Many oral health products, such as toothpaste and mouthwash, contain harmful ingredients.

The mouth and gums are particularly susceptible to absorbing and transporting substances quickly into the bloodstream. In addition, some of the ingredients in oral health products can act locally to disrupt the natural balance of “good” and “bad” bacteria in our mouth, which can impact oral health.

Which Products or Ingredients Should I Avoid?
Triclosan: Is an antibacterial and antifungal agent. It is considered an endocrine (hormone) disrupting chemical and can contribute to making bacteria resistant to antibiotics. In 2017, the Food and Drug Administration (USA)  issued a final rule banning triclosan in over-the-counter soaps and hand sanitizers. Most companies that make toothpaste and oral care products have removed triclosan from their products.

Sodium lauryl (laureth) sulfate (SLS, SLES): Is used as a surfactant or foaming agent in toothpaste. It can cause chronic oral lesions (canker sores) and cracking at the corners of the mouth. It is often very irritating to oral tissues, triggers inflammation, and may also promote hypersensitivity to some metals.

Artificial sweeteners: Chemical sugar substitutes are often added to improve flavour in toothpaste. Common sweetening ingredients in oral care products are saccharin and aspartame. These sweeteners can alter the functioning of the “good” bacteria in our digestive tract, which can negatively affect health.

Propylene glycol: Propylene glycol, polyethylene, and similar plastic chemicals are added to many toothpastes and oral care products. In 2015, the Microbead-Free Waters Act (USA) was signed into law, which no longer allows plastic particles called “microbeads” in body care products. However, some oral care products still contain propylene glycol and other synthetic plastic compounds. These additives may disrupt hormonal balance, may cross the blood-brain barrier, and irritate gums and other tissues.

Titanium dioxide: Titanium dioxide’s sole function is to make toothpaste look white. This ingredient is particularly worrisome if in nanoparticle form (making it more easily absorbed) and may be carcinogenic, neurotoxic, and genotoxic.

Alcohol-based mouthwashes: Alcohol-based mouthwashes disrupt the oral microbiome and dry out the oral tissues. This drying can increase the risk of oral cancers. Many alcohol-based mouthwashes also contain other toxic ingredients, including artificial dyes and parabens (endocrine disruptors).

Teflon-coated dental floss: Some dental flosses (e.g., Glide®) are slippery because they are coated with Teflon® (polytetrafluoroethylene or PTFE). Teflon has been linked to certain cancers and endocrine disruption.

Fluoride: Fluoride usage in dental products is controversial. The chemical may accumulate in tissues, leading to displacement of iodine, an essential nutrient. Too much fluoride can be particularly harmful to children and their developing teeth; they tend to swallow a lot of the toothpaste they use, which can lead to fluorosis (showing up as mottling of teeth). Fluoride-containing products should be used discriminately. Fluoride should only be used topically and rinsed out afterwards; it should not be ingested. Dental professionals should opt for topically applied silver diamine fluoride to minimise side effects, as this form of fluoride is the best choice to immediately arrest tooth decay.

Which Products Should I Use?

Toothpastes or tooth powders: The gentle but mechanical action of tooth brushing plays the biggest role in breaking up the bacterial biofilms that lead to tooth decay. Toothpastes or powders should not be too abrasive, as they can damage the enamel. Tooth powders made from baking soda (even
homemade with salt) can be too abrasive if individuals brush too hard or have gum recession, where the soft and vulnerable root is exposed. Numerous natural toothpastes and powders are available, and some contain antiseptic herbal ingredients as well as essential oils to break up biofilm. Some of these products can actually stain teeth and create surfaces for plaque to stick, so those particular brands should be avoided.  Tooth powders and pastes, if made from calcium carbonate (natural chalk) or clay, are typically gentle and safe for tooth enamel. Products made with amorphous calcium phosphate are also manufactured to enhance remineralization of teeth and aid in preventing decay.

Mouthwashes: Avoid mouthwashes containing alcohol and chemical additives such as artificial colouring and flavourings. Available natural products contain no alcohol, often use essential oils, and may contain additional ingredients such as safe sweeteners (e.g., xylitol, stevia) or minerals for remineralization of enamel surfaces. Numerous DIY mouthwash recipes are also available online.

Dental floss: Most waxed dental flosses are made with just wax, which helps safely and effectively clean between the teeth. Avoid floss made with Teflon Manufacturers are not required to disclose ingredients in dental floss, so you may need to contact the manufacturer about the ingredients. Generally speaking, thicker flosses are preferable, especially those labelled as “woven” or “expanding,” which expand when they get wet.

Bleaching products: Most over-the-counter bleaching products contain preservatives and other chemical additives. Those designed to minimise sensitivity contain potassium nitrate, and keeping these products in the mouth for long periods (i.e., overnight) often leads to swallowing much of the
peroxide, nitrate, preservatives, and other additives. The best choice is to have bleaching performed in the dentist’s office. If you opt for an over-the- counter product, choose one in which the bleaching tray is kept in the mouth for short periods of time (i.e., 30 minutes or less).

REFERENCES
1. Department of Health and Human Services, Food and Drug Administration. 5 things to know about triclosan. https://www.fda.gov/consumers/consumer-updates/5-things-know-about-triclosan. Updated May 16, 2019. Accessed April 3, 2020.
2. Tuncer Budanur D, Yas MC, Sepet E. Potential hazards due to food additives in oral hygiene products. J Istanb Univ Fac Dent.2016;50(2):61-69. doi:10.17096/jiufd.72103.
3. Alli BY, Erinoso OA, Olawuyi AB. Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a systematic review. J OralPathol Med. 2019;48(5):358–364. doi:10.1111/jop.12845.
4. Department of Health and Human Services, Food and Drug Administration. The Microbead-Free Waters Act: FAQs. https://www.fda.gov/cosmetics/cosmetics-laws-regulations/microbead-free-waters-act-faqs. Updated November 2017. Accessed April6, 2020.
5. Department of Health and Human Services, Food and Drug Administration. Safety and effectiveness of health careantiseptics; topical antimicrobial drug products for over-the-counter human use. https://www.federalregister.gov/documents/2017/12/20/2017-27317/safety-and-effectiveness-of-health-care-antiseptics-topical-antimicrobial-drug-products-for.Accessed April 6, 2020.
6. Suez J, Korem T, Zilberman-Schapira G, Segal E, Elinav E. Non-caloric artificial sweeteners and the microbiome: findings andchallenges. Gut Microbes. 2015;6(2):149–155. doi:10.1080/19490976.2015.10177006.