The Truth about Toxins in Toothpaste

Barbara Tritz
· April 10, 2023 ·

13 minutes

Growing up in the 1960s, we were a loyal Crest toothpaste family. The thought of using any other toothpaste was out of the question. Switching to Colgate was blasphemy. We believed we needed to use commercial toothpaste with fluoride or our teeth would rot from cavities. Giving up “commercial” toothpaste is hard. Nowadays, I have at minimum six different toothpaste tubes in my drawer (none contain fluoride and I will explain why shortly).

Toothpaste is in every bathroom and used at least once but better yet twice daily. Do you even know what ingredients are in there and their purpose? How safe are these ingredients? And, really, how effective is it in doing the job of keeping your mouth healthy? Today’s post will take a deep dive into this sacred and much beloved household product that we believed (at least in my house growing up) had to be sanctioned by the ADA and was the very best product to keep our teeth healthy.

The Job of Toothpaste

Toothpaste
Overloaded Toothbrush

We ask a lot of toothpaste. It has so many jobs to do: stop tooth decay, remineralize teeth, protect from bad bacteria, reduce plaque and tartar buildup, heal gums, stop tooth sensitivity, remove stains, whiten teeth, and even give us minty fresh breath. It is a tall order for one little tube of paste. Madison avenue has convinced us we need toothpaste for all these issues, when really, the thing toothpaste does best is help remove plaque from teeth.

Permeable Routes

Did you know – in our lifetime we will use about 20 gallons of toothpaste? With that in mind, we probably should know exactly what we are putting in our mouths and subsequently into our bodies. The mouth is super absorbable. The area underneath the tongue is very permeable- medicine put there is rapidly absorbed into the body. That’s called the “sublingual route”. There is also a “buccal route” in the cheek area. These “routes” are 4000 times more permeable than through the skin and almost as potent a way to get chemicals into the body as an injection. As such, my thought as I researched this article: if we would not eat toothpaste why are we even putting it in our mouth? Toothpaste should be free and safe to swallow.

History

Just a quick sidestep to history because I thought these facts interesting.

Early tooth care consisted of powders that contained powdered ox hooves, myrrh, powdered and burnt egg shells, pumice, crushed bones, or oyster shell. The first commercial toothpaste came along in the 1870s. Toothpaste in a tube came to be in 1880 because Dr. Washington Sheffield of New London CT. got the idea from his son to put toothpaste into a collapsible tube after seeing Parisian artists using paint from tubes. Early toothpaste tubes were made of tin and lead.

Further fun fact- old toothpaste tubes were recycled to make lead bullets during WWII.

However, neither toothpaste in a tube nor tooth powder caught on rapidly. By the beginning of the 20th century only 7% of households used toothpaste whether in tubes or jars, and tooth decay was a national epidemic. Mr. Claude Hopkins, an advertising genius was asked to come up with an advertising campaign for this new product called “Pepsodent” that was minty, foamy and tasted good. Within ten years he convinced 65% of American households they needed this product.

An early toothpaste jiggle that is sure to be stuck in your head:

“You’ll wonder where the yellow went when you brush your teeth with Pepsodent.”

As part of that advertising campaign, they included a phrase about seeing your dentist twice a year. There is literally no science to back that up yet the twice-yearly dental hygiene visits still stand to this day. Pepsodent’s commercials did inspire people to embrace daily toothbrushing and helped create an entire preventive dental movement.

Toothpaste Labels

Toothpaste ingredients are divided into active and inactive ingredients.

“Active ingredients” are those that actually are medicinal with a proven health benefit to treat or prevent disease. Fluoride, potassium nitrate, hydroxyapatite, calcium and phosphate, or arginine fall into this category.

“Inactive ingredients” are all the rest. According to the FDA: a “substance as having no effect on a drug’s absorption or metabolism, which is added for manufacturer expediency.” These inactive ingredients hold the toothpaste together and make it taste better.

Crest toothpaste ingredients

Toothpaste is marketed as a cosmetic if it contains no active ingredients. Then it is assumed its job is to act as a polishing agent to help remove plaque from the mouth and give you that minty breath.

