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Let’s Talk Toothpaste

By Dr. Marisa Weiss on July 31st, 2013 Categories: Uncategorized

Like washing our hands and moisturizing our skin, brushing our teeth is an everyday habit that’s 100% routine. We do it without thinking about it at all.

Once in a while, though, we should. In the past, we’ve talked about making safe soap and moisturizer choices. Now it’s time to give toothpaste some attention, too. Any product you use every day is worth thinking about.

When’s the last time you changed your toothpaste brand? If you’ve been using the same one since grade school, you’ll be dazzled by the choices now available. Stores offer shelf after shelf of pastes and gels that are anti-tartar, anti-cavity, anti-gingivitis (gum inflammation), or all three. Many have added features like breath freshening and teeth whitening and brightening, and there are flavors galore.

While most toothpastes on the market are free of chemicals of concern and have a very low risk of exposing you to anything harmful, there are some that contain questionable ingredients. You probably don’t have to give up your favorite brand, but it’s a good idea to check the active ingredients to be sure. In particular, look for triclosan.

Triclosan in toothpaste?

Triclosan is an antibacterial chemical found in a variety of products, including many body washes. Some companies have added it to toothpastes, too, because it can help prevent gingivitis. But regular exposure to triclosan may be harmful to humans and the environment for a number of reasons:

  • Antibiotic resistance: The American and Canadian medical associations have called for companies to stop using triclosan in consumer products because of concerns that it contributes to antibiotic resistance. Antibiotic resistance happens when bacteria stop responding to a product that’s supposed to kill them, such as an antibiotic. So even though you take an antibiotic to get rid of an infection caused by bacteria, it doesn’t help.
  • Hormone disruption: Triclosan can disrupt how estrogen and other hormones act in the body by blocking them or acting like them. This may throw off the body’s hormonal balance. Because estrogen can make hormone-receptor-positive breast cancer develop and grow, many women choose to limit their exposure to chemicals that can act like estrogen.
  • Cancer risk: Sunlight can degrade triclosan into a form of dioxin, a family of toxic chemicals that may increase the risk of cancer if you’re regularly exposed to them over long periods of time. Scientists at the National Toxicology Program are doing research to figure out if exposure to triclosan is a risk for developing cancer. Still, most toothpaste tubes are opaque so the sun doesn’t penetrate them. Plus, the paste or gel is only on the brush for a few seconds before you put it in your mouth, so the likelihood of triclosan in toothpaste turning into dioxin is extremely low.

There is another concern about triclosan based on studies in cells and animals:

  • Muscle function: Test tube and animal studies using doses similar to those used by people in everyday life have shown that triclosan can affect muscle function. In animal studies, it reduced muscles’ ability to contract, reducing leg muscle strength as well as the heart’s ability to move blood.

Many toothpastes have never had triclosan as an ingredient, and it’s been voluntarily phased out of others. But not all toothpastes are triclosan-free yet.

If you’re not sure whether your toothpaste contains triclosan, it’s easy to find out: just check the active ingredients on the tube or box. (If a product contains any triclosan at all, it must be listed as an active ingredient.) If triclosan is listed, consider tossing it. Triclosan isn’t essential for preventing gingivitis. The best way to prevent gingivitis is by brushing, flossing, and seeing a dentist regularly.

What about fluoride?

Fluoride is in 95% of toothpastes; about 5% are fluoride-free.

Fluoride is a natural trace element — a compound that naturally occurs in soil and plants in very small amounts — that strengthens and remineralizes tooth enamel. It also has antibacterial activity that may help control plaque. Plaque is the film of bacteria that builds up on teeth and gums and can cause gum disease and tooth decay. The Centers for Disease Control recommend fluoride toothpaste for preventing cavities. Federal agencies and mainstream medicine generally consider fluoride safe at doses people typically get.

You may wonder if fluoride is really necessary for cavity prevention and if it’s safe. The value of fluoride in toothpaste and water is controversial. Some people are concerned that we’re exposed to too much, particularly because adding fluoride to public water supplies is common in many areas of the United States. Fluoride in water reduces cavity rates, but it exposes people to an unknown dose of fluoride. Taking fluoride supplements on top of drinking fluorinated water is usually more than you need and may even be too much. Ingesting too much fluoride can cause dental fluorosis, which alters tooth enamel and causes white spots on teeth. The condition occurs in children whose teeth are still forming and isn’t apparent until permanent teeth grow in. Adults aren’t at risk for fluorosis since their permanent teeth have already formed. While it is possible to overdose on fluoride (a potentially lethal dose is about 5 mg of fluoride per kg of body weight; you’re exposed to about 0.27 mg in fluoride toothpaste), you would have to take huge amounts of fluoride supplements or other fluoride-enhanced products — dying from fluoride poisoning is EXTREMELY rare.

