Editing Toothpaste (section)

==Safety==
===Fluoride===
Fluoride-containing toothpaste can be acutely toxic if swallowed in large amounts,<ref>{{cite journal | vauthors = Canedy D |title=Toothpaste a Hazard? Just Ask the F.D.A |url=https://query.nytimes.com/gst/fullpage.html?sec=health&res=9406E2D81338F937A15750C0A96E958260 |journal=New York Times |date=March 24, 1998 |access-date=December 21, 2008}}</ref><ref name="Delivering Better Oral Health 2007">Delivering Better Oral Health: An evidence-based toolkit for prevention. NHS. UK, 2007.</ref> but instances are exceedingly rare and result from prolonged and excessive use of toothpaste (i.e. several tubes per week).<ref>{{cite journal | vauthors = Roos J, Dumolard A, Bourget S, Grange L, Rousseau A, Gaudin P, Calop J, Juvin R | display-authors = 6 | title = [Osteofluorosis caused by excess use of toothpaste] | journal = Presse Médicale | volume = 34 | issue = 20 Pt 1 | pages = 1518–20 | date = November 2005 | pmid = 16301964 | doi = 10.1016/S0755-4982(05)84216-2 }}</ref> Approximately 15&nbsp;mg/kg body weight is the acute lethal dose, even though as small amount as 5&nbsp;mg/kg may be fatal to some children.<ref name="Kidd-2016">{{Cite book|title=Essentials of Dental Caries | vauthors = Kidd E, Fejerskov O |publisher=Oxford University Press|year=2016|isbn=978-0-19-873826-8|pages=97 }}</ref>

The risk of using fluoride is low enough that the use of full-strength toothpaste (1350–1500 ppm fluoride) is advised for all ages. However, smaller volumes are used for young children, for example, a smear of toothpaste until three years old.<ref name="Delivering Better Oral Health 2007" /> A major concern of [[dental fluorosis]] is for children under 12 months ingesting excessive fluoride through toothpaste. Nausea and vomiting are also problems which might arise with topical fluoride ingestion.<ref name="Kidd-2016" />

===Diethylene glycol===
The inclusion of sweet-tasting but toxic [[diethylene glycol]] in Chinese-made toothpaste led to a recall in 2007 involving multiple toothpaste brands in several nations.<ref>[https://www.nytimes.com/imagepages/2007/09/30/world/20071001_PANAMA_GRAPHIC.html "Tainted toothpaste across the world"], New York Times, September 30, 2007.</ref> The world outcry made Chinese officials ban the practice of using diethylene glycol in toothpaste.<ref>{{cite web | vauthors = Bogdanich W | url = https://www.nytimes.com/2007/10/01/world/americas/01panama.html | title = The Everyman Who Exposed Tainted Toothpaste | work = [[The New York Times]] | date = 1 October 2007 }}</ref>

===Triclosan===
Reports have suggested triclosan, an active ingredient in many kinds of toothpastes, can combine with [[chlorine]] in tap water to form [[chloroform]].<ref name="pmid15926568">{{cite journal | vauthors = Rule KL, Ebbett VR, Vikesland PJ | title = Formation of chloroform and chlorinated organics by free-chlorine-mediated oxidation of triclosan | journal = Environmental Science & Technology | volume = 39 | issue = 9 | pages = 3176–85 | date = May 2005 | pmid = 15926568 | doi = 10.1021/es048943+ | bibcode = 2005EnST...39.3176R }}</ref> An animal study revealed the chemical might modify hormone regulation, and many other lab researches proved bacteria might be able to develop resistance to triclosan in a way which can help them to resist antibiotics also.<ref>{{cite news|url=http://topnews.net.nz/content/23170-fda-reviewing-triclosan-antibacterial-agent-found-soap|title=FDA Reviewing Triclosan, an Antibacterial Agent Found in Soap| vauthors = Mukherjee K |date=2010-09-04|access-date=2010-10-27}}</ref>