We were taught to look for the America Dental Association (ADA) Seal of Acceptance. It is given based on “rigorous independent expert testing” to show the product is safe, and effective in preventing decay or relieving sensitivity or other oral problems. Fluoride is the only anticavity product the ADA will accept. The seal has been around for 90 years, and Americans have come to trust the products the ADA recommends.

Deeper Dive into the Ingredients

Ingredients are broken down into the job they have to do within the toothpaste:

Water or Aqua is about 20 to 40% of the toothpaste product.

Abrasives: Mica, calcium carbonate, calcium pyrophosphate, dicalcium phosphate, sodium bicarbonate, and hydrated silica.

The ADA measures abrasivity using the Relative Dentin Abrasivity (RDA) scale, which compares the abrasivity of toothpaste to a standard reference value of 100. To be considered safe and effective, the RDA of a toothpaste must be at or below 2.5x the reference, or 250 RDA. (Personally, I prefer to use a toothpaste with an RDA below 80. If you have a question about the RDA value of your toothpaste, I encourage you to call the company and ask them.)

Anti cavity agent: Fluoride in the form of sodium fluoride, stannous fluoride or sodium monofluorophosphate.

Detergents make up approximately .55 to 2% of product: sodium lauryl sulfate (SLS), sodium lauroyl sarcosinate, ammonium lauryl sulfate, sodium laureth sulfate and diethanolamine (DEA) .

Flavorants: Mint of all kinds such as spearmint, peppermint, and wintergreen, and sweeteners – sorbitol, saccharine, aspartame and xylitol.

Remineralizers: Arginine, calcium phosphate, Nano hydroxyapatite, tricalcium phosphate, amorphous calcium phosphate.

Humectants keep the water in the toothpaste and maintain its smooth consistency: glycerin, glycerol, polyethylene glycol (PEG 8/PEG12/PEG32), propylene glycol, poloxamer 407.

Anti-sensitivity agents: Strontium chloride, potassium nitrate, arginine.

Anti-Tartar/Anti-Plaque: Zinc citrate, activated edathamil, pyrophosphates, tetra sodium pyrophosphate and disodium pyrophosphate. 

Anti-bacterial agents: Chlorine dioxide, chlorhexadine, cetylpyridinium chloride, essential oils, zinc citrate.

Buffering agents keep the pH stable: Phosphoric acid, sodium citrate, sodium hydroxide, disodium phosphate, aluminum hydroxide, trisodium phosphate, and pyrophosphates (also used to prevent calculus formation).

Binding agents thicken and bind the toothpaste together giving the paste a smooth consistency: Carageenan,carbomber, xanthum gum, titanium dioxide, hydroxymethylcellulose.

Coloring agents or dyes: Blue 1, Green 3, Blue1Lake, Red 3, Yellow 6.

Whitening agents in toothpaste do not actually change the tooth color but rather work at removing stains: Titanium dioxide, sodium tripolyphosphate, covarine, peroxide.

Preservatives so microbes won’t grow and you don’t have to keep the toothpaste in the fridge: Sodium benzoate, parabens, alcohol, denatured alcohol, butylated hydroxytoluene (BHT).

WOW! Even I had never looked that deeply into all the possible ingredients in toothpaste. Have you ever really read the back of the toothpaste box to see what is in your toothpaste? Not all of them are toxic but it is worth reviewing what is put into toothpaste.

Toxins Within Toothpaste

All that to get us here to the ingredients I see as questionable and potential toxins. For more information, check out the Environmental Working Group (EWG) and please always do your research.

Active Ingredient

#1. Fluoride:

Most over the counter toothpastes contain fluoride. For a much more indepth review of why I have major concerns with fluoride please read my article: “Fluoride the Destroyer.”

Some health issues I did not cover in that article: research that connects reduction in the male hormone testosterone with fluoridation and reduces the sperm count resulting in male infertility. Women faired no better. Sodium fluoride damaged their ovarian and uterine structures. Reproductive hormones were lower and fertility was also reduced.

The warning label on the toothpaste box should be enough to catch your eye.

The WARNING
Doesn’t it make you concerned?

Children under age six should never have fluoride toothpaste because they do not have the reflexes to properly spit out the paste after brushing. Children over six should only have a rice-grain sized dab of fluoride toothpaste. How many of you knew that?

