After federal health officials discovered last month that tainted Chinese toothpaste had entered the United States, they warned that it would most likely be found in discount stores.
In fact, the toothpaste has been distributed much more widely. Roughly 900,000 tubes containing a poison used in some antifreeze products have turned up in hospitals for the mentally ill, prisons, juvenile detention centers and even some hospitals serving the general population.
The toothpaste was handed out in dozens of state institutions, mostly in Georgia but also in North Carolina, according to state officials. Hospitals in South Carolina and Florida also reported receiving Chinese-made toothpaste, and a major national pharmaceutical distributor said it was recalling tainted Chinese toothpaste.
The Food and Drug Administration has advised consumers to discard all Chinese-made toothpaste, regardless of the brand.
State officials in Georgia and North Carolina said all the tainted tubes were being replaced with brands made outside China. The officials said there had been no reports of illnesses caused by the toothpaste.
Officials of the Food and Drug Administration said toothpaste with even small amounts of the bad ingredient, diethylene glycol, a syrupy poison, had a “low but meaningful risk of toxicity and injury” for children and people with kidney or liver disease.
“This stuff does not belong in toothpaste, period,” a spokesman for the drug agency, Doug Arbesfeld, said. “No Chinese toothpaste has come into the country since the end of May.”
Since the Panamanian government found Chinese toothpaste with diethylene glycol in May, countries from Latin America to West Africa to Japan have seized the toothpaste.
Panama last year inadvertently mixed the poison made in China into 260,000 bottles of cold medicine, killing at least 100 people, prosecutors there said.
Diethylene glycol is often used in Chinese toothpaste in place of its more expensive chemical cousin glycerin. Chinese regulators have said that toothpaste with small amounts of diethylene glycol is not harmful and that international concern is unjustified.
After the drug agency expressed concern about tainted toothpaste, the Georgia Department of Administrative Services checked to see whether Chinese toothpaste was being used by the state. The department found it in 83 prisons, 4 mental health centers and 4 juvenile detention centers, said Rick Beal, contracts manager for the department.
Mr. Beal said officials confiscated 5,877 remaining cases, each with 144 tubes, of the Springfresh brand. Tests showed the toothpaste had a diethylene glycol concentration of about 5 percent, he said.
The state bought the toothpaste for about 9 cents a tube in 2002. Mr. Beal said he did not know how many tubes had been used.
There are no reports of harm resulting from the toothpaste, bought from a distributor, American Amenities in Seattle.
“We do not know who their manufacturer from China was,” Mr. Beal said.
A lawyer for American Amenities, Jesse Lyon, said it had recalled all suspect shipments of the product and had decided to stop importing Chinese toothpaste. Mr. Lyon said he believed that American Amenities had about 30 institutional customers, with Georgia being the largest.
A spokesman for the North Carolina Department of Corrections, George Dudley, said his agency estimated that it bought 22,000 tubes of Pacific brand Chinese toothpaste with a small amount of diethylene glycol from Pacific Care Products in San Francisco.
Pacific Care did not respond to a request for comment, but an executive wrote to North Carolina officials that the toothpaste came from Amercare Products, also in Seattle. A spokeswoman for Amercare declined to comment.
Chinese toothpaste containing “trace amounts” of diethylene glycol has also been recalled from healthcare institutions by McKesson, a major pharmaceutical distributor and health services company, said a spokesman, James Larkin.
Mr. Larkin said although this particular brand, McKesson EverFRESH, was not on the drug agency’s list of contaminated toothpaste, McKesson asked a laboratory to test it. When small amounts of diethylene glycol turned up, the company recalled the product, he said.
“We went back through our records, and every customer that ever bought the product was contacted,” Mr. Larkin said.
He added that on short notice he could not determine how many customers had bought the product.
One institution that did was Florida Hospital Waterman, a 200-bed institution in Tavares, Fla.
“We pulled that product,” Bonnie Zimmerman of the hospital said.
Ms. Zimmerman said that the toothpaste that replaced it also came from China and it had “trace amounts” of diethylene glycol. It, too, was removed, she said.
In South Carolina, four hospitals in the Greenville Hospital System also removed Chinese toothpaste, even though its distributor said it did not have diethylene glycol, said John Mateka, executive director of materials management for the group.