=== Polyethylene glycol – PEG ===
[[Polyethylene glycol|PEG]] is a common ingredient in some of the formulas of toothpastes; it is a hydrophilic [[polymer]] that acts as a [[dispersant]] in toothpastes. Also, it is used in many cosmetic and pharmaceutical formulas, for example: ointments, osmotic [[laxative]]s, some of the [[nonsteroidal anti-inflammatory drug]]s, other medications and household products.<ref>{{cite journal | vauthors = Fruijtier-Pölloth C | title = Safety assessment on polyethylene glycols (PEGs) and their derivatives as used in cosmetic products | journal = Toxicology | volume = 214 | issue = 1–2 | pages = 1–38 | date = October 2005 | pmid = 16011869 | doi = 10.1016/j.tox.2005.06.001 | bibcode = 2005Toxgy.214....1F }}</ref>  However, 37 cases of PEG [[hypersensitivity]] (delayed and immediate) to PEG-containing substances have been reported since 1977,<ref name="Wenande-2016">{{cite journal | vauthors = Wenande E, Garvey LH | title = Immediate-type hypersensitivity to polyethylene glycols: a review | journal = Clinical and Experimental Allergy | volume = 46 | issue = 7 | pages = 907–22 | date = July 2016 | pmid = 27196817 | doi = 10.1111/cea.12760 | s2cid = 1247758 }}</ref> suggesting that they have unrecognized allergenic potential.<ref name="Wenande-2016"/>

===Miscellaneous issues and debates===
With the exception of toothpaste intended to be used on pets such as dogs and cats, and toothpaste used by [[astronaut]]s, most toothpaste is not intended to be swallowed, and doing so may cause [[nausea]] or [[diarrhea]]. Tartar fighting toothpastes have been debated.<ref>{{cite web|url=http://www.toxictoothpaste.org/ |archive-url=https://web.archive.org/web/20120423145344/http://www.toxictoothpaste.org/ |archive-date=2012-04-23 |title=Tartar Fighting Toothpastes & Toxic Reactions|work=toxictoothpaste.org}}</ref>  Sodium lauryl sulfate (SLS) has been proposed to increase the frequency of [[mouth ulcer]]s in some people, as it can dry out the protective layer of oral tissues, causing the underlying tissues to become damaged.<ref>[http://www.dentalgentlecare.com/cancer_sores_copy(1).htm Canker Sores] {{webarchive|url=https://web.archive.org/web/20060208030507/http://www.dentalgentlecare.com/cancer_sores_copy%281%29.htm |date=February 8, 2006 }}. Dentalgentlecare.com. Retrieved on April 4, 2013.</ref> In studies conducted by the university of Oslo on [[recurrent aphthous ulcer]]s, it was found that SLS has a denaturing effect on the oral [[Mucous membrane|mucin]] layer, with high affinity for proteins, thereby increasing epithelial permeability.<ref>{{cite journal | vauthors = Herlofson BB, Barkvoll P | title = The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers | journal = Acta Odontologica Scandinavica | volume = 54 | issue = 3 | pages = 150–3 | date = June 1996 | pmid = 8811135 | doi = 10.3109/00016359609003515 }}</ref> In a double-blind cross-over study, a significantly higher frequency of [[Aphthous stomatitis|aphthous ulcers]] was demonstrated when patients brushed with an SLS-containing versus a detergent-free toothpaste. Also patients with [[Oral lichen planus|Oral Lichen Planus]] who avoided SLS-containing toothpaste benefited.<ref>{{cite book| vauthors = Nikiforuk G |title=Understanding dental caries. prevention: basic and clinical aspects|date=1985|publisher=Karger|location=Basel|isbn=978-3-8055-3905-0 | doi = 10.1159/000409915 | pages=87–112|chapter=5 Fluoride Dentifrices and Fluoride Rinses}}</ref><ref>{{cite journal | vauthors = Barkvoll P, Rølla G | title = Triclosan protects the skin against dermatitis caused by sodium lauryl sulphate exposure | journal = Journal of Clinical Periodontology | volume = 21 | issue = 10 | pages = 717–9 | date = November 1994 | pmid = 7852618 | doi = 10.1111/j.1600-051x.1994.tb00792.x }}</ref>

===Alteration of taste perception===
After using toothpaste, [[orange juice]] and other fruit juices are known to have an unpleasant taste if consumed shortly afterwards. [[Sodium dodecyl sulfate|Sodium lauryl sulfate]], used as a surfactant in toothpaste, alters taste perception. It can break down [[phospholipid]]s that inhibit taste receptors for sweetness, giving food a bitter taste. In contrast, apples are known to taste more pleasant after using toothpaste.<ref>{{Cite journal| vauthors = DeSimone JA, Heck GL, Bartoshuk LM |title=Surface active taste modifiers: a comparison of the physical and psychophysical properties of gymnemic acid and sodium lauryl sulfate|journal=[[Chemical Senses]]|year=1980|volume=5|pages=317–330|doi=10.1093/chemse/5.4.317|issue=4}}</ref> Distinguishing between the hypotheses that the bitter taste of orange juice results from stannous fluoride or from sodium lauryl sulfate is still an unresolved issue and it is thought that the [[menthol]] added for flavor may also take part in the alteration of taste perception when binding to lingual [[thermoreceptor|cold receptors]].{{citation needed|date=December 2014}}

