Editing Toothpaste (section)

===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.