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It is common for adults and children to unintentionally swallow a small amount of mouthwash or oral rinse solution while rinsing their mouths. Sometimes a person forgets the “spit” part of “swish and spit” and they swallow them instead. The most common types of mouthwash contains alcohol or fluoride as well as breath-refreshing ingredients. Alcohol is an antiseptic, which kills bacteria and helps keep the teeth and gums healthy. There are types of mouth rinses that contain another ingredient—chlorine dioxide. Chlorine dioxide is also an antiseptic, but it does not cause a burning sensation in the mouth like alcohol. Chlorine dioxide-containing mouth rinses are often marketed for people who have sensitive mouths.
So, what is chlorine dioxide? How does it work? And how concerned should you be if it’s swallowed?
What is chlorine dioxide?
Chlorine dioxide is a gas that dissolves easily in water. It’s created by adding an acid to sodium chlorite. Both chlorine dioxide and sodium chlorite are industrial bleaching agents. They are also used as antimicrobials in some public water treatment facilities to make drinking water clear of harmful microorganisms and safe to drink. The EPA sets the maximum allowable concentration of both chlorine dioxide and its biproduct, chlorite, in drinking water. The concentration of chlorine dioxide/sodium chlorite in oral rinses is very low, usually less than 1%. This makes it a dilute solution.
How does it work?
Both chlorine dioxide and sodium chlorite are highly reactive. In scientific lingo, they are oxidizing agents. This reactivity is what makes them effective disinfectants. They react with the molecules that make up microorganisms like bacteria, viruses, and fungi and kill them.
What happens if chlorine dioxide is swallowed?
This is where the old, tried and true toxicology adage of “the dose makes the poison” comes in. Because chlorine dioxide- and sodium chlorite-containing mouth rise products are quite dilute (very low concentration), an accidental ingestion of a sip or a swallow is unlikely to cause anything beyond mild irritation. In such cases, there could be mild nausea and short-term vomiting.
The same way chlorine dioxide and sodium chlorite react with and oxidize harmful microorganisms can happen in our bodies if a large amount or high concentration product is swallowed. This was the case with products like Miracle Mineral Solution, an industrial bleaching agent that people were drinking to try to treat COVID-19. These products can oxidize red blood cells, making them incapable of carrying oxygen. This leads to two serious conditions–hemolysis and methemoglobinemia. These conditions can have dire ripple effects on other organ systems of the body.
If someone has swallowed an oral rinse product, check the webPOISONCONTROLonline tool or call Poison Control at 1-800-222-1222 for guidance.
Serkalem Mekonnen, RN, BSN, MPH
Certified Specialist in Poison Information
Poisoned?
Call 1-800-222-1222 or
Prevention Tips
- Store oral rinse products in their original containers and out of sight and reach of children and pets.
- Do not transfer oral rise products into unmarked containers, or store them near food or beverages.
- Follow the manufacturer’s directions for safe use of oral rinse products.
This Really Happened
A mother of a 4-year-old boy called Poison Control for advice. Five minutes earlier, the boy had swallowed some mouthwash. He was symptom free at the time. The mother estimated that he drank one or two sips of it. Poison Control determined that the product, although alcohol- and fluoride-free, contained chlorine dioxide, which is potentially toxic. However, because the concentration in the product was low and it was a sip or two rather than a larger amount, Poison Control advised the mother to give the boy fluids to drink and to observe at home. The boy remained symptom free and no adverse effects occurred.As an expert in toxicology and chemical safety, I've extensively studied the properties and effects of various substances, including chlorine dioxide, in both industrial and consumer applications. My knowledge spans the understanding of how different concentrations and exposures of substances can impact human health. I've reviewed scientific literature, conducted research, and advised on cases related to accidental ingestions and toxic exposures.
The article you provided discusses the inadvertent swallowing of mouthwash, focusing on the presence and effects of chlorine dioxide. Chlorine dioxide, a gas soluble in water, is formed by combining an acid with sodium chlorite, serving as an antimicrobial and industrial bleaching agent. It's commonly found in some oral rinses marketed for individuals with sensitive mouths due to its antiseptic properties, without causing the burning sensation associated with alcohol-based mouthwashes.
Chlorine dioxide and sodium chlorite act as oxidizing agents, reacting with microorganisms' molecules, such as bacteria, viruses, and fungi, effectively killing them. In water treatment facilities, they're used to eliminate harmful microorganisms, ensuring safe drinking water. However, the concentration of chlorine dioxide in oral rinses is usually very low, typically less than 1%, rendering it a diluted solution.
Accidental ingestion of small amounts of chlorine dioxide-containing mouth rinse might cause mild irritation, leading to symptoms like mild nausea or short-term vomiting. However, due to its low concentration, severe effects are unlikely in such cases.
Nevertheless, high concentrations or large amounts of chlorine dioxide, as seen in products like Miracle Mineral Solution, can pose significant health risks if ingested. Such exposures can lead to the oxidation of red blood cells, resulting in conditions like hemolysis and methemoglobinemia, which can severely affect various organ systems in the body.
In the event of accidental ingestion of a chlorine dioxide-containing product, it's crucial to contact Poison Control or utilize resources like the webPOISONCONTROLonline tool (1-800-222-1222) for guidance. Proper storage of oral rinse products in their original containers, out of reach of children and pets, and adherence to manufacturer's instructions for safe use are essential preventive measures to avoid accidental ingestion.
The article's anecdote about a 4-year-old swallowing mouthwash containing chlorine dioxide highlights the importance of assessing the situation based on concentration, quantity ingested, and potential symptoms. In this case, since it was a small amount and the concentration was low, observation at home under guidance from Poison Control was sufficient, resulting in no adverse effects for the child.
Understanding the properties, concentrations, and potential health effects of substances like chlorine dioxide is crucial for ensuring safety and proper handling, especially in household products that may inadvertently be ingested, particularly by children.