===Whitening toothpastes===
Many toothpastes make whitening claims. Abrasion is the principal way that toothpaste removes stains, and toothpastes that are not marketed as whitening can still remove stains by abrasion.<ref name="The New York Times-2022"/> Some of these toothpastes contain peroxide, the same ingredient found in tooth bleaching gels. Whitening toothpaste cannot alter the natural color of teeth or reverse discoloration by penetrating surface stains or decay. To remove surface stains, whitening toothpaste may include abrasives to gently polish the teeth or additives such as [[sodium tripolyphosphate]] to break down or dissolve stains. When used twice a day, whitening toothpaste typically takes two to four weeks to make teeth appear whiter. Whitening toothpaste is generally safe for daily use, but excessive use might damage tooth enamel.<ref>{{cite web | vauthors = Salinas TJ | url = http://www.mayoclinic.com/health/whitening-toothpaste/AN01818 | title = Whitening toothpaste: Does it actually whiten teeth? | work = Mayo Clinic | url-status = live | archive-url = https://web.archive.org/web/20080503211651/http://www.mayoclinic.com/health/whitening-toothpaste/AN01818 | archive-date = May 3, 2008 | df = mdy-all }}</ref> A recent systematic review in 2017 concluded that nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing extrinsic stains, irrespective of whether or not a chemical discoloration agent was added.<ref>{{cite journal | vauthors = Soeteman GD, Valkenburg C, Van der Weijden GA, Van Loveren C, Bakker E, Slot DE | title = Whitening dentifrice and tooth surface discoloration-a systematic review and meta-analysis | journal = International Journal of Dental Hygiene | volume = 16 | issue = 1 | pages = 24–35 | date = February 2018 | pmid = 28573755 | doi = 10.1111/idh.12289 | hdl = 11245.1/70dfdb36-d5af-412c-8032-423c258f89cf | s2cid = 3848563 | url = https://pure.uva.nl/ws/files/65470544/Front_matter.pdf | hdl-access = free }}</ref> However, the whitening process can permanently reduce the strength of the teeth, as the process scrapes away a protective outer layer of enamel.<ref>{{cite web|url=http://sciencefocus.com/qa/are-yellow-teeth-stronger|title=Are yellow teeth stronger?|work=sciencefocus.com}}</ref>

===Herbal and natural toothpastes===

Herbal toothpastes are marketed to consumers who wish to avoid some of the artificial ingredients commonly found in regular toothpastes. The ingredients found in so-called natural toothpastes vary widely but often include [[baking soda]], [[aloe]], [[eucalyptus oil]], [[myrrh]], [[camomile]], [[calendula]], neem, [[toothbrush tree]], plant extract (strawberry extract), and essential oils. Many herbal toothpastes do not contain fluoride or [[sodium lauryl sulfate]].<ref name="Janakiram-2020"/>

A 2020 meta-analysis showed some evidence for the efficacy of herbal toothpaste, albeit from poor quality studies.<ref name="Janakiram-2020"/> According to a study by the [[Delhi Institute of Pharmaceutical Sciences and Research]], many of the herbal toothpastes being sold in India were adulterated with [[nicotine]].<ref name="it01">{{cite news|url=http://indiatoday.intoday.in/story/toothpastes-contain-cancer-causing-nicotine-study/1/150836.html|title=Toothpastes contain cancer causing nicotine, finds study| vauthors = Chandra N |date=September 11, 2011|work=Mail Today|publisher=indiatoday.in|access-date=22 August 2014}}</ref>

[[Charcoal]] has also been incorporated in toothpaste formulas; however, there is no evidence to determine its safety and effectiveness, and the American Dental Association does not recommend its use.<ref name="The New York Times-2022">{{cite web | title=Is Teeth Whitening Safe? What to Know and Products to Use | website=The New York Times | date=2022-10-03 | url=https://www.nytimes.com/2022/10/03/well/live/teeth-whitening-safety.html | access-date=2023-06-29}}</ref>