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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 23  |  Issue : 2  |  Page : 59-60

Can toothpaste carry drugs to fight pulmonary infections?


1 Centre for Scientific Research and Development, Immunology Laboratory, People's University, Bhopal, Madhya Pradesh, India
2 Department of Pharmacology, People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India

Date of Web Publication11-Oct-2018

Correspondence Address:
Dr. Vijay Thawani
Department of Pharmacology, People's College of Medical Sciences and Research Centre, Bhanpur, Bhopal - 462 037, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmgims.jmgims_29_18

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  Abstract 


Toothpastes have been used as vehicles to deliver drugs in the oral cavity. Scientists delivered antibiotics to oral cavity through toothpastes and postulated that toothpastes may also be used to deliver antibiotics to tackle fatal lung diseases. Cystic fibrosis is a rare lung disease due to genetic disorder which results in excess mucus production in the lungs. This lung infection is treated with antibiotics which are given intravenously, inhaled, or given orally. Positive results have been reported with antibiotics in toothpastes, which can be extrapolated to deliver these for pulmonary diseases.

Keywords: Antibiotics, cystic fibrosis, lung disease, triclosan


How to cite this article:
Khan FN, Thawani V. Can toothpaste carry drugs to fight pulmonary infections?. J Mahatma Gandhi Inst Med Sci 2018;23:59-60

How to cite this URL:
Khan FN, Thawani V. Can toothpaste carry drugs to fight pulmonary infections?. J Mahatma Gandhi Inst Med Sci [serial online] 2018 [cited 2018 Oct 22];23:59-60. Available from: http://www.jmgims.co.in/text.asp?2018/23/2/59/243128




  What is a Toothpaste? Top


It is a paste or gel dentifrice used with a toothbrush to clean and maintain the esthetics and health of teeth. It promotes oral hygiene, serves as an abrasive, aids in removing dental plaque and food remnants, assists in suppressing halitosis, and delivers active ingredients to help prevent dental caries and gingivitis.[1]


  Medications in Toothpaste Top


Many antibiotics are added to toothpaste for the treatment of oral and dental diseases. This route can also be utilized to deliver medicines for lung diseases. Triclosan, an antibacterial agent, is a common toothpaste ingredient. Triclosan or zinc chloride prevents gingivitis, reduces tartar, and bad breath.[1],[2] There was no evidence of harmful effects associated with the three year use of triclosan toothpastes.[3] Chlorhexidine mouthwash has a positive effect in controlling plaque and gingivitis.[4] However, a negative side effect is tooth surface discoloration which can affect the patient's compliance.[5] Xylitol is more effective than fluoride alone in preventing dental caries in children's permanent teeth. It has not been found to cause any harmful effects.[6]

Water fluoridation was praised as a major achievement of the 20th century.[7] However, there is the probability of fluoride reacting with chlorine in water to form chloroform which is probably a carcinogen and can be harmful.[8] Fluoride-containing toothpaste can be toxic if swallowed in large amounts. A major concern of dental fluorosis in children under 12 months of age is ingesting excessive fluoride through toothpaste. Nausea and vomiting are also the problems which might arise with topical fluoride ingestion.[7],[9],[10]

Inclusion of diethylene glycol as sweetener in China-made toothpastes led world outcry, leading to ban, due to its toxicity.[11],[12]

Polyethylene glycol (PEG) is also used in some toothpastes. It is hydrophilic polymer that acts as a dispersant and is used in many cosmetic and pharmaceutical formulas, for example, nonsteroidal anti-inflammatory drugs, other medications, and household products.[13] It has unrecognized allergenic potential, and PEG hypersensitivity has been reported.[14]


  Cystic Fibrosis Top


Out of the world's top 20 polluted cities, 13 belong to India and lung diseases rank second in the list of top 20 causes of death. Cystic fibrosis (CF) is a rare lung disease due to genetic disorder[15] which is inherited in an autosomal recessive manner. It is caused by the presence of mutations in both copies of the gene where single working copy is carrier and other is normal for the CF transmembrane conductance regulator protein. Lung problems are responsible for death in 80% of people with CF. In every 2500–3500 people, it affects the lungs, pancreas, liver, kidneys, and intestine.[16],[17] It results in excess mucus production in the lungs which acts as a magnet for bacteria, causing blockage of airways. Long-term issues include difficulty in breathing and coughing up mucus as a result of frequent lung infections. Other signs and symptoms may include sinus infections, poor growth, fatty stool, clubbing of the fingers and toes, and infertility in most males. Different people may have different degrees of symptoms.[16]


  Antibiotic Toothpastes Active in Lung Diseases Top


There is no known cure for CF.[18] However, scientists suggest that component of toothpastes can help to cope with this fatal lung disease. Lung infections are treated with antibiotics which may be given intravenously, inhaled, or orally.[16]

The CF bacteria are difficult to eradicate because of protection offered (up to 99.9%) by a slimy barrier known as a biofilm produced by Pseudomonas aeruginosa, which allows the disease to thrive even when treated with antibiotics. There are many common other biofilm-related infections that people get, namely ear infections and swollen painful gums. But more serious, potentially fatal diseases join the ranks of CF which include endocarditis (inflammation of the heart) and infections from artificial hip and pacemaker implants.[19]

Triclosan is a biocide and reduces/prevents bacterial growth in oral cavity. However, triclosan alone in toothpaste was noneffective against Pseudomonas aeruginosa biofilm in CF. When combined with an antibiotic tobramycin, it showed a positive result on the biofilm but did not clear the lungs. Patients inhale tobramycin, yet find themselves chronically infected.[19] Sometimes, azithromycin, inhaled hypertonic saline, and salbutamol are used with triclosan for long term which may also be useful in CF. Lung transplantation is an option if lung function continues to worsen.[1] Pancreatic enzyme replacement and fat-soluble vitamin supplementation are important, especially in the young.[16],[18] Airway clearance techniques such as chest physiotherapy have some short-term benefit, but long-term effects are unclear.[20] The average life expectancy with CF is between 42 and 50 years in the developed world.[21] Triclosan and variety of antibiotics crack this biofilm protection in CF.


