|
 
 |
| REVIEW ARTICLE |
|
| Year : 2019 | Volume
: 24
| Issue : 2 | Page : 71-74 |
|
Are all additives of toothpastes rational?
Abin Mani1, Vijay Thawani2
1 Centre for Scientific Research and Development, People's University, Bhopal, Madhya Pradesh, India
2 People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| Date of Web Publication | 17-Sep-2019 |
Correspondence Address:
Dr. Vijay Thawani
People's College of Medical Sciences and Research Centre, Bhanpur, Bhopal - 462 037, Madhya Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmgims.jmgims_34_18
Absorption of drugs is more in human oral cavity. Humans get daily exposure to the additives of dentifrices which contain toxic chemicals. The practice of using commercial dentifrices can cause toxic problems to user, and this issue is unfortunately not in public domain and also ignored by the Government. The best way is to avoid it, is to use natural safe tooth cleaners.
Keywords: Dentifrices, oral absorption, oral health, safe cleaner, toxicity
How to cite this article:
Mani A, Thawani V. Are all additives of toothpastes rational?. J Mahatma Gandhi Inst Med Sci 2019;24:71-4 |
| Introduction | |  |
The human oral mucous membrane has high absorption, and the chemicals entering the oral cavity are absorbed into the blood. Denitrifies are used in daily hygiene. Hence, these must be the safest products for humans use. The commercially available denitrifies have many ingredients which are toxic. These pea-sized dollops on the toothbrush, twice a day, add up to lots of toxic accumulation. There is a need of carefully choosing the toothpaste since many of the popular brands contain toxic ingredients that may be avoided.
Toothpaste 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]
| Sodium Lauryl Sulfate | | |
Most of the toothpastes have sodium lauryl sulfate (SLS) or lauryl sarcosinate, a foaming lather (detergent) which keeps paste in the mouth and removes dirt and grease from the teeth. Detergents cause sensitization and interfere with the functioning of taste buds by breaking up the phospholipids. It irritates the oral tissues and can cause canker sores, oral ulcers, stomach problems, and even cancer.[2],[3] The SLS is a carcinogen and contains traces of 1,4-dioxane, which is classified by the International Agency for Research on Cancer as a Group 2B carcinogen. Moreover, it also causes toxic to the aquatic life.[4]
| Flavorings | | |
The taste of toothpastes is due to the strong flavoring agents and the sweeteners which mask the taste of other ingredients and enhance palatability of toothpaste. The commonly used artificial flavors include mint, cinnamon, anise, vanilla and popular fruits and leaves. The sweeteners used in the toothpaste are aspartame, sucralose, xylitol, and sodium saccharin. Flavor additives are oils, extracts, or synthetic. These additives can cause irritation to oral tissues and trigger heartburn. Inclusion of diethylene glycol as a sweetener in China-made toothpastes led to world outcry, leading to ban, due to its toxicity.[5],[6] Aspartame is the most common artificial sweetener used, which is 200 times sweeter than sugar. Aspartame has been known to be metabolized inside the body to poisonous methanol and formaldehyde and its side effects include migraine, dizziness, seizures, nausea, numbness, muscle spasms, weight gain, rashes, depression, fatigue, irritability, insomnia, vision problems, hearing loss, heart palpitations, anxiety, vertigo, memory loss, brain tumors, birth defects, and joint pain. Aspartame consumption can lead to Alzheimer's disease, diabetes, multiple sclerosis, epilepsy, lymphoma, Parkinson's disease, and fibromyalgia.[7],[8] Saccharin is petroleum-based sugar substitute from crude oil and is 350 times sweeter than cane sugar, hence used in toothpaste. It has been linked to a cancer-causing agent.
