Shelves and shelves of toothpastes, mouth rinses, teeth whiteners and more — which one to buy? In addition to having to choose from a multitude of items, patients also may have questions about the chemicals that make up these products. Dental professionals field questions about toothpaste and whiteners with ingredients such as fluoride, sodium lauryl sulfate (SLS), triclosan, and hydrogen peroxide and/or carbamide peroxide. Some patients favor products free of these elements and move toward what are perceived as better, natural products. Dental professionals should have knowledge of the chemicals in dental products that patients are likely to encounter.
Fluoride is found in toothpaste, mouthwash and even in foods, pesticides and bottled water. Suspicion has consistently shrouded the implementation of fluoridated municipal water, mostly due to people viewing it as “forced medication,” despite the drop in tooth decay rates since its introduction.
There also is a fear that fluoride consumption may cause systemic maladies. According to a systematic review conducted by the Community Preventive Services Task Force (CPSTF) in 2013, fluoride has been inconclusively associated with bone cancer risk, hormone interruption, accelerated aging and joint problems. Even though no scientific evidence exists to connect exposure or consumption of fluoride to any systemic conditions, online anti-fluoride communities continue to perpetuate its perceived “dangers.”
Stumbling across information included in anti-fluoride sites could cause some to decline fluoride application in the dental office and avoid fluoridated oral care products. Yet it is important for patients to know that, according to recent research published in the February 2018 issue of the Journal of Gerodontology, the addition of fluoride is necessary for cavity prevention.
Sodium lauryl sulfate (SLS)
SLS is a chemical agent added to products used for personal hygiene and household cleaning. It is the chemical that creates lather. Concerns of skin, eye and lung irritation, organ toxicity and cancer shadow SLS use and have caused many to seek sulfate-free personal care and household cleaning products. Yet according to a November 2015 study in Environmental Health Insights, which reviewed the human and environmental toxicity profiles of SLS, “SLS is an acceptable surfactant for use in household cleaning product formulations from toxicological and sustainability perspective.”
According to the FDA, SLS has 61 different dosage forms, including dental and topical, that are approved for use in personal care products. Those concerned about cancer risk from exposure to SLS may be confused with contamination by a similar chemical, sodium laureth sulfate. During the ethoxylation process, it is possible for this chemical to become contaminated with 1,4-Dioxane. According to the Agency for Toxic Substances and Disease Registry, 1,4-Dioxane is a trace contaminant of some chemicals used in cosmetics, detergents and shampoos. Facilities that manufacture both SLS and sodium laureth sulfate could potentially contaminate SLS with 1,4-Dioxane, which is possibly carcinogenic, according to the International Agency for Research on Cancer (IARC).
Triclosan was added to personal care and household products to reduce or prevent bacterial contamination, but as of December 2017, the FDA issued a final rule that stopped the use of the ingredient in these products due to insufficient data about its safety and effectiveness. According to a January 2016 publication in The Annual Review of Pharmacology and Toxicology, recent research has raised concerns, showing that triclosan could disrupt hormones, interfere with immune functioning and possibly contribute to antibiotic resistance.
Although triclosan has been barred from other products regulated by the FDA, it is still in toothpaste. In 1997, the FDA reviewed data on triclosan in Colgate Total and confirmed that triclosan helped prevent gingivitis as claimed. Colgate Total is currently the only toothpaste available in the United States that contains the chemical, according to Consumer Reports.
Hydrogen peroxide/carbamide peroxide
Teeth whitening products such as over-the-counter strips, professionally made take-home trays and gel, or even in-office professional whitening also may draw concern from consumers. According to a June 2014 article published in the Journal of Evidence-Based Dental Practice, though, research shows that when used as directed by manufacturers, bleaching products are safe. There are risks, however.
The article reports that aggressive bleaching with any carbamide peroxide or hydrogen peroxide gel can cause discoloration to composite restorations, changes of tooth structure, susceptibility to demineralization and compromise bonding of composite restorations. In-office bleaching can cause tooth sensitivity and gingival irritation. Whitening toothpastes and rinses contain smaller amounts of hydrogen peroxide than whitening gels, thus significantly lessening this risk. Dental professionals should present all risks and benefits to patients considering bleaching products.
Activated charcoal toothpaste and powders
Activated charcoal products are trendy and have been added to many personal care items, including toothpaste. Activated charcoal is viewed as a natural additive. In fact, according to a March 2016 study in the British Journal of Clinical Pharmacology, activated charcoal has been used for acute poison control and acute overdoses since the 1800s. This chemical works by binding with positively charged elements, including toxins and free-radicals. When used in the oral cavity, it is thought to bind to and remove plaque and surface stains. However, a September 2017 article in the Journal of the American Dental Association reveals that evidence is insufficient to uphold claims of safety and efficacy of charcoal toothpaste. Users should be cautious due to the abrasivity of some of these products, especially charcoal powders. If applied too liberally or too frequently, enamel erosion may occur.
If there are chemicals that patients are unfamiliar with in oral care products, they may be prompted to explore alternative options. It is beneficial for dental professionals to be well-educated on the risks and concerns surrounding chemicals in dental products on the market today so that patients can be guided in the right direction for better overall dental health.
~ Elizabeth Gutierrez, RDH