  Conclusion Top


Head, neck, and face have higher blood circulation than rest of the body. Buccal absorption of drugs is well known. Some drugs are selectively given sublingually for fast pharmacological effects, bypassing first-pass hepatic metabolism and immediate delivery to heart, for example, nitrates in angina pectoris. Toothpastes have been used to deliver drugs in oral cavity. It is a logical thought to extend such use to carry and deliver the drugs for pulmonary infections in lungs. Thus, the antibiotic mixed toothpaste may provide effective opportunity for treatment of different lung diseases which otherwise are difficult to be reached.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
American Dental Association Description of Toothpaste. Available from: https://www.ada.org/en/member-center/oral-health-topics/toothpastes [Last accessed on 2018 May 28].  Back to cited text no. 1
    
2.
Cooney CM. Triclosan comes under scrutiny. Environ Health Perspect 2010;118:A242.  Back to cited text no. 2
    
3.
Gunsolley JC. A meta-analysis of six-month studies of antiplaque and antigingivitis agents. J Am Dent Assoc 2006;137:1649-57.  Back to cited text no. 3
    
4.
James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev 2017;3:CD008676.  Back to cited text no. 4
    
5.
Slot DE, Berchier CE, Addy M, Van der Velden U, Van der Weijden GA. The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: A systematic review. Int J Dent Hyg 2014;12:25-35.  Back to cited text no. 5
    
6.
Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev 2015;3:CD010743.  Back to cited text no. 6
    
7.
Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Achievements in public health, 1900-1999: Fluoridation of drinking water to prevent dental caries. MMWR Morb Mortal Wkly Rep 1999;48:933-40.  Back to cited text no. 7
    
8.
Rule KL, Ebbett VR, Vikesland PJ. Formation of chloroform and chlorinated organics by free-chlorine-mediated oxidation of triclosan. Environ Sci Technol 2005;39:3176-85.  Back to cited text no. 8
    
9.
Delivering Better Oral Health: An Evidence-based Toolkit For Prevention. UK: NHS; 2007.  Back to cited text no. 9
    
10.
Kidd E, Fejerskov O. Essentials of Dental Caries. Oxford, UK:Oxford University Press; 2016. p. 97.  Back to cited text no. 10
    
11.
Tainted Toothpaste across the World. New York Times; 30 September, 2007. Available from: www.nytimes.com/imagepages/2007/09/30/world/20071001_PANAMA_GRAPHIC.html. [Last accessed on 2018 May 28].  Back to cited text no. 11
    
12.
Bogdanich W. The Everyman Who Exposed Tainted Toothpaste. New York Times; 1 October, 2007. Available from: https://www.nytimes.com/2007/10/01/world/americas/01panama.html. [Last accessed on 2018 May 28].  Back to cited text no. 12
    
13.
Fruijtier-Pölloth C. Safety assessment on polyethylene glycols (PEGs) and their derivatives as used in cosmetic products. Toxicology 2005;214:1-38.  Back to cited text no. 13
    
14.
Wenande E, Garvey LH. Immediate-type hypersensitivity to polyethylene glycols: A review. Clin Exp Allergy 2016;46:907-22.  Back to cited text no. 14
    
15.
Rupavate S. Lung Disease – Causes, Types, Symptoms, Diagnosis, Treatment and Prevention. Available from: http://www.thehealthsite.com/diseases-conditions-lung-disease/. [Last accessed on 2018 May 28].  Back to cited text no. 15
    
16.
O'Sullivan BP, Freedman SD. Cystic fibrosis. Lancet 2009;373:1891-904.  Back to cited text no. 16
    
17.
Hodson M, Geddes D, Bush, A. Cystic fibrosis. 3rd ed. London: Hodder Arnold; 2012. p. 3.  Back to cited text no. 17
    
18.
Massie J, Delatycki MB. Cystic fibrosis carrier screening. Paediatr Respir Rev 2013;14:270-5.  Back to cited text no. 18
    
19.
Waters C, Gleason S. Ingredient in Your Toothpaste May Combat Severe Lung Disease. Available from: https://www.msutoday.msu.edu/news/2018/ingredient-in- your-toothpaste-may-combat-severe-lung-disease/. [Last accessed on 2018 May 28].  Back to cited text no. 19
    
20.
Warnock L, Gates A. Chest physiotherapy compared to no chest physiotherapy for cystic fibrosis. Cochrane Database Syst Rev 2015;9: CD001401.  Back to cited text no. 20
    
21.
Ong T, Ramsey BW. Update in cystic fibrosis 2014. Am J Respir Crit Care Med 2015;192:669-75.  Back to cited text no. 21
    




 

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Abstract
What is a Toothp...
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Cystic Fibrosis
Antibiotic Tooth...
Conclusion
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