Editing Toothpaste (section)

==Ingredients==
Toothpastes are derived from a variety of components, the three main ones being abrasives, fluoride, and detergent.

===Abrasives===
Abrasives constitute 8-20% of a typical toothpaste.<ref name="Lippert-2013" /> These insoluble particles are designed to help remove plaque from the teeth.<ref name="Aspinall-2021">{{cite journal | vauthors = Aspinall SR, Parker JK, Khutoryanskiy VV | title = Oral care product formulations, properties and challenges | journal = Colloids and Surfaces B: Biointerfaces | volume = 200 | pages = 111567 | date = April 2021 | pmid = 33454623 | doi = 10.1016/j.colsurfb.2021.111567 | s2cid = 231634828 | url = https://centaur.reading.ac.uk/95441/1/Oral%20care%20product%20formulations-revised%20unmarked.pdf }}</ref> The removal of plaque inhibits the accumulation of tartar ([[Calculus (dental)|calculus]]) helping to minimize the risk of gum disease.<ref>{{cite journal | vauthors = van der Weijden F, Slot DE | title = Oral hygiene in the prevention of periodontal diseases: the evidence | journal = Periodontology 2000 | volume = 55 | issue = 1 | pages = 104–23 | date = February 2011 | pmid = 21134231 | doi = 10.1111/j.1600-0757.2009.00337.x }}</ref> Representative abrasives include particles of [[aluminum hydroxide]] (Al(OH)<sub>3</sub>), [[calcium carbonate]] (CaCO<sub>3</sub>), [[magnesium carbonate]] (MgCO<sub>3</sub>), [[sodium bicarbonate]], various [[calcium hydrogen phosphate]]s, various [[silica]]s and [[zeolite]]s, and [[hydroxyapatite]] (Ca<sub>5</sub>(PO<sub>4</sub>)<sub>3</sub>OH).

After the [[Microbead-Free Waters Act of 2015]], the use of [[microbeads]] in toothpaste has been discontinued in the US,<ref>{{Cite web|title=What Are Microbeads In Toothpaste?|url=https://www.colgate.com/en-us/oral-health/brushing-and-flossing/what-are-microbeads-in-toothpaste|work=[[Colgate-Palmolive|Colgate]]|date=|access-date=November 28, 2022}}</ref> however since 2015 the industry has shifted toward instead using [[FDA]]-approved "rinse-off" [[Metallised film|metallized-plastic]] [[glitter]] as their primary [[abrasive agent]].<ref>{{Cite news|author=Caity Weaver|title=What Is Glitter? A strange journey to the glitter factory.|url=https://www.nytimes.com/2018/12/21/style/glitter-factory.html|work=[[The New York Times]]|date=December 21, 2018|access-date=November 28, 2022}}</ref><ref>{{Cite web|author=Trisha Bartle|title=TikTok Is Going Deep On The Glitter Conspiracy Theories–Is It Toothpaste, Boats, Or Something Else?|url=https://collective.world/tiktok-is-going-deep-on-the-glitter-conspiracy-theories-is-it-toothpaste-boats-or-something-else/|work=Collective World|date=October 17, 2022|access-date=November 28, 2022}}</ref><ref>{{Cite news|author=Dr. Beccy Corkill|title=The Glitter Conspiracy Theory: Who Is Taking All Of The Glitter?|url=https://www.iflscience.com/the-glitter-conspiracy-theory-who-is-taking-all-of-the-glitter-66761|work=[[IFLScience]]|date=December 21, 2022|access-date=January 18, 2023}}</ref> Some brands contain powdered white [[mica]], which acts as a mild abrasive, and also adds a cosmetic glittery shimmer to the paste. The polishing of teeth removes stains from tooth surfaces, but has not been shown to improve dental health over and above the effects of the removal of [[Dental plaque|plaque]] and Calculus.<ref name="Weinert-2005">{{cite book | vauthors = Weinert W | chapter = Oral Hygiene Products | title = Ullmann's Encyclopedia of Industrial Chemistry | date = 2005 | publisher = Wiley-VCH | location = Weinheim | doi = 10.1002/14356007.a18_209 | isbn = 3527306730}}</ref>