The toothpaste box warns you to call the posion control center if they ingest more than that. The amount of fluoride in one pea-sized glob of toothpaste is approximately 1/4 milligram. That is the same amount of fluoride in one glass of water yet water does not come with a warning label. There are still people making baby formula from fluoridated tap water. I hope this stops to make you think.

Even if fluoride stopped tooth decay 100% it is still a hard no-go for me because of the damage it does to the heart, brain, and joints. In our biological dental world, we have so many more and better tools and education, and we no longer have any need for fluoride.

Inactive Ingredients

Detergent

#2. Sodium Lauryl Sulfate:

If you have ever brushed your teeth and then had a drink of orange juice – you will have tasted the effects of SLS. It breaks down the phospholipids that inhibit taste receptors for sweetness, and gives your juice its bitter taste. You’ll only make that mistake once.

It’s the “I just brushed my teeth and drank something” face.

SLS is used as a detergent. Its foaming action helps spread the toothpaste to all the nooks and crannies. The problem with SLS (besides what it does to taste buds) is how it irritates the skin. It ruptures the bonds that hold our cells together. While the research shows it does not “cause” canker sores, it does prolong them when they do erupt.

The thing I see most often that I can tie directly to SLS is “tissue sloughing” in the mouth. This is probably related to the skin irritation I mention above. The cheek and gum tissues (we call this the oral mucosa) peels just like an onion skin does. I can literally wipe off this layer of tissue with the back of my mirror. That is tissue damage. Do you really want to use a product that is doing the direct opposite of what you want?

(Long ago I tried a new toothpolish sample I received and I experienced that kind of tissue sloughing myself. This new toothgel caused my entire mouth to peel. I had literal strings of tissue. While it did not hurt, I knew it was not right and did stop using it right away.)

The EWG says SLS is a low toxic hazard. I still do not recommend this product if only because of what I see it does to the oral tissues. If you do prefer a foaming toothpaste, rinse very well after use.

In addition to its impact on the oral mucosa, SLS is a possible environmental toxin. We certainly have lots of products that foam and get washed into our waterways, causing problems for our marine life. Do we need it in toothpaste? No, not really. It is a marketing trick. It does not matter if toothpaste foams. That does not make it work any better.

SLS Just Doing its Thing

I recommend you consider toothpaste without SLS, especially if you get frequent canker sores.

My big take-away and huge concern – does the tissue sloughing that occurs in some people make it possible for the other ingredients to be even more quickly absorbed into the body?

#3. Diethanolamine (DEA)

Another foaming agent used in toothpaste is Diethanolamine (DEA). It does help prevent tartar build up and reduces plaque but it has some very major downsides.

The EWG has labeled it a 10 on their scale. (10 being worst)

Score legend
DEA scored a 10

DEA goes by many names so beware, it could be lurking in your toothpaste. It is banned in Canada.

It is a known hormone disruptor, skin irritant, human respiratory toxin and carcinogen. When Ethanolamines are used in the same product as certain preservatives that break down into nitrogen, they can form nitrosamines. Nitrosamines are a class of more than a dozen different chemicals, which the International Agency for Research on Cancer lists individually as possible and known carcinogens. It is this conversion of diethanolamine into N-nitrosamines that may be carcinogenic that is the main concern with DEA.

Yet the FDA says you have no need to be alarmed. When I looked this ingredient up on the ADA website this is what I found:

Ironic that they say they are “your source for lifelong learning” yet have zero information on DEA…

Be very aware of DEA and all its many names. Read labels.

Binder

#4. Carrageenan

Carrageenan is considered natural because it comes from red seaweed.

Red Seaweed

The controversy surrounding carrageenan is due to how it is processed. If it is proccessed with alkaline substances, it is safe to use. If it is processed with acid it creates a substance called “degraded carrageenan” and becomes what they call poligeenan which is not approved as a food additive. Poligeenan is an inflammatory agent. It is recognized as a possible human carcinogen, and is connected with gut tumors and ulcers. The concern is that non-degraded carrageenan may mix with stomach acid and become the degraded carrageenan. More research is needed to ensure the safety of this ingredient.

If you have intestinal distress which improves by avoiding carrageenan products (it is a common additive in many foods and drinks) it might be best to avoid this in your toothpaste as well.