Dental fluorosis — and not any other concerns — is the reason why dentists advise parents to use only a pea-sized amount of toothpaste for children and to supervise kids when they brush their teeth, according to the American Dental Association. The U.S. Food and Drug Administration requires toothpaste to carry a warning not for a specific concern but because fluoride is classified as a drug. Any product containing an ingredient considered a drug has to recommend professional help if a person ingests too much.

Still, some people worry that ingesting too much fluoride is linked to cancer risk. A possible relationship between fluoridated water and cancer risk has been debated for years, but many studies, in both humans and animals, have shown no association. Reviews done by the National Cancer Institute and other groups have concluded that there’s no strong evidence to date that links water fluoridation and cancer.

If you want to reduce your exposure to fluoride, you can use toothpaste and drink water without fluoride. You may have to drink bottled water, depending on where you live. (Check on the public water supply fluoridation in your region.)

A note about chemical exposure

The hazards of chemical exposure depend on a lot of things, including amount of exposure (dose), frequency of exposure, duration of exposure, and age when exposed. Chemicals called carcinogens usually require regular exposures over long periods of time in order to contribute to the cause of cancer. It can be a regular, low exposure over time or a large exposure for brief periods over time. Most of the data we have are from laboratory animals, not people. We also know that certain times of life are more sensitive to chemical exposures than others. For example, exposure during adolescence, when you’re building your breast tissue, is called a “window of susceptibility.” That’s when you’re laying down the foundation of your future breast health. Radiation exposure during that time, even a low dose for a short time, can be enough to lead to a higher risk of breast cancer later in life. For adult women, the breast is more resistant to insults from the outside environment after age 25, although the environment can still influence how your cells are built and run.

In this and other Think Pink, Live Green expert columns, we look at things in your life that go in, on, and around you. Whenever there’s a significant concern coming out of the lab or from human studies, we want to help you make the best choices. If something may pose a hazard, in the absence of solid research in people, we lean on the Precautionary Principle. Basically it means that it’s better to be safe than sorry. Our goal is to help you make the best choices for you and your family.

What about xylitol?

If you look at toothpaste labels, you’ll often see an ingredient called xylitol. Xylitol may be a strange word, but the ingredient has been around for decades and is considered safe. It’s a sugar alcohol made from plants and is used as a no-calorie sweetener in toothpaste.

It also might be good for your teeth. Although it’s unclear yet whether simply brushing with a xylitol-containing toothpaste reduces tooth decay, studies have found that chewing gum with xylitol does.

How to choose a toothpaste

As with so many other products, it’s always smart to check the ingredients in a toothpaste. It’s a good idea to steer clear of any containing triclosan. Luckily, the majority of toothpastes pose little to no risk, according to the Environmental Working Group (EWG) database. Several of the low hazard toothpastes should be readily available at your local grocery or drugstore.

Here are some things to keep in mind when you’re shopping for toothpaste:

  • If you’d like to know about the ingredients in your toothpaste, check the EWG Skin Deep database. There are more than 350 toothpastes listed.
  • Besides triclosan, some toothpastes also may contain other ingredients that could be hazardous to your health. Look out for parabens, in particular. Plus be aware that flavors can contain undisclosed ingredients.
  • Many whitening toothpastes are considered safe to use. However, a few contain a preservative called butylated hydroxytoluene (BHT). Avoid these toothpastes. BHT can cause headaches, dizziness, and fatigue, and there’s some debate over a link to cancer risk.
  • Keep in mind that even products described as “all-natural” or “made with organic ingredients” still may contain hazardous ingredients.
  • If you’re interested in an alternative to toothpaste, try baking soda. It’s safe and effective, and studies have confirmed that it helps remove stains and plaque. Most people have some in their pantry. It has a very strong salty taste, though, which is why many people prefer toothpaste.

It’s nice to know that there are so many good options for toothpaste. Do keep in mind, though, that it takes more than toothpaste to keep teeth clean, bright, and healthy. It’s particularly important to skip the sodas and sports drinks, which can erode tooth enamel and make them vulnerable to decay. And don’t forget to floss!

Which toothpaste do you use? Have you used the same brand since you were a child?

Dr. Marisa Weiss

Marisa Weiss, M.D. is the founder, president and guiding force behind Breastcancer.org, the world's most trafficked online resource for medically reviewed breast health and breast cancer information, reaching over 8 million visitors per year. A breast cancer oncologist with over twenty years of active practice in the Philadelphia region, Dr. Weiss is regarded as a visionary advocate for her innovative and steadfast approach to informing, empowering, and treating patients with breast cancer.

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