| Dyes And Colorings | | |
Blue, red, yellow and green are the popular dyes used in the toothpaste. Red #30, red #33, blue #1, and yellow #5 are artificial food dyes. The FD and C blue dye No. 2 is the popularly used. It might be related to learning and behavioral issues such as hyperactivity in children, severe allergic reactions, and other health problems such as cancer.[9],[10]
| Fluoride | | |
Almost all the conventional toothpastes sold in the US have fluoride.[10] Fluoride strengthens tooth enamel and makes teeth more resistant to acid produced by bacteria. However, health risk of fluoride is high in children. It can cause permanent tooth discoloration, stomach problems, skin rashes, and impairment in glucose metabolism. The US Food and Drug Administration (FDA) advocates warning label on fluoride toothpaste.[11] Fluoride is a toxic chemical that accumulates in tissues over time, wreaks havoc with enzymes, and produces a number of serious adverse health effects, including neurological and endocrine dysfunction. Children are particularly at risk for adverse effects of overexposure.[12]
Water fluoridation was praised as the major achievement in 20th century.[13] However, there is a probability of fluoride reacting with chlorine in water to form chloroform which is a carcinogen and can be harmful.[14] Fluoride-containing toothpaste can be toxic if swallowed in large amounts. A major concern of dental fluorosis in children above 12 months of age is ingesting excessive fluoride through toothpaste. Nausea and vomiting are also the problems which might arise with topical fluoride ingestion.[13],[15],[16]
| Antimicrobials | | |
Antimicrobials of toothpaste retard oral bacterial growth. The additives include hexetidine/zinc citrate, triclosan, amyloglucosidase/glucose oxidase, and sodium fluoride/sodium monofluorophosphate.[17] Triclosan, an antibacterial agent to fight gingivitis, is found in FDA-approved toothpaste Colgate Total. Antibiotic resistance and endocrine disruption are the growing concerns of the irrational use of triclosan. Problems due to triclosan includes breast, ovarian, prostate and testicular cancer, preterm and low birth weight babies, precocious puberty in girls, and undescended testicles in boys, weakened heart muscle function, endocrine issues, and bone deformation. Studies showed that triclosan caused fetal bone malformations in mice and rats, which may hint at hormonal effects. Triclosan may interfere with cell signaling in the brain, heart, and other cells.[18] It may promote breast cancer progression.[19] In 2016, the FDA banned triclosan in soaps; however, to the surprise, it is still allowed in toothpaste.
Many antibiotics are added to toothpaste for the treatment of oral/dental diseases. Triclosan is a common toothpaste ingredient which prevents gingivitis and reduces tartar and bad breath.[20] Chlorhexidine mouthwash has a positive effect in controlling plaque and gingivitis.[21]
| Abrasives | | |
Silica, sodium bicarbonate (baking soda), calcium carbonate, calcium phosphate, alumina, marble, and eggshells are used to remove debris and residual surface stains from teeth but are abrasive to the teeth. Baking soda and calcium also act as toothpaste abrasive ingredients. Baking soda releases carbon dioxide, producing additional foam during brushing. It can cause abrasion in the tooth leading to sensitive teeth and receding gums.[22]
| Thickening Agents | | |
Carrageenan, cellulose gum, guar gum, xanthan gum, and gluten are used to thicken the toothpaste, which make the toothpaste thick and tacky.[23] Gluten causes celiac disease. Carrageenan is a common thickening agent in toothpastes. It has potential to cause inflammation in the intestine and colonic tumors.
Humectants, such as glycerol, propylene, glycol, and sorbitol, all prevent water loss from toothpaste and help to keep it moist. Xylitol is also used for this purpose, which provides moisture and prevents cavities. It is more effective than fluoride in preventing dental caries in children's permanent teeth. It has not been found to cause any harmful effect.[24]
Propylene glycol is used as a surfactant in toothpaste. It is a hydrophilic polymer that acts as a dispersant and is used in many cosmetic and pharmaceutical formulae, for example, nonsteroidal anti-inflammatory drugs, other medications, and household products.[25] Safety of propylene glycol in personal care products is lacking. It is known to be a skin, eye, and lung irritant and causes organ toxicity, cancer, and reproductive issue and skin irritation.[26] White pastes include titanium dioxide used for white opaque appearance. It has allergenic potential, and polyethylene glycol (PEG) hypersensitivity has been reported.[27] PEG is a common ingredient of toothpastes as a dispersant and has an allergenic potential.
| Preservatives | | |
Sodium benzoate, methylparaben, and ethylparaben are the common preservatives used in toothpaste. Parabens mimic the hormone estrogen and can potentially cause cancer, developmental, and reproductive issues. Sodium benzoate is a safer preservative.[10]
| Diethanolamine | | |
The diethanolamine (DEA) is found in foaming toothpastes. It is a known hormone disrupter and reacts with other ingredients to form a potential carcinogen called N-nitroso DEA, which is readily absorbed through the skin and has been linked with cancers of the stomach, esophagus, liver, and bladder.[10] The Environmental Working Group ranks DEA as a number 10 in its cosmetics database (the most toxic score) due to high concerns of organ toxicity, contamination concerns, irritation, and moderate cancer risk.