#5. Titanium Dioxide- a second binding agent as well as a “whitening agent” of concern is this ingredient. Titanium dioxide (TiO2) is added to toothpaste to make it white and creamy.

White Toothpaste Contains TiO2

The concern is the size of the particle of TiO2. Nanoparticles range in size from one to 100 nanometer in diameter.

When it becomes a nanoparticle, it can cause oxidative stress resulting in:

  “cell damage, genotoxicity, inflammation, immune response etc. The extent and type of damage strongly depends on physical and chemical characteristics of TiO2 nanoparticles, which govern their bioavailability and reactivity. Based on the experimental evidence from animal inhalation studies TiO2 nanoparticles are classified as “possible carcinogenic to humans” by the International Agency for Research on Cancer and as occupational carcinogen by the National Institute for Occupational Safety and Health.”

While TiO2 is mostly used on the skin in cosmetics and sunscreen, my concern is the tiny particle size and absorption into the body via the sloughed or inflamed tissues in the mouth.

The EWG labels it a “possible” carcinogen.

Enough information to at least stop and make you look at labels.

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FYI- whitening toothpastes do not change the color of your teeth. They are just more abrasive with the goal of removing stain and plaque from the teeth, and in the case of TiO2, act as a paint and make your teeth appear whiter. If you want whiter teeth ask your dental professional for help. You have to get bleaching agents into the enamel and physically change the structure of the enamel to reflect light differently. That’s the best way to whiten teeth.

Preservatives

#6. Parabens

Parabens are preservatives. They extend the shelflife of your toothpaste. Parabens are a known endocrine disruptor.

Current research shows that it can adversely affect reproductive and endocrine systems in women. The women in this study with the highest urinary output of parabens were those that brushed their teeth twice a day.

Parabens along with other chemicals in our cosmetics build up in our bodies and contribute to autoimmune disorders. When parabens are combined with BPA (Bisphenol-A) and PFAS (per and poly-fluoroalkyl) substances they worked together to change breast cell biology, increasing the risk of breast cancer.

(I just learned about PFAS from a patient. She informed me my favorite floss also contains this toxic chemical. SO, now I am back on the hunt for new, non-toxic floss.)

#7. Butylated hydroxytoluene (BHT)

Another preservative to be wary of is BHT. We need preservatives so we do not need to store our toothpaste in the fridge and so microbes don’t grow in it. The FDA says it is safe but not enough is known about its long range effects and its safety on skin (especially broken skin). It functions as an antioxidant. BHT is used medicinally to treat viral infections such as genital herpes and cold sores. It damages the outer layer of these viral cells.

EWG gave it a 5 on its scale. Previous studies show a connection to cancer in rats, mice and chickens but current research shows it to be safe and not a endocrine disruptor. The European Commison considers BHT safe for inclusion in toothpastes at a maximum concentration of .1%.

My concerns: Does it kill the good viruses too? How much is absorbed through the oral mucosa when the tissue is irritated by SLS?

This one is worth monitoring closely.

Humectant

#8. Polyethylene Glycol (PEG-8 and PEG-12)

Humectants keep products creamy smooth. They lock the moisture in and make it foamy.

Allergy to products containing PEG-8, PEG -12, PEG-1450, and pyrophosphates can cause anaphylaxis.

The EWG rated it a 3 on their scale due to its allergy potential.

Another problem of concern with use of PEG, is that while being manufactured, 1,4 dioxanemay be released as a byproduct. The FDA states it is a potential human carcinogen. The EPA did an indepth anaylsis of 1,4 dioxane found no concerns at this time.

Coloring Agents

#9. Artificial Dyes

Toothpaste is filled with dyes to make it more visually appealing, especially for children. Who doesn’t like a sparkly blue toothpaste?

Red 3, Blue 1, Green 3, and Blue 1 Lake are the dyes used in toothpaste. (FDA-approved list) The FDA maintains the current dyes are safe.

Colorful Dyes that Hurt

Dyes are made from coal tar, and are petroleum based.

The concern with coloring agents is the link to hyperactivity, anxiety, and possibly migraines in children who are sensitive to the dyes. (Genetics play a role when combined with dyes.) Other health connections to be aware of: allergic reactions, skin irritations, nervous system toxicity, and even cancer.