Abrasives, like the dental polishing agents used in dentists' offices, also cause a small amount of enamel erosion which is termed "polishing" action. The abrasive effect of toothpaste is indicated by its [[Relative dentin abrasivity|RDA]] value. Toothpastes with RDA values above 250 are potentially damaging to the surfaces of teeth. The [[American National Standards Institute]] and [[American Dental Association]] considers toothpastes with an RDA below 250 to be safe and effective for a lifetime of use.<ref>{{cite web |title=Toothpastes |url=https://www.ada.org/en/member-center/oral-health-topics/toothpastes |website=www.ada.org |publisher=American Dental Association |access-date=6 July 2021}}</ref>

===Fluorides===
{{main|Fluoride therapy}}

[[Fluoride]] in various forms is the most popular and effective active ingredient in toothpaste to prevent cavities.<ref name="Aspinall-2021"/> Fluoride is present in small amounts in plants, animals, and [[History of water fluoridation|some natural water sources]]. The additional fluoride in toothpaste has beneficial effects on the formation of dental enamel and bones. [[Sodium fluoride]] (NaF) is the most common source of fluoride, but [[stannous fluoride]] (SnF<sub>2</sub>), and [[sodium monofluorophosphate]] (Na<sub>2</sub>PO<sub>3</sub>F) are also used.<ref name="Aspinall-2021" />  At similar fluoride concentrations, toothpastes containing stannous fluoride have been shown to be more effective than toothpastes containing sodium fluoride for reducing the incidence of dental caries and [[Acid erosion|dental erosion]],<ref>{{cite journal | vauthors = West NX, He T, Macdonald EL, Seong J, Hellin N, Barker ML, Eversole SL | title = Erosion protection benefits of stabilized SnF<sub>2</sub> dentifrice versus an arginine-sodium monofluorophosphate dentifrice: results from in vitro and in situ clinical studies | journal = Clinical Oral Investigations | volume = 21 | issue = 2 | pages = 533–540 | date = March 2017 | pmid = 27477786 | pmc = 5318474 | doi = 10.1007/s00784-016-1905-1 }}</ref><ref>{{cite journal | vauthors = Ganss C, Lussi A, Grunau O, Klimek J, Schlueter N | title = Conventional and anti-erosion fluoride toothpastes: effect on enamel erosion and erosion-abrasion | journal = Caries Research | volume = 45 | issue = 6 | pages = 581–9 | date = 2011 | pmid = 22156703 | doi = 10.1159/000334318 | s2cid = 45156274 | url = https://boris.unibe.ch/7527/ }}</ref><ref>{{cite journal | vauthors = West NX, He T, Hellin N, Claydon N, Seong J, Macdonald E, Farrell S, Eusebio R, Wilberg A | display-authors = 6 | title = Randomized in situ clinical trial evaluating erosion protection efficacy of a 0.454% stannous fluoride dentifrice | journal = International Journal of Dental Hygiene | volume = 17 | issue = 3 | pages = 261–267 | date = August 2019 | pmid = 30556372 | pmc = 6850309 | doi = 10.1111/idh.12379 }}</ref><ref>{{cite journal | vauthors = Zhao X, He T, He Y, Chen H | title = Efficacy of a Stannous-containing Dentifrice for Protecting Against Combined Erosive and Abrasive Tooth Wear In Situ | journal = Oral Health & Preventive Dentistry | volume = 18 | issue = 1 | pages = 619–624 | date = June 2020 | pmid = 32700515 | doi = 10.3290/j.ohpd.a44926 }}</ref><ref>{{cite journal | vauthors = Stookey GK, Mau MS, Isaacs RL, Gonzalez-Gierbolini C, Bartizek RD, Biesbrock AR | title = The relative anticaries effectiveness of three fluoride-containing dentifrices in Puerto Rico | journal = Caries Research | volume = 38 | issue = 6 | pages = 542–50 | date = 2004 | pmid = 15528909 | doi = 10.1159/000080584 | s2cid = 489634 | doi-access = free }}</ref> as well as reducing [[gingivitis]].