What are the effects of ingesting Efferdent (sodium bicarbonate and citric acid)?

Efferdent Ingestion: Safety Profile and Clinical Management

Accidental ingestion of Efferdent denture cleaning tablets is generally not harmful and typically causes only mild local effects, with complete resolution expected with supportive care alone.

Evidence from Denture Tablet Ingestion Studies

The most relevant data comes from a large surveillance study of denture cleaning tablet exposures:

• In 46 documented cases of denture tablet ingestion, local effects were mostly mild in nature, occurring in only 22 patients (48%) 1
• Systemic effects were reported in only 2 patients, and even in these cases the connection to ingestion was doubtful 1
• The majority of exposures involved accidental ingestion of a single tablet, with older adults (52%) and children (30%) comprising the largest affected groups 1

Active Ingredients and Their Safety Profile

Efferdent contains sodium bicarbonate and citric acid as its primary active ingredients. Both components have well-established safety profiles:

Sodium Bicarbonate Safety

• Sodium bicarbonate is routinely used therapeutically in much larger doses than present in a single denture tablet 2
• Oral sodium bicarbonate at therapeutic doses of 2-4 g/day (25-50 mEq/day) is safely used long-term in chronic kidney disease patients 2
• A single Efferdent tablet contains far less sodium bicarbonate than therapeutic doses used for medical conditions 3, 4

Citric Acid Safety

• Sodium citrate (which citric acid converts to in the body) is equivalent to sodium bicarbonate for treating acidosis in diarrheal illness, demonstrating its safety profile 3, 4
• In controlled trials, citrate-containing solutions showed no adverse effects and were as safe as bicarbonate solutions 3, 4

Expected Clinical Course

Based on the available evidence:

• Most patients remain asymptomatic or develop only mild local irritation of the mouth, throat, or stomach 1
• All documented cases of denture tablet overdose resolved completely with supportive care alone 5
• Monitor for potential gastrointestinal symptoms including mild nausea or throat discomfort, which typically resolve spontaneously 1

Recommended Management Approach

For single tablet ingestion:

• Provide reassurance that serious toxicity is extremely unlikely 1
• Ensure adequate hydration to dilute any local irritant effects 5
• Monitor for gastrointestinal symptoms, which if present are typically mild and self-limited 1
• No specific antidote or decontamination is required for single tablet ingestion 1

For multiple tablet ingestion or symptomatic patients:

• Monitor vital signs and provide respiratory support only if needed 5
• Ensure adequate hydration to prevent complications 5
• Observe for development of symptoms, though serious effects remain unlikely even with multiple tablets 1

Important Caveats

• The effervescent reaction (fizzing) when the tablet contacts water or saliva may cause more alarm than actual harm 6
• Patients with pre-existing cardiac or renal disease may theoretically be more sensitive to sodium load, though this has not been reported as problematic in actual ingestion cases 2
• Contact a poison control center if large quantities are ingested or if unusual symptoms develop, though this is rarely necessary 1