Toothpaste: Oral Health and Hygiene

• Toothpaste is a dentifrice used with a toothbrush to clean and maintain teeth aesthetics and oral health.
• Toothpaste promotes oral hygiene.
• Toothpaste includes an abrasive to help remove dental plaque and food.
• Toothpaste assists in suppressing halitosis.
• Toothpaste helps remove superficial staining
• Toothpaste delivers active ingredients (commonly fluoride).
• Toothpaste helps prevent tooth decay (dental caries) and gum disease (gingivitis).
• Salt and sodium bicarbonate (baking soda) can be substituted for commercial toothpaste, but large amounts of swallowed toothpaste can be toxic.
• Toothpastes came into general use in 19th-century Britain as tooth powders.
• Toothpaste use can be traced back to Ancient Egypt and Ancient Rome.
• Early Victorian Britain toothpowders contained salt, pulverized brick, chalk, and coal
• Toothpastes have evolved and are constantly being updated on the market.
• Health Care Professionals must stay updated on trends to advise patients on product choices.

Functions of Toothpaste

• Prevents and reduces caries by applying fluoride.
• Assists in plaque and stain removal from the dentition.
• Prevents gingival inflammation through antimicrobials.
• Achieves desensitization
• Improves appearance with whitening agents.
• Provides confidence by improving breath.
• Enhances the toothbrushing experience.

Toothpaste Constituents

• Toothpaste constituents include active and non-active ingredients.

Non-Active Constituents of Toothpaste

• Non-active constituents include emulsifiers, binding agents, detergents, foaming agents, humectants, preservatives, sweeteners, flavorings, coloring agents, polishing agents, and abrasives

Emulsifier/Binding Agents

• Emulsifier/binding agents make up 1-5% of the total volume
• These agents hold ingredients together, prevent separation of solid/liquid components, increase stability, and extend shelf life.
• Examples include carragheenates, alginates, carboxymethyl cellulose, colloidal silica, and acacia gum.

Detergents/Foaming Agents

• Detergents/foaming agents make up 1-2% of the total volume
• These provide bubbly foam, loosen debris, distribute paste, and can create dryness/issues in some people.
• Commonly used agents are Sodium Lauryl Sulphate and Sodium N-lauryl Sarcosinate.

Humectants

• Humectants makes up 10-30% of the total volume
• These keep toothpaste moist and prevent hardening upon air exposure.
• Commonly used humectants include water, glycerine, and propylene glycol.

Preservatives

• Preservatives makes up 0.05-1% of the total volume
• They prevent bacterial contamination, maintain product purity, and increase shelf life.
• Examples are alcohol, benzoates, and phenols.

Sweeteners

• Used to sweeten the paste, enhance taste/acceptability, and mask other ingredient tastes.
• Examples include sorbitol, saccharin, and xylitol.

Flavourings

• Flavourings mask the taste of other ingredients, especially sodium lauryl sulphate, making the paste palatable.
• Commonly used flavors include peppermint, spearmint, aniseed, eucalyptus, lemon, menthol, and wintergreen (methyl salicylate).

Colouring agents

• Colouring Agents make the paste more eye catching
• Different dyes are used in different products.
• Some pastes use more than one pigment
• Chlorophyll and Titanium Dioxide are used.

Polishing Agents/Abrasives

• Polishing Agents/Abrasives make up 20 to 40+%
• They have a mild abrasive action to control and remove superficial stains.
• Commonly used agents include Calcium carbonate, Dicalcium phosphate, Silica particles, Sodium chloride, Zirconium silicate, Calcium pyrophosphate and Hydrated alumina.

Active Constituents of Toothpaste

• Active ingredients provide additional benefits.
• Fluoride is the most common active ingredient, present in over 95% of toothpastes.

Types of Fluoride

• Sodium Monofluorphosphate (MFP)
• Sodium Fluoride (NaF)
• Stannous Fluoride (Sn F2)
• Fluoride helps prevent caries.
• Fluoride is added to help make the tooth surface more resistant to acid and encourage remineralization.

Fluoride Toothpaste Recommendations

• Low-level fluoride toothpastes (under 1000 ppm) are not recommended.
• Children 0-3 years should use a smear of paste over 1000 ppm.
• Children 3-6 years (pea size) should use 1350-1500 ppm.
• Over 6 years, adolescents, and adults should use 1350-1500 ppm.
• Over 10 years and high-risk individuals may be prescribed toothpaste with 2800 ppm fluoride.
• Very high-risk adults may be prescribed toothpaste with 5000 ppm.
• Brush twice a day with a fluoride toothpaste.
• Fluoride amount should be based on age, risk factors, and other fluoride sources.
• Use a "spit, don't rinse" technique.

Desensitizing Agents

• Assist with dentine sensitivity (a common problem affecting over 50% of adults).
• Examples include Strontium chloride, Potassium chloride, Potassium nitrate, Sodium citrate, Strontium acetate, and Calcium sodium phosphosilicate (Novamin).

Anti-Plaque/Antimicrobial Agents

• Added to restrict plaque biofilm creation and development with antibacterial effects.
• Triclosan prevents bacteria from producing specific enzymes for proliferation.
• Other agents used include Zinc citrate trihydrate, chlorhexidine, and sodium ricioleate.

Whitening Agents

• Whitening toothpastes have become popular, but their effect is often minimal despite claims.
• The main effect is to remove superficial stains.
• Bleaching by a registered Dental Professional is required for true whitening.
• Most whitening toothpastes rely on optical brightening effects, stain removal by proteolytic enzymes, or additional abrasive action.
• Agents include charcoal, sodium bicarbonate, silica, and carbamide peroxide.
• Abrasive action can cause sensitivity and increase abrasion of the tooth structure.

Anti-Calculus (Anti-Tartar) Agents

• These agents have little evidence to support calculus formation reduction
• Their claim is from added agents like Calcium pyrophosphates and Sodium hexametaphosphate
• They interfere with plaque mineralization, affecting calculus formation.
• These items have no effect on fixed calculus deposits which require a professional removal.