<ref name="Parkinson-2020">{{cite journal | vauthors = Parkinson CR, Milleman KR, Milleman JL | title = Gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice: a 24-week randomized controlled trial | journal = BMC Oral Health | volume = 20 | issue = 1 | pages = 89 | date = March 2020 | pmid = 32216778 | pmc = 7098169 | doi = 10.1186/s12903-020-01079-6 | doi-access = free }}</ref><ref name="Hu-2019">{{cite journal | vauthors = Hu D, Li X, Liu H, Mateo LR, Sabharwal A, Xu G, Szewczyk G, Ryan M, Zhang YP | display-authors = 6 | title = Evaluation of a stabilized stannous fluoride dentifrice on dental plaque and gingivitis in a randomized controlled trial with 6-month follow-up | journal = Journal of the American Dental Association | volume = 150 | issue = 4S | pages = S32–S37 | date = April 2019 | pmid = 30797257 | doi = 10.1016/j.adaj.2019.01.005 | s2cid = 73488958 }}</ref><ref name="Mankodi-2005">{{cite journal | vauthors = Mankodi S, Bartizek RD, Winston JL, Biesbrock AR, McClanahan SF, He T | title = Anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice | journal = Journal of Clinical Periodontology | volume = 32 | issue = 1 | pages = 75–80 | date = January 2005 | pmid = 15642062 | doi = 10.1111/j.1600-051X.2004.00639.x | doi-access = free }}</ref><ref name="Archila-2004">{{cite journal | vauthors = Archila L, Bartizek RD, Winston JL, Biesbrock AR, McClanahan SF, He T | title = The comparative efficacy of stabilized stannous fluoride/sodium hexametaphosphate dentifrice and sodium fluoride/triclosan/copolymer dentifrice for the control of gingivitis: a 6-month randomized clinical study | journal = Journal of Periodontology | volume = 75 | issue = 12 | pages = 1592–9 | date = December 2004 | pmid = 15732859 | doi = 10.1902/jop.2004.75.12.1592 }}</ref><ref name="Clark-Perry-2020">{{cite journal | vauthors = Clark-Perry D, Levin L | title = Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials | journal = International Dental Journal | volume = 70 | issue = 6 | pages = 418–426 | date = December 2020 | pmid = 32621315 | doi = 10.1111/idj.12588 | pmc = 9379195 | s2cid = 220336087 }}</ref> Some stannous fluoride-containing toothpastes also contain ingredients that allow for better stain and calculus removal.<ref>{{cite journal | vauthors = Papas A, He T, Martuscelli G, Singh M, Bartizek RD, Biesbrock AR | title = Comparative efficacy of stabilized stannous fluoride/sodium hexametaphosphate dentifrice and sodium fluoride/triclosan/copolymer dentifrice for the prevention of periodontitis in xerostomic patients: a 2-year randomized clinical trial | journal = Journal of Periodontology | volume = 78 | issue = 8 | pages = 1505–14 | date = August 2007 | pmid = 17668969 | doi = 10.1902/jop.2007.060479 | s2cid = 24785092 }}</ref> A systematic review revealed stabilised stannous fluoride-containing toothpastes had a positive effect on the reduction of plaque, gingivitis and staining, with a significant reduction in [[Calculus (dental)|calculus]] and halitosis compared to other toothpastes.<ref>{{cite journal | vauthors = Johannsen A, Emilson CG, Johannsen G, Konradsson K, Lingström P, Ramberg P | title = Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review | journal = Heliyon | volume = 5 | issue = 12 | pages = e02850 | date = December 2019 | pmid = 31872105 | pmc = 6909063 | doi = 10.1016/j.heliyon.2019.e02850 | doi-access = free | bibcode = 2019Heliy...502850J }}</ref> Furthermore, numerous clinical trials have shown gluconate chelated stannous fluoride toothpastes possess superior protection against dental erosion and [[Dentin hypersensitivity|dentine hypersensitivity]] compared to other fluoride-containing and fluoride-free toothpastes.<ref name="West-2021">{{Cite journal|last1=West|first1=Nicola X.|last2=He|first2=Tao|last3=Zou|first3=Yuanshu|last4=DiGennaro|first4=Joe|last5=Biesbrock|first5=Aaron|last6=Davies|first6=Maria|date=February 2021|title=Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion|journal=Journal of Dentistry|volume=105|pages=103566|doi=10.1016/j.jdent.2020.103566|issn=1879-176X|pmid=33383100|s2cid=229940161|doi-access=free|hdl=1983/34d78138-703d-484f-864f-ece3d3610d64|hdl-access=free}}</ref>

