders have concerns about the risk associated with performing their duties when these drugs may be involved. The Drug Enforcement Agency and the National Institute for Occupational Safety and Health have warned of potentially significant harm and suggested protective equipment. Anecdotal reports suggest that minimal exposure while performing normal duties can cause dizziness or feeling like one’s body is “shutting down.” However, no reports have yet involved clinical effects consistent with a significant opioid poisoning. The evidence to date indicates there is minimal risk to first responders encountering patients who have overdosed on these substances or encountering situations involving small amounts of the drugs. First responders need to balance safety with mobility and efficiency.


Risks from inhalation, skin exposure and eye exposure are all minimal.

  • Inhalation: Even in circumstances involving manufacturing of fentanyl and analogs, nearly 200 minutes of exposure is required to reach a starting dose of fentanyl. It is extremely unlikely a significant exposure would occur in a first responder.
  • Dermal: Therapeutic fentanyl patches intended for skin absorption require prolonged contact time, an occluded area and a delivery system. Short exposure to powder which is then brushed or washed off with water would be extremely unlikely to lead to significant absorption. Note: Alcohol hand sanitizers will not remove the drug and may increase absorption.
  • Ocular: Eye contact is unlikely, but should be avoided.


Naloxone is indicated only for a patient who has respiratory depression—a patient breathing very slowly or not at all. These patients will also be unarousable or unconscious. Although limited information is available related to fentanyl and its analogs, animal data suggest that humans should respond to naloxone in these cases. Note that large doses, greater than 10 mg, are unlikely to be helpful.


Standard precautions are reasonable, despite limited data.

  • Recognize opioid effects:
    • Drowsiness (naloxone NOT indicated)
    • Pinpoint pupils (naloxone NOT indicated)
    • Respiratory depression (naloxone indicated)
  • Dermal protection:
    • Use nitrile gloves for routine handling (evidence processing)
    • Wear coveralls in heavily contaminated areas
  • Eye protection:
    • Safety goggles/glasses if face splashing is expected (unlikely)
  • Respiratory protection:
    • N95 or P100 ONLY IF there are significant amounts of powder in the air (unlikely)
  • After skin or eye exposure:
    • Wash with large amounts of water if the skin or eyes are exposed
    • Do not use hand sanitizer

Adapted from the ACMT/AACT position statement “Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders.”

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How to use bug spray safely

Summer is here and many of us in northern New England will be spending more time outside. It’s a busy time for everyone, including the Northern New England Poison Center. During the warmer months, the poison center manages many calls about pesticides, such as insect repellants, often  referred to as bug spray.

Insect repellants with DEET can be very effective at preventing bites from mosquitos, ticks and other pests. This can this help you avoid pain and itchiness from bites, and also help prevent diseases such as Lyme. Depending on the amount of DEET in the product, an insect repellent will keep ticks away for two to ten hours, and mosquitoes for two to twelve hours.

Use insect repellants safely by following these steps: 

  • Read the directions on the product label each time you use it, and follow the directions carefully.
  • Do not apply insect repellant over cuts, wounds, or irritated skin.
  • Do not apply it near your eyes or mouth.
  • Wash the product off with soap and water once you are indoors, and wash treated clothing before you wear it again.
  • Call the poison center at 1-800-222-1222 if you spray into eyes or get in mouth, or if you think you are having a bad reaction to DEET.

Take special care with children. Products with a concentration of 30% DEET or less have been shown to be safe for children older than two months. An adult should always apply insect repellants to children. Avoid using the product on children’s hands.

Pesticide SafetyGuide to reading a pesticide label

Pesticides include many more products than just insect repellants, though. Common pesticides found in the home include weed killers, ant traps, flea treatments, rat poison and disinfectants. Every product classified as a pesticide is required to give standard information on the label. Click on the graphic to the right for a guide to reading a pesticide label.

Here are some general tips for using pesticides safely:

  • Read and carefully follow the directions on the pesticide label for use, safety, storage and disposal. Read the label each time you use the product.
  • Use pesticides in a well-ventilated area and keep kids and pets away during application.
  • Never use an outdoor-use pesticides indoors.
  • Store all pesticides out of reach of children and pets.
  • Keep pesticides in their original labeled containers, and store them separately from food, drinks, medications and other products.
  • If you have pesticides you no longer need, be sure to dispose of them properly. Call your town office or local waste facility to find out the best way to get rid of these products in your community.

