It’s a scene that plays out in bathrooms across the world each morning: squeezing out a dollop of minty toothpaste onto a wet toothbrush, sticking it into your mouth, and suddenly gagging, retching, or even vomiting into the sink. This involuntary reaction can seem bizarre and frustrating, especially for a daily self-care routine. But toothpaste-induced vomiting is more common than many realize.
Surveys show 17-30% of people have experienced vomiting after brushing their teeth. Understanding the science behind these unpleasant reactions can help identify ways to prevent toothpaste from triggering the vomit reflex.
The Physiology of Vomiting
Before exploring the reasons toothpaste may cause vomiting, it helps to understand what happens in the body to produce a vomit response. Vomiting is a protective reflex controlled by the brainstem and triggered by:
- The chemoreceptor trigger zone (CTZ): This area in the brainstem monitors chemical changes in the blood and cerebrospinal fluid that signal toxicity or irritation. The CTZ contains receptors that sense emetics and toxins.
- The vagus nerve: This cranial nerve transmits sensory information about the gastrointestinal tract to the brainstem. It communicates signals of gastrointestinal irritation.
- The vestibular system: Signals from the inner ear and brain regions controlling balance and motion can also stimulate the vomit reflex when perturbed.
When the brainstem receives enough stimuli signaling a potential threat like poisoning or infection, it coordinately activates:
- Increased salivation to protect the teeth from stomach acid
- Rhythmic, forceful contraction of stomach and intestinal muscles
- Relaxation of the esophageal sphincter
- Contraction of diaphragm and chest muscles
This pumps the stomach contents up and propels them out through the mouth. Vomiting rapidly eliminates undesirable substances before they are absorbed further.
Causes of Toothpaste-Induced Vomiting
Now that we understand the anatomy behind vomiting, what exactly in toothpaste could trigger this response? There are a few key ingredients and characteristics that provoke the brainstem or vagus nerve for some individuals:
High Concentrations of Mint Oil
Minty flavor gives toothpaste its distinctive taste. But natural mint oils and menthol contain high concentrations of pulegone and other volatile compounds. These can irritate mucous membranes and trigger the vagus nerve or CTZ reflexes, especially in large doses.
Toothpaste brands use varying strengths of mint oils. Children’s toothpastes often have very mild flavors, while formulas for adults may contain stronger mint concentrations up to 2%. More natural or herbal brands also tend to have more intense mint oils than classic commercial toothpastes.
For those prone to vomiting, strong mint acts as an emetic – inducing nausea and gagging when it contacts the throat and gastrointestinal lining. Even small doses seem to be choke-worthy.
Abrasive Silica Particles
The gritty texture of toothpaste comes from abrasives like hydrated silica, calcium carbonate, and alumina that help scrub away plaque and stains. However, these minerals may irritate sensitive tissues.
As toothpaste travels toward the back of the tongue, silica particles mechanically stimulate the throat and upper esophageal lining. In those with sensitive gag reflexes, this sensation triggers sudden retching. Children often spit out toothpaste to avoid this abrasive texture and taste.
Detergents Like Sodium Lauryl Sulfate (SLS)
Foaming agents give toothpaste its frothy, cleaning action. SLS is the most common active ingredient added to make toothpaste foam. But some find SLS irritates the mouth, especially those prone to mouth ulcers or canker sores.
Excess foam from SLS washes over the tongue, gums, cheeks, and throat during brushing. This chemical irritation stimulates nerve endings linked to nausea and vomiting reflexes. SLS also breaks down the lipid barriers protecting mucous membranes from toxins and microbes. This further aggravates the tissue.
While low levels of fluoride help remineralize enamel, high concentrations are an irritant. Excessive fluoride early in life can cause fluorosis, making teeth more prone to sensitivity and staining. Those with fluorosis may experience greater nausea from toothpaste.
Standard toothpastes contain 1000-1500 ppm fluoride. But prescription strength toothpastes go up to 5000 ppm, which may trigger vomiting when swallowed. Children’s toothpaste contains less than 500 ppm fluoride.
Triggers for Those Prone to Nausea
Beyond just the toothpaste ingredients, certain individuals are predisposed to vomiting from various triggers. Toothpaste happens to hit a number of sensitivities tied to nausea and vomiting:
- Pregnancy: Hormonal changes make pregnant women susceptible to vomiting from tastes, textures, and scents. Morning sickness sufferers tend to have an oversensitive gag reflex.
- GERD/Acid Reflux: Stomach acid washing over the esophageal lining makes those with reflux prone to nausea with minimal stimulation. Toothpaste foaming in the mouth and throat can aggravate this.
- Allergies: Ingredients like mint oil or SLS may cause topical or systemic allergic reactions. Vomiting expels the allergen.