Much of the toothpaste sold in the United States has 1,000 to 1,100 parts per million fluoride. In European countries, such as the UK or Greece, the fluoride content is often higher; a sodium fluoride content of 0.312% w/w (1,450 [[Parts per million|ppm]] fluoride) or stannous fluoride content of 0.454% w/w (1,100 ppm fluoride) is common. All of these concentrations are likely to prevent [[tooth decay]], according to a 2019 [[Cochrane review]].<ref name="Walsh-2019" /> Concentrations below 1,000 ppm are not likely to be preventive, and the preventive effect increases with concentration.<ref name="Walsh-2019" /> Clinical trials support the use of high fluoride (5,000 ppm fluoride) dentifrices, for prevention of root caries in elderly adults by reducing the amount of plaque accumulated, decreasing the number of [[Streptococcus mutans|mutans streptococci]] and [[Lactobacillus|lactobacilli]] and possibly promoting calcium fluoride deposits to a higher degree than after the use of traditional fluoride containing dentifrices.<ref name="Walsh-2019" />

Most toothpaste products have a shelf life of about two years, after which the fluoride and antibacterial properties may become less effective.{{cn|date=January 2025}} While expired toothpaste is generally safe to use, regulatory bodies like the FDA require expiration dates on fluoride-containing toothpaste to ensure optimal effectiveness.{{cn|date=January 2025}}

===Surfactants===
Many, although not all, toothpastes contain [[sodium dodecyl sulfate|sodium lauryl sulfate (SLS)]] or related [[surfactant]]s (detergents). SLS is found in many other personal care products as well, such as [[shampoo]], and is mainly a [[foaming agent]], which enables uniform distribution of toothpaste, improving its cleansing power.<ref name="Weinert-2005"/>

===Other components===

====Antibacterial agents====
[[Triclosan]], an antibacterial agent, is a common toothpaste ingredient in the United Kingdom. Triclosan or [[zinc chloride]] prevent gingivitis and, according to the American Dental Association, helps reduce [[Dental tartar|tartar]] and [[bad breath]].<ref name=ADA-toothpaste/><ref name=FDA-Triclosan>{{cite journal| title = Triclosan: What Consumers Should Know | journal = FDA | url = https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm | archive-url = https://web.archive.org/web/20100411202211/http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm | url-status = dead | archive-date = April 11, 2010 | date=April 17, 2010 | author = Office of the Commissioner }}</ref> A 2006 review of clinical research concluded there was evidence for the effectiveness of 0.30% triclosan in reducing plaque and gingivitis.<ref>{{cite journal | vauthors = Gunsolley JC | title = A meta-analysis of six-month studies of antiplaque and antigingivitis agents | journal = Journal of the American Dental Association | volume = 137 | issue = 12 | pages = 1649–57 | date = December 2006 | pmid = 17138709 | doi = 10.14219/jada.archive.2006.0110 | quote = Seventeen studies support the antiplaque, antigingivitis effects of dentifrices containing 0.30 percent triclosan, 2.0 percent Gantrez copolymer. | s2cid = 9347082 }}</ref>  Another Cochrane review in 2013 has found that triclosan achieved a 22% reduction in plaque, and in gingivitis, a 48% reduction in [[Bleeding on probing|bleeding gums]]. However, there was insufficient evidence to show a difference in fighting [[periodontitis]] and there was no evidence either of any harmful effects associated with the use of triclosan toothpastes for more than 3 years. The evidence relating to plaque and gingivitis was considered to be of moderate quality while for periodontitis was low quality.<ref>{{cite journal | vauthors = Riley P, Lamont T | title = Triclosan/copolymer containing toothpastes for oral health | journal = The Cochrane Database of Systematic Reviews | issue = 12 | pages = CD010514 | date = December 2013 | volume = 2013 | pmid = 24310847 | pmc = 6775959 | doi = 10.1002/14651858.CD010514.pub2 | veditors = Riley P }}</ref> Recently, triclosan has been removed as an ingredient from well-known toothpaste formulations. This may be attributed to concerns about adverse effects associated with triclosan exposure. Triclosan use in cosmetics has been positively correlated with triclosan levels in human tissues, plasma and breast milk, and is considered to have potential neurotoxic effects.<ref>{{cite journal | vauthors = Ruszkiewicz JA, Li S, Rodriguez MB, Aschner M | title = Is Triclosan a neurotoxic agent? | journal = Journal of Toxicology and Environmental Health Part B: Critical Reviews | volume = 20 | issue = 2 | pages = 104–117 | date = 2017-02-17 | pmid = 28339349 | doi = 10.1080/10937404.2017.1281181 | bibcode = 2017JTEHB..20..104R | s2cid = 25568004 }}</ref> Long-term studies are needed to substantiate these concerns.