If someone swallows or inhales a pesticide, or gets one in their eyes or on their skin, call the poison center at 1-800-222-1222, chat online or text POISON to 85511. The poison center is available 24/7, and all calls are free and confidential.

For general questions about the choosing, storing or using pesticides, call the National Pesticide Information Center at 1-800-858-7378 or visit

Crossposted with the UVM Medical Center blog.

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Fiddleheads: How to safely enjoy a seasonal treat

There is a rich tradition of foraging for fiddleheads in northern New England. These wild-growing ferns can be a tasty treat, as long as you take care when harvesting and cooking them.

Ostrich fern fiddlehead by David Fuller
Ostrich fern fiddlehead by David Fuller, UMaine Cooperative extension

Find only ostrich ferns

The fiddleheads we know as a regional delicacy are the coiled fronds of the ostrich fern. They take their name from their similarity to the scrolls at the top of a violin. These ferns grow in the early spring, generally in a four- to six-week window between late April and early June.

Most types of ferns have fiddleheads, though, so it’s important to be sure you can expertly identify the ostrich fern before you go foraging. Other types of fern may not be nearly as tasty—and can be harmful.

The University of Maine Cooperative Extension has a helpful guide to identifying ostrich ferns. If you are unsure, it’s better to play it safe.

Thorough cooking is key

Eating raw or undercooked fiddleheads has been associated with a number of outbreaks of foodborne illness over the years. While the exact cause of the food poisoning is not known, symptoms are similar to other kinds of foodborne illness, including vomiting and diarrhea. These symptoms may show up in as little as half an hour, but can take as long as 12 hours to appear.

Take these steps to lower your chances of getting foodborne illness from fiddleheads:

  • Wash the fiddleheads thoroughly, until the brown, papery covering has rubbed off and the water runs clean.
  • Cook the fiddleheads thoroughly before using them in any recipe. You can steam them in the microwave or on the stove for 10-12 minutes, or boil them for about 15 minutes.

If you have questions about fiddleheads, poisonous plants or foodborne illness, remember the poison center is here 24/7 to help. Just call 1-800-222-1222 or chat online.

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Three ways you can help prevent poisonings: Safe use, safe storage, safe disposal

Most poisonings that happen at home involve products like medications and cleaners. Following three basic principles when it comes to medications and household products can help you prevent poisonings and make you and your family safer.


Follow all the directions on the product packaging. Read the directions each time you use the product.

A medicine cabinet  
Storing your medications up high in a locked cabinet can help prevent poisonings.

For medications, the directions may include information like:

  • When to take it and how often
  • Whether to take it with food or water
  • Whether you need to avoid alcohol, certain foods, or certain other medications

 If it is a prescription medication, it should only be taken by the person it was prescribed to.

It’s important to know what medical conditions your medications are for. If you are uncertain, have a conversation with your doctor or pharmacist.

For cleaning products, the directions will give you information such as:

  • How to apply the product
  • Whether you need to dilute it by mixing it with water
  • Whether you need to ventilate the room while using it
  • Whether you need to wait awhile before returning to the room

Many other household products will have directions on the label for safe usage. A few examples are:

  • Pesticides, such as bug spray and weed killer
  • Art and office supplies
  • Personal care items, such as deodorants and dental products.


Keep all potentially poisonous products up high, out of the reach of children and pets—in a locked cabinet if possible.

Re-seal the product as soon as you are done using it, and put it away as soon as possible.


The best way to prevent poisonings is to have as few potentially poisonous products in your home as possible. For that reason, it’s important to safely get rid of products you no longer need as soon as possible. These can include:

  • Expired medications
  • Cleaning products you no longer use
  • Broken household items such as compact fluorescent lightbulbs

Disposal methods depend on the type of product, as well as state and local regulations. If the product label does not give directions on how to get rid it, try contacting your town office. Many towns have specific medication take-back days or household hazardous waste collection days for items such as old cleaners and broken CFLs.

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