What are the excipients in toothpastes?



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Medicines Q&As







Q&A 357.2


What are the excipients in toothpastes?

Prepared by UK Medicines Information (UKMi) pharmacists for NHS healthcare professionals



Before using this Q&A, read the disclaimer at www.ukmi.nhs.uk/activities/medicinesQAs/default.asp

Date prepared: December 2012


Summary





  • Toothpastes contain excipients which can cause adverse reactions affecting the mouth and lips, and systemic hypersensitivity.

  • The excipients most commonly implicated are flavourings such as spearmint, peppermint, fennel, cinnamon and cassia oil, but preservatives, foaming agents, antibacterials, pyrophosphates and essential oils can also cause adverse reactions.

  • This Medicines Q&A lists the toothpastes widely available in the UK and the excipients they contain which have been associated with adverse reactions or may be undesirable.





Background
Toothpastes contain a large number of excipients including fluoride, abrasives, detergents, binding agents, humectants, preservatives, colouring agents, antiseptics and flavourings [1]. There are reports that some of these excipients cause adverse oral reactions such as cheilitis (due to allergic or irritant contact dermatitis – ACD and ICD), peri-oral eczema, stomatitis, lichenoid reactions, burning mouth syndrome, loss of taste and systemic reactions such as anaphylaxis and rhinitis [1-23]. In a retrospective study of 202 patients referred to a tertiary dermatology centre with eczematous cheilitis, 25.9% of cases were caused by toothpastes, the second most common cause after lip cosmetics [2].

The excipients most commonly implicated are flavourings (and their active compounds) – spearmint (carvone), peppermint (menthol), fennel (anethole) and cinnamon or cassia oil (cinnamic aldehyde) [1,3,4]. Others that have been reported to cause contact allergic reactions include the antibacterial, triclosan [5], foaming agents such as cocamidopropyl betaine [6] and sodium lauryl sulphate [7,8], and preservatives such as parabens [2], polyethylene glycol [9] and sodium benzoate [10]. Pyrophosphates in tartar-control toothpastes have caused ICD with ulceration, sloughing, erythema, fissuring and a burning sensation [11,12]. Tartar-control toothpastes containing pyrophosphates can be a particular problem as they contain higher concentrations of flavourings and detergents to mask the bitter taste of these compounds and increase their solubility [11,12]. Essential oils (tea tree oil and propolis) [3,24] and fragrances (limonene and linalool) [25] have also been reported to cause allergy.


For patients who experience adverse effects that are thought to be due to their toothpaste, changing to another product that does not contain the suspected excipient results in complete resolution of symptoms within a few weeks or months [3,6,11,12,15,16,18,19,26]. If ACD is suspected, patch testing can be helpful in identifying the likely allergen [27,28].

Answer
The following table is a list of toothpastes widely available in the UK and the excipients they contain which are associated with irritant or allergic reactions affecting the mouth and lips, or systemic adverse effects. It can be used to choose a suitable product that does not contain excipients suspected to be the cause of adverse reactions. The table also includes fluoride content, and sweeteners and other excipients which may be undesirable.

Key: CAPB cocamidopropyl betaine NS detail not specified

PEG polyethylene glycol PPM parts per million

PP pyrophosphate SLS sodium lauryl sulphate






Toothpaste name and manufacturer

Fluoride (ppm)

Excipients associated with adverse reactions (see Limitations)

Other excipients

Anti-bacterial

Flavouring

Foaming agent

Fragrance

Preservative/

Solvent

Pyro-phosphate

Other

Sweetener

Alcohol

Aloe Dent by Optima Consumer Health (Telephone 01274 526360)

Children’s Aloe & Green Tea (tube)

None

Tea tree

Aroma NS













Sorbitol

Xylitol








Children’s Aloe Vera (tube)

None

Tea tree

Aroma NS













Sorbitol

Xylitol








Sensitive Aloe Vera (tube)

None

Tea tree

Menthol

Peppermint















Sorbitol

Xylitol







Sensitive Aloe Vera with Fluoride (tube)

1500

Tea tree

Menthol

Peppermint















Sorbitol

Xylitol








Triple Action Aloe Vera (tube)

None

Tea tree

Menthol

Peppermint















Sorbitol

Xylitol








Triple Action Aloe Vera with Fluoride (tube)

1500

Tea tree

Menthol

Peppermint















Sorbitol

Xylitol








Whitening Aloe Vera (tube)

None

Tea tree

Menthol

Peppermint















Sorbitol

Xylitol








Whitening Aloe Vera with Fluoride (tube)