[[Chlorhexidine]] is another antimicrobial agent used in toothpastes; however, it is more commonly added in [[mouthwash]] products.<ref>{{cite journal | vauthors = Brookes ZL, Bescos R, Belfield LA, Ali K, Roberts A | title = Current uses of chlorhexidine for management of oral disease: a narrative review | journal = Journal of Dentistry | volume = 103 | pages = 103497 | date = December 2020 | pmid = 33075450 | pmc = 7567658 | doi = 10.1016/j.jdent.2020.103497 }}</ref> [[Sodium laureth sulfate]], a foaming agent, is a common toothpaste ingredient that also possesses some antimicrobial activities.<ref>{{cite journal | vauthors = Vranić E, Lacević A, Mehmedagić A, Uzunović A | title = Formulation ingredients for toothpastes and mouthwashes | journal = Bosnian Journal of Basic Medical Sciences | volume = 4 | issue = 4 | pages = 51–8 | date = October 2004 | pmid = 15628997 | pmc = 7245492 | doi = 10.17305/bjbms.2004.3362 }}</ref> There are also many commercial products available in the market containing different [[essential oil]]s, [[herb]]al ingredients (e.g. [[chamomile]], [[neem]], [[chitosan]], ''[[Aloe vera]]''), and natural or plant extracts (e.g. [[hinokitiol]]).<ref>{{cite journal | vauthors = Janakiram C, Venkitachalam R, Fontelo P, Iafolla TJ, Dye BA | title = Effectiveness of herbal oral care products in reducing dental plaque & gingivitis – a systematic review and meta-analysis | journal = BMC Complementary Medicine and Therapies | volume = 20 | issue = 1 | pages = 43 | date = February 2020 | pmid = 32046707 | pmc = 7076867 | doi = 10.1186/s12906-020-2812-1 | doi-access = free }}</ref> These ingredients are claimed by the manufacturers to fight plaque, bad breath and prevent [[gum disease]]. A 2020 systematic metareview found that herbal toothpastes are as effective as non-herbal toothpastes in reducing dental plaque at shorter period of follow-up (4 weeks).<ref name="Janakiram-2020">{{cite journal | vauthors = Janakiram C, Venkitachalam R, Fontelo P, Iafolla TJ, Dye BA | title = Effectiveness of herbal oral care products in reducing dental plaque & gingivitis – a systematic review and meta-analysis | journal = BMC Complementary Medicine and Therapies | volume = 20 | issue = 1 | pages = 43 | date = February 2020 | pmid = 32046707 | pmc = 7076867 | doi = 10.1186/s12906-020-2812-1 | oclc = 8531076494 | doi-access = free }}</ref> However, this evidence comes from low-quality studies.

The stannous ([[tin]]) ion, commonly added to toothpastes as stannous fluoride or [[Tin(II) chloride|stannous chloride]], has been shown to have antibacterial effects in the mouth. Research has shown that stannous fluoride-containing toothpaste inhibits extracellular polysaccharide ([[Extracellular polysaccharide|EPS]]) production in a multispecies [[biofilm]] greater than sodium fluoride-containing toothpaste.<ref>{{cite journal | vauthors = Cheng X, Liu J, Li J, Zhou X, Wang L, Liu J, Xu X | title = Comparative effect of a stannous fluoride toothpaste and a sodium fluoride toothpaste on a multispecies biofilm | journal = Archives of Oral Biology | volume = 74 | pages = 5–11 | date = February 2017 | pmid = 27838508 | doi = 10.1016/j.archoralbio.2016.10.030 }}</ref> This is thought to contribute to a reduction in plaque and gingivitis when using stannous fluoride-containing toothpastes when compared to other toothpastes, and has been evidenced through numerous clinical trials.<ref name="Parkinson-2020" /><ref name="Hu-2019" /><ref name="Mankodi-2005" /><ref name="Archila-2004" /><ref name="Clark-Perry-2020" /> In addition to its antibacterial properties, stabilised stannous fluoride toothpastes have been shown to protect against dental erosion and dentine hypersensitivity, making it a multifunctional component in toothpaste formulations.<ref name="West-2021" />

