Editing Toothpaste (section)

====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" />