- Associative Learning: Previous negative experiences with toothpaste vomiting can subconsciously amplify anxiety and reactivity over time. The brain now associates brushing with vomiting.
- Oral Thrush: This fungal overgrowth of Candida yeast oversensitizes the mouth and throat, making them ridiculously easy to gag and vomit.
- Medications: Some drugs like opioids, antidepressants, chemotherapy, and antibiotics increase nausea and vomiting as a side effect.
Tips to Prevent Toothpaste-Induced Vomiting
If toothpaste has you sprinting for the sink or garbage can each morning, a few simple modifications to your routine can help stop the sickness.
1. Switch Toothpaste Brand or Flavor
Test out toothpastes with varying ingredients to identify your sensitivities:
- Try brands with no SLS like Sensodyne, Squigle, or Hello
- Pick a mild kids fruit-flavored toothpaste
- Opt for Tom’s of Maine antiplaque and whitening toothpaste which uses naturally-sourced silica
- Check out activated charcoal toothpaste like Hello or Dirt for something grit-free
2. Dilute Regular Toothpaste
Add a dollop of toothpaste to half a cup of warm water and mix. This dilutes the strength of abrasives, mint, and detergents. Gradually increase concentration once tolerated.
3. Brush With Less Toothpaste
Using just a pea-sized amount of paste on your brush limits excess foam and flavor. Focus brushing on the teeth rather than tongue to avoid gagging.
4. Try Brushing and Rinsing Before Eating
Brushing on an empty stomach first thing in the morning lowers reflux risk. Rinse mouth thoroughly after brushing to wash away residue. Wait at least 30 minutes before eating breakfast.
5. Sip Water While Brushing
Frequently swishing and spitting water while brushing keeps concentration of toothpaste lower in the mouth. This limits interaction with the throat.
6. Use Children’s Toothbrush
The smaller head and softer bristles make children’s toothbrushes less likely to trigger a gag reflex. The bristles still remove plaque without as much abrasion.
7. Switch to Mouthwash
Daily rinsing with antiseptic mouthwash gives some teeth cleaning benefits without abrasives. However, mouthwash alone cannot remove plaque buildup.
8. Try Oil Pulling or Saltwater Rinse
Swishing coconut oil or diluted salt water in the mouth is an ancient ayurvedic technique to reduce bacteria and whiten teeth without irritating additives.
When to Seek Medical Care
While adjusting your oral hygiene methods and products may solve toothpaste intolerance, it’s important to seek medical care if:
- Vomiting becomes frequent or severe despite changes
- You experience oral thrush symptoms like white patches or sores
- Brushing triggers severe stomach or chest pain
- You have difficulty keeping any food or liquid down
- Vomiting leads to dehydration and weight loss
See your dentist to identify causes like gum disease, fluoride sensitivity, or acid erosion. See your doctor to explore issues like acid reflux, pregnancy, migraines, cyclic vomiting syndrome, gastroparesis, or food allergies. Medication or further specialty referrals may be needed.
Toothpaste vomiting affects more people than you may think. But with the right modifications, brushing can stay part of your morning wellness routine. Pay attention to which ingredients, flavors, and brushing techniques cause problems for you. Iteratively changing these factors and being patient with your body’s adjustment can ultimately stop vomiting in its tracks.
Frequently Asked Questions
Why does toothpaste make me gag?
Gagging from toothpaste stems from many of the same ingredients and conditions. Detergents create irritation and foaming inside the mouth. Abrasives physically stimulate the throat. Strong mint flavors trigger the gag reflex. Underlying issues like acid reflux, oral thrush, and allergies heighten sensitivity.
Why do I throw up when I brush my tongue?
The tongue has an extremely sensitive gag reflex to protect the airway. Bristles stimulating the back of the tongue signals the brain to vomit. Avoiding the tongue or using slower, lighter strokes may help. Anesthetic gels used for gagging dental patients could also reduce reactivity.
Can I brush my teeth without toothpaste?
You can brush without paste, but it will be less effective at removing plaque and bacteria. The abrasives in toothpaste also help scrub stains. Use foamless non-SLS toothpaste or dilute regular toothpaste to minimize vomiting triggers. The mouthwash and oil pulling options also skip toothpaste.
Why does the smell of toothpaste make me nauseous?
Mint and other toothpaste aromas can trigger nausea before the toothpaste even enters your mouth. Smell activates the trigeminal nerve which conveys sensations from the nose and mouth to the brainstem vomiting center. Switching to a very mild or unscented brand may help overcome this conditioned aversion.
Is vomiting from toothpaste serious?
Occasional vomiting from brushing is common and not serious on its own. However, frequent projectile vomiting, continued vomiting throughout the day, or vomiting up blood signal a medical condition requiring prompt evaluation. Seek help to identify and manage underlying causes.