The makers of Crest toothpaste must face a lawsuit after a judge approved a motion allowing parents to question whether the brand’s packaging implies that children can use more of the product than is safe.
U.S. District Judge Jorge Alonso ruled on Friday that a picture on Procter & Gamble’s product boxes showing an entire strip of toothpaste being used on a brush could violate numerous state consumer protection laws, according to Reuters.
Fluoride is used in toothpaste to strengthen tooth enamel and prevent tooth decay. According to the World Health Organization, the safe limit of fluoride in toothpaste is between 1,000 and 1,500 parts per million.
If children ingest too much fluoride, the Cleveland Clinic says that they may develop fluorosis. This is a cosmetic condition that is not painful and can cause discoloration on children’s teeth.
As a result, children are recommended to use toothpaste with low amounts of fluoride, and parents are encouraged to instruct their children to spit out the toothpaste once they have finished brushing their teeth.
Those details played a key role in Judge Alonso’s ruling.
"The fact that swallowing fluoride poses health risks to children is an essential element of the story plaintiffs are telling; it is the reason for the recommendation that they use only a smear or dab,” Judge Alonso said, according to Reuters.
Procter & Gamble later attempted to claim that federal law had preempted the lawsuit and that the instructions on its packaging were clear, as it sought to dismiss the case.
The Chicago-based judge’s ruling comes just weeks after Texas Attorney General Ken Paxton signed an agreement with Colgate-Palmolive Company to change the company’s packaging. The new packaging will adjust the amount of toothpaste depicted on a child’s toothbrush, replacing a stick of toothpaste with a “pea-sized” amount.
New packaging for its Colgate and Tom’s of Maine products was subsequently rolled out on November 1, 2025.
However, in April, the controversial U.S. Health Secretary Robert F. Kennedy Jr ignited another debate over the safety of fluoride. Kennedy announced that he planned to order the Centers for Disease Control and Prevention to ditch any recommendations of using fluoride in water.
Fluoridation, the process of adding fluoride to water, is designed to strengthen tooth enamel and reduce oral health disparities. Maintaining an equal level of fluoride means that more deprived areas do not experience greater tooth decay than more affluent neighborhoods.
Since the Secretary of Health cannot order communities to stop fluoridating their water, as that is within the jurisdiction of the Environmental Protection Agency, Kennedy’s order was limited to the CDC.
However, he did praise Utah’s Republican governor, Spencer Cox, for banning fluoride in drinking water in March 2025.
“I’m very, very proud of this state for being the first state to ban it, and I hope many more will,” he told reporters at the time.
Previously, he had branded fluoride as a “dangerous neurotoxin,” and claimed that it has been associated with arthritis and thyroid disease. Other critics have asserted that fluoride has a link to higher rates of cancer.
Despite this, the American Cancer Society says that most studies “have not found a strong link” between cancer diagnosis rates and water fluoride levels.
Much of the debate has centered on Osteosarcoma, a rare form of cancer that is diagnosed in around 500 children and teens every year.
A 1990 study conducted on male lab rats found that higher rates of fluoridated drinking water were associated with higher cancer rates. However, this finding could not be replicated in female rats or in mice of either sex.
According to the American Cancer Society, the U.S. Public Health Service wrote in 1991 that “optimal fluoridation of drinking water does not pose a detectable cancer risk to humans as evidenced by extensive human epidemiological data available to date.”
The Independent has contacted Procter & Gamble, the Department of Health and Human Services, and Ken Paxton for comment.
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