| Microbeads | | |
Microbeads are tiny plastic pellets. These enter the water system and contaminate the environment. It can absorb toxins and are eaten by aquatic life and subsequently enter the human food chain. The microbeads are also reported in patient's teeth and gums. They create space for bacterial growth and cause gum diseases. Biodegradable plastic such as polylactic acid is replacing the plastic microbeads but even that causes gum diseases.[28],[29]
| The Others | | |
The American Dental Association approves all fluoride toothpastes, and the US FDA tests the toothpastes for safety and effectiveness. Toothpaste includes whiteners and tartar-control products. Tetrasodium pyrophosphate removes calcium and magnesium from saliva, which reduces tartar deposits on teeth. Whiteners, such as sodium carbonate, break down into bleaching peroxides which bleach tooth enamel. Other chemicals include sodium hydroxide, pentasodium triphosphate, arginine, and acrylic polymers. Alcohol dehydrates the oral cavity and causes dryness. It can contribute to gingivitis.[10] The presence of nicotine has been reported in six popular herbal dentifrices.[30] Nicotine gives addictive potential to the particular brand, and the effects of smokeless nicotine include oral mucosal and precancerous lesions, gingival recession, cardiovascular risk factors, causation of diabetes mellitus, reproductive health effects, and increased mortality.[31] Nicotine rapidly crosses the placental barrier and has toxic effects on the fetus.[30] Strontium chloride, potassium nitrate, arginine, and calcium sodium phosphosilicate are also found in some toothpastes recommended for reducing the sensitivity of teeth. Sodium polyphosphate is used to minimize tartar formation, and chlorhexidine is recommended for controlling the plaque and gingivitis. Discoloration of enamel is the side effects of these chemicals.
| Conclusion | | |
Head, neck, and face have higher blood circulation compared to rest of the body. Buccal absorption of drugs is well known in kinetics. Some drugs are selectively given sublingually for fast pharmacological effects, bypassing first-pass hepatic metabolism and immediate delivery. Toothpastes have been used to deliver drugs in oral cavity.
The article states the harmful effects of toothpastes and advise that all are not safe. The chemicals, pesticides, genetically modified organisms, ingredients, glutens, fluoride, saccharin, SLS, abrasives, carrageenan, parabens, triclosan, artificial sweeteners, additives, propylene glycol, detergents, synthetics, and nicotine may be there in the toothpaste.
The commercial toothpaste can best be avoided and oral health was maintained with simple cooking ingredients such as coconut oil which inhibits acid-producing oral bacteria. Bentonite clay, salt, baking soda, stevia, essential oils, preferably peppermint, along with water, and coconut oil can provide the safest tooth cleaner in daily use. Baking soda and salt are the best tooth cleaners. Good oral health can be maintained by brushing, flossing, and healthy diet. Sugar of the diet is the main causative agent for dental diseases. Diet rich in nutrients and low in sugars and starch can keep teeth and gums healthy.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | American Dental Association. Description of Toothpaste. Toothpaste. [Last accessed on 2018 Jun 13].  |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| 7. | |
| 8. | |
| 9. | |
| 10. | |
| 11. | |
| 12. | |
| 13. | 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. |
| 14. | 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. |
| 15. | |
| 16. | Kidd E, Fejerskov O. Essentials of dental caries. 4 th ed. New York, USA: Oxford University Press. 2016; p. 373-8. |
| 17. | |
| 18. | |
| 19. | Lee HR, Hwang KA, Nam KH, Kim HC, Choi KC. Progression of breast cancer cells was enhanced by endocrine-disrupting chemicals, triclosan and octylphenol, via an estrogen receptor-dependent signaling pathway in cellular and mouse xenograft models. Chem Res Toxicol 2014;27:834-42. |
| 20. | Cooney CM. Triclosan comes under scrutiny. Environ Health Perspect 2010;118:A242. |
| 21. | 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. |
| 22. | Ahrari F, Hasanzadeh N, Rajabi O, Forouzannejad Z. Effectiveness of sodium bicarbonate combined with hydrogen peroxide and CPP-ACPF in whitening and microhardness of enamel. J Clin Exp Dent 2017;9:e344-50. |
| 23. | |
| 24. | 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;26:CD010743. |
| 25. | Fruijtier-Pölloth C. Safety assessment on polyethylene glycols (PEGs) and their derivatives as used in cosmetic products. Toxicology 2005;214:1-38. |
| 26. | |
| 27. | Wenande E, Garvey LH. Immediate-type hypersensitivity to polyethylene glycols: A review. Clin Exp Allergy 2016;46:907-22. |
| 28. | |
| 29. | |
| 30. | Agrawal SS, Ray RS. Nicotine contents in some commonly used toothpastes and toothpowders: A present scenario. J Toxicol 2012;2012:237506. |
| 31. | Winn DM. Tobacco use and oral disease. J Dent Educ 2001;65:306-12. |
|
Search Pubmed for