Natural toothpastes contain no artifical dyes. We don’t need the dyes. While they may entice children to brush, they do nothing to improve the flavor. Start your child out with a fancy colored toothbrush and a rice-grain sized smear of toothpaste. They will never miss the colors.

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Oral Health Awareness

We may ask too much of toothpaste. Manufacturers have done their best to address these “wants” from consumers. They have added numerous ingredients in order to make the very best, all powerful and encompassing toothpaste.

So often people ask me what is the “best” toothpaste? I can only say “it depends”. What do you want it to accomplish? Prevent tooth decay? Desensitizer? Plaque reducer? Remineralizer? Cure bad breath?

The real eye-opener and takeaway from today’s article is read labels. Do your own research and know exactly what you are putting into your body, especially because these chemicals are absorbed through the oral tissues.

If you would not eat it, would you really want it in your mouth?

Too much toothpaste, Too much dye.

There is no one perfect paste. Each toothpaste has its pluses and minuses. While most of the ingredients are safe and non-toxic, some are quite questionable. The real job of toothpaste is to aid the operator (that’s you) in removing plaque and food debris from the oral cavity as easily and quickly as possible. It depends on how effective and thorough the operator is in using the tools- IE toothbrush, oral irrigation, interproximal tools (floss, picks and interproximal brushes) along with toothpaste to do the job properly. (FYI you cannot rush this, just sayin’) Please do add in the care and expert instructions of your fabulous dental hygiene professional. Prevention is our specialty.

Learning how to effectively use these tools on a twice daily basis will go a long way to achieving oral health and systemic wellness. There are really no shortcuts. Toothpaste is only part of the answer.

Be well my friends,

Sincerely,

Barbara Tritz BRDH

Queen Of Dental Hygiene

Hello, I'm Barbara Tritz

Unveiling the Stories Behind Dental Hygiene

Loving science, especially biology, from an early age, Barbara is a registered dental hygienist, certified biological hygienist, and orofacial myofunctional therapist. In 2019, she received the Hu-Friedy/ADHA Master Clinician Award from the American Dental Hygienist Association.

Share your thoughts below!

3 Comments

  1. Caroline

    I notice that there seems to divided opinions about HA TP. Some dentists/hygienists are pro HA TP, while others say no it’s potentially dangerous or it’s not approved by the dental association for use. For the lay person it’s confusing. I guess their training, experience and vested interests need to be factored.

    Reply
  2. Caroline

    Hello Barbara. This is a duplicate of a previous comment that I recently posted on your blog about Hydroxyapatite toothpaste – apologies as I can’t find my other comment. There is an ex dentist with a public profile who is stating that HA TP is not safe to use and it’s not approved by the dental association. Maybe I won’t name them but they are keen on Crest. Dr Burhenne is a fan and it seems that you are too, so for the lay person it’s confusing. Is it ok or not to use? Is the nano form ok to use? thanks

    Reply
    • Barbara Tritz

      Hello Caroline,
      I agree with Dr Burhenne that Nano Ha is safe and very effective in addressing tooth decay and remineralization. Your tooth is made up of calcium and phosphate, NOT fluoride. Dr. Burhenne posted Jaqueline Carcaramo’s list of the research on the safety of Nano hydroxyapatite (https://askthedentist.com/hydroxyapatite-studies/) He is very thorough in his own research as well. Everything I have read supports this viewpoint. The ADA still supports using mercury as well as fluoride- both neurotoxins. Anyone who thinks mercury-silver fillings are safe to use has lost my support. We must stop putting bandaids on teeth and get to the building blocks of health. These new Nano Ha toothpastes are safe to swallow. Crest sure is not! Anything with a warning label should not be allowed in you mouth, let alone a child’s. I have several great toothpastes I use and will be posting a list of these shortly. Commercial toothpastes with all these chemicals are unnecessary and harmful. We can and must do better. Thanks for commenting and allowing me to respond. I think I need to do an entire post on Nano Ha and what it does for teeth! And I have a new product I will include that allows the tooth to rebuild enamel with the Nano Ha products! It’s an exciting time to be in dentistry.
      Happy New Year.
      Warmly,
      Barbara

      Reply

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