1500

Tea tree

Menthol

Peppermint















Sorbitol

Xylitol











Aquafresh by GlaxoSmithKline Consumer (Telephone 020 8047 2500)

Big Teeth 6+ years (tube)

1400




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin




Extreme Clean Pure Breath (tube)

1400




Aroma NS

SLS




PEG-6




Sorbitol

Saccharin




Extreme Clean Pure Breath Whitening (tube)

1400




Aroma NS

Citral


CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin





Extreme Clean Whitening (tube)

1400




Aroma NS

Citral


CAPB

SLS





PEG-6




Sorbitol

Saccharin




Fresh and Minty (pump/tube)

1450




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin




Iso-Active Fresh Mint Foaming gel (pump)

1450




Aroma NS

CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin





Iso-Active Triple Protection Whitening Cool Mint (pump)

1450




Aroma NS

CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




Aquafresh by GlaxoSmithKline Consumer (Telephone 020 8047 2500)

Little Teeth 4-6 years (tube)

1400




Aroma NS







Parabens

PEG-6





Xylitol

Saccharin




Mild and Minty (pump/tube)

1450




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin




Milk Teeth 0-3 years (tube)

1000




Aroma NS

SLS

Limonene







Sorbitol

Saccharin




Multi-Action+Whitening (pump/tube)

1450




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin







Arm and Hammer by Church and Dwight UK (Telephone 01303 858735)

Advance White (tube)

No details available from the manufacturer or their website

Advance White Sensitive (tube)

No details available from the manufacturer or their website

Brilliant Sparkle gel (tube)

No details available from the manufacturer or their website

Enamel Care (tube)

No details available from the manufacturer or their website

Enamel Care Sensitive (tube)

No details available from the manufacturer or their website

Max Booster (tube)

No details available from the manufacturer or their website

Original Coolmint (tube)

No details available from the manufacturer or their website




Beverly Hills Formula by Purity Laboratories (Telephone 00 353 1842 6611 - ROI)

Dentist’s Choice Gum & Whitening Expert (tube)

1000




Doublemint

SLS

Limonene







Sorbitol

Xylitol


Saccharin




Natural White (tube)

1000

Triclosan

Doublemint

SLS

Limonene

PEG-32




Sorbitol

Xylitol


Saccharin




Natural White Gentle Sensitive (tube)

1000




Doublemint

SLS

Limonene







Sorbitol

Xylitol


Saccharin




Natural Whitening Expert (tube)

None




Herbalmint

SLS




PEG-1500




Sorbitol

Xylitol


Saccharin




Perfect White (tube)

1400




Peppermint

CAPB

SLS


Limonene

PEG-32

Tetrasodium PP

Sorbitol

Saccharin




Perfect White Sensitive (tube)

1400




Peppermint

CAPB

SLS


Limonene

PEG-32

Tetrasodium PP

Sorbitol

Saccharin




Beverly Hills Formula by Purity Laboratories (Telephone 00 353 1842 6611 - ROI)

Sensitive Whitening Expert (tube)


1000




Doublemint

SLS

Limonene







Sorbitol

Xylitol


Saccharin




Total Breath Whitening (tube)

1300

Triclosan

Peppermint

SLS

Limonene

PEG-32




Sorbitol

Xylitol


Saccharin





Total Enamel Sensitive (tube)

1300




Peppermint

SLS

Limonene







Sorbitol

Xylitol


Saccharin





Total Protection Whitening (tube)

1000

Triclosan

Doublemint


SLS

Limonene

PEG-32




Sorbitol

Xylitol


Saccharin









Biosis by Biosis (Telephone 0845 004 4844)

Alba Pura Neutral toothpowder (tub)

None































Biotene by GlaxoSmithKline Consumer (Telephone 020 8047 2500)

Fluoride for People with a Dry Mouth (tube)

1000




Aroma NS

Menthol








Sodium benzoate

Calcium PP

Sorbitol

Xylitol











BioXtra by Life Stream Pharma (Telephone 07711 088164)

Moisturising (tube)

1500



Menthol

Anethole





Limonene

Linalool



Sodium benzoate




Sorbitol

Xylitol









BlanX by Acdoco (Telephone 0845 0178 000)

Active Enamel Protection (pump)

890




Aroma NS

SLS

Eugenol

Limonene



Benzylalcohol

PEG-32


Sodium benzoate




Sorbitol

Xylitol


Saccharin




Advanced Whitening (pump)

890




Anethole

Menthol


Peppermint

SLS

Eugenol

Limonene



Parabens

PEG-32






Sorbitol

Xylitol


Saccharin





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