Toothpastes compositions and review

The market offers a wide range of dental products including many different toothpastes, but which of them is the best according to patient’s needs ?

In this short lecture we will explore some of the most common toothpastes and we will differentiate them according to characteristics, compositions and indications.

The majority of toothpastes combine fluoride components to control and prevent caries appearance with other ingredients to control plaque, tartar and gum disease.

Toothpastes generally have the following basic composition: (1)

• Water (20-40%)
• Abrasives (50%): such as aluminum hydroxide, calcium hydrogen phosphates, calcium carbonate, silica and hydroxyapatite
• Fluoride: mainly in the form of sodium fluoride. Stannous fluoride and sodium monofluorophosphate have also been used
• Detergents: mainly sodium lauryl sulfate (SLS) with concentration ranges of 0.5–2%
• Antibacterial agents: such as triclosan or zinc chloride
• Flavourants including spearmint, peppermint, and wintergreen
• Remineralizers: in some toothpastes containing hydroxyapatite nanoparticles and calcium phosphate
• Humectants: including glycerol, xylitol, sorbitol, polyethylene glycol, and propylene glycol
• Antisensitivity agents: in sensitive toothpastes containing strontium chloride and potassium nitrate or arginine
• Anticalculus agents: such as sodium polyphosphate or zinc citrate.

Toothpaste composition usually varies depending on brand, manufacturer and special indications.
Those indication can be generally resumed into:

1. caries control
2. enamel remineralization
3. gum protection
4. periodontal control
5. dental sensitivity control
6. teeth whitening

Toothpastes are also commercialized for specific population depending on age.
Toothpastes indicated for children usually have a decreased fluoride component, varying from 500ppm to 1000ppm. Normal toothpastes usually present 1250ppm of fluoride component and they can be used for the general population, including children, when the amount of paste is adjusted according to age to avoid overexposure.

Fluoride component

According to the datas reviewed by J.W. Nicholson et al.:

“Fluoride is added to toothpaste, typically at levels equivalent to 1000 ppm in fluoride, usually as an inorganic compound, typically sodium fluoride, sodium monofluorophosphate or stannous fluoride. However, organic aminofluorides can also be used and are effective. For many years, it was assumed that all of these fluoride compounds were more or less equivalent in their effectiveness, but there are reports that suggest differences between them. For example, a meta‐analysis has demonstrated that toothpastes containing NaF are more effective in protecting against caries than toothpastes containing monofluorophosphate by an amount that is small but statistically significant [153]. Also, an experimental (in vitro) study has suggested that stannous fluoride is more effective in protecting against demineralisation of enamel than sodium fluoride”. (2)

Fluoride components have also been proved to have an important effect in enamel remineralization. In fact according to the words of J.W. Nicholson et al.:

“When fluoridated toothpastes are used, one of the effects is that fluoride levels increase, and such an effect is detectable after a single use. This fluoride is taken up both by the dental plaque and by the demineralized enamel as a result of increases in fluoride levels in saliva between 100 and 1000 times the initial level. Although this initial elevation in concentration lasts for only 1–2 h, regular use of fluoridated toothpaste can raise the general level of fluoride in the saliva”. (2)

Commercial toothpastes and specific composition

Here we propose a review of the ingredients composition of some between the most common commercially available toothpastes as you can compare them and choose the one is more adapt for your patient’s needs.

References:

(1) Biocompatibility of oral care products, K. Moharamzadeh, 2017
(2) Fluoride in Dentistry and Dental Restoratives, John W. Nicholson, Beata Czarnecka, in Fluorine and Health, 2008