====Flavorants====
Toothpaste comes in a variety of [[food coloring|colors]] and [[Flavor (taste)|flavor]]s, intended to encourage use of the product. The three most common flavorants are [[peppermint]], [[spearmint]], and [[wintergreen]]. Toothpaste flavored with peppermint-anise oil is popular in the Mediterranean region. These flavors are provided by the respective oils, e.g. peppermint oil.<ref name="Weinert-2005"/> More exotic flavors include Anethole [[anise]], [[apricot]], [[bubblegum]], [[cinnamon]], [[fennel]], [[lavender]], [[neem]], [[ginger]], [[vanilla]], [[lemon]], [[orange (fruit)|orange]], and [[pine]]. Alternatively, unflavored toothpastes exist.

====Remineralizing agents====
Chemical repair ([[Remineralisation of teeth|remineralization]]) of early tooth decay is promoted naturally by [[saliva]].<ref>{{cite journal | vauthors = Featherstone JD | title = Remineralization, the natural caries repair process—the need for new approaches | journal = Advances in Dental Research | volume = 21 | issue = 1 | pages = 4–7 | date = August 2009 | pmid = 19717404 | doi = 10.1177/0895937409335590 | s2cid = 206573422 }}</ref> However, this process can be enhanced by various remineralisation agents.<ref>{{cite journal | vauthors = Cochrane NJ, Cai F, Huq NL, Burrow MF, Reynolds EC | title = New approaches to enhanced remineralization of tooth enamel | journal = Journal of Dental Research | volume = 89 | issue = 11 | pages = 1187–97 | date = November 2010 | pmid = 20739698 | doi = 10.1177/0022034510376046 | s2cid = 27176221 }}</ref> Fluoride promotes remineralization, but is limited by bioavailable calcium.<ref>{{cite journal | vauthors = Shen P, Walker GD, Yuan Y, Reynolds C, Stanton DP, Fernando JR, Reynolds EC | title = Importance of bioavailable calcium in fluoride dentifrices for enamel remineralization | journal = Journal of Dentistry | volume = 78 | pages = 59–64 | date = November 2018 | pmid = 30099066 | doi = 10.1016/j.jdent.2018.08.005 | s2cid = 51968882 }}</ref> Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) is a toothpaste ingredient containing bioavailable calcium that has been widely researched to be the most clinically effective remineralization agent that enhances the action of saliva and fluoride.<ref>{{cite journal | vauthors = Pithon MM, Baião FS, Sant'Anna LI, Tanaka OM, Cople-Maia L | title = Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: A systematic review | journal = Journal of Investigative and Clinical Dentistry | volume = 10 | issue = 2 | pages = e12391 | date = May 2019 | pmid = 30680921 | doi = 10.1111/jicd.12391 | s2cid = 59250500 }}</ref><ref>{{cite journal | vauthors = Wu L, Geng K, Gao Q | title = Early Caries Preventive Effects of Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) Compared with Conventional Fluorides: A Meta-analysis | journal = Oral Health & Preventive Dentistry | volume = 17 | issue = 6 | pages = 495–503 | date = 2019-12-20 | pmid = 31825022 | doi = 10.3290/j.ohpd.a43637 }}</ref><ref>{{cite journal | vauthors = Tao S, Zhu Y, Yuan H, Tao S, Cheng Y, Li J, He L | title = Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis | journal = PLOS ONE | volume = 13 | issue = 4 | pages = e0196660 | date = 2018-04-30 | pmid = 29709015 | pmc = 5927405 | doi = 10.1371/journal.pone.0196660 | bibcode = 2018PLoSO..1396660T | doi-access = free }}</ref><ref name="Philip-2019">{{cite journal | vauthors = Philip N | title = State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management | journal = Caries Research | volume = 53 | issue = 3 | pages = 284–295 | date = 2019 | pmid = 30296788 | pmc = 6518861 | doi = 10.1159/000493031 }}</ref> Peptide-based systems, hydroxyapatite nanocrystals and a variety of [[calcium phosphate]]s have been advocated as remineralization agents; however, more clinical evidence is required to substantiate their effectiveness.<ref name="Philip-2019" />
[[File:Zahncremes.jpg|thumb|200px|alt=A photo of 6 tubes of toothpaste where each tube is a unique brand|Toothpaste is sold in many brands.]]

====Miscellaneous components====
Agents are added to suppress the tendency of toothpaste to dry into a powder. Included are various sugar alcohols, such as [[glycerol]], [[sorbitol]], or [[xylitol]], or related derivatives, such as [[1,2-propylene glycol]] and [[polyethyleneglycol]].<ref name=Field>Simon Quellen Field "Why There's Antifreeze in Your Toothpaste: The Chemistry of Household Ingredients" 2008, Chicago Review Press. {{ISBN|1-55652-697-0}}</ref> [[Strontium chloride]] or [[potassium nitrate]] is included in some toothpastes to reduce sensitivity. Two systemic meta-analysis reviews reported that [[arginine]], and  calcium sodium phosphosilicate – CSPS containing toothpastes are also effective in alleviating dentinal hypersensitivity respectively.<ref>{{cite journal | vauthors = Yang ZY, Wang F, Lu K, Li YH, Zhou Z | title = Arginine-containing desensitizing toothpaste for the treatment of dentin hypersensitivity: a meta-analysis | journal = Clinical, Cosmetic and Investigational Dentistry | volume = 8 | pages = 1–14 | date = 2016-01-07 | pmid = 26793006 | pmc = 4708190 | doi = 10.2147/CCIDE.S95660 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Hu ML, Zheng G, Zhang YD, Yan X, Li XC, Lin H | title = Effect of desensitizing toothpastes on dentine hypersensitivity: A systematic review and meta-analysis | journal = Journal of Dentistry | volume = 75 | pages = 12–21 | date = August 2018 | pmid = 29787782 | doi = 10.1016/j.jdent.2018.05.012 | s2cid = 44141866 }}</ref> Another randomized clinical trial found superior effects when both formulas were combined.<ref>{{cite journal | vauthors = Hall C, Mason S, Cooke J | title = Exploratory randomised controlled clinical study to evaluate the comparative efficacy of two occluding toothpastes – a 5% calcium sodium phosphosilicate toothpaste and an 8% arginine/calcium carbonate toothpaste – for the longer-term relief of dentine hypersensitivity | journal = Journal of Dentistry | volume = 60 | pages = 36–43 | date = May 2017 | pmid = 28219674 | doi = 10.1016/j.jdent.2017.02.009 | doi-access = free }}</ref>

Sodium polyphosphate is added to minimize the formation of tartar.{{citation needed|date=February 2018}}

Chlorohexidine mouthwash has been popular for its positive effect on controlling plaque and gingivitis,<ref>{{cite journal | vauthors = James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, Whelton H, Riley P | display-authors = 6 | title = Chlorhexidine mouthrinse as an adjunctive treatment for gingival health | journal = The Cochrane Database of Systematic Reviews | volume = 3 | pages = CD008676 | date = March 2017 | issue = 12 | pmid = 28362061 | pmc = 6464488 | doi = 10.1002/14651858.CD008676.pub2 }}</ref> however, a systemic review studied the effects of Chlorhexidine toothpastes and found insufficient evidence to support its use, tooth surface discoloration was observed as a side effect upon using it, which is considered a negative side effect that can affect patients' compliance.<ref>{{cite journal | vauthors = Slot DE, Berchier CE, Addy M, Van der Velden U, Van der Weijden GA | title = The efficacy of chlorhexidine dentifrice or gel on plaque, clinical parameters of gingival inflammation and tooth discoloration: a systematic review | journal = International Journal of Dental Hygiene | volume = 12 | issue = 1 | pages = 25–35 | date = February 2014 | pmid = 24034716 | doi = 10.1111/idh.12050 }}</ref>

[[Sodium hydroxide]], also known as lye or caustic soda, is listed as an inactive ingredient in some toothpaste, for example Colgate Total.

=== Xylitol ===
A systematic review reported two out of ten studies by the same authors on the same population showed toothpastes with xylitol as an ingredient were more effective at preventing dental caries in permanent teeth of children than toothpastes containing fluoride alone. Furthermore, xylitol has not been found to cause any harmful effects. However, further investigation into the efficacy of toothpastes containing xylitol is required as the currently available studies are of low quality and high risk of bias.<ref>{{cite journal | vauthors = Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV | title = Xylitol-containing products for preventing dental caries in children and adults | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD010743 | date = March 2015 | volume = 2015 | pmid = 25809586 | doi = 10.1002/14651858.CD010743.pub2 | pmc = 9345289 }}</ref>