What are the excipients in toothpastes?



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Medicines Q&As







Q&A 357.4


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: April 2015


Summary





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

  • 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 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, rhinitis and breathing difficulties [1-25]. 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].

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 [5,6], foaming agents such as cocamidopropyl betaine [7,8] and sodium lauryl sulphate [9,10], and preservatives such as parabens [2], polyethylene glycol [7,11] and sodium benzoate [12]. Pyrophosphates in tartar-control toothpastes have caused ICD with ulceration, sloughing, erythema, fissuring and a burning sensation [13,14]. 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 [13,14]. Essential oils (tea tree oil and propolis) [3,26] and fragrances (limonene and linalool) [27] 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 [3,8,13,14,17,18,20,21,28]. If ACD is suspected, patch testing can be helpful in identifying the likely allergen [29,30].

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 Health & Nutrition (Telephone 01274 526360)

Children’s Fluoride-free

None

Tea tree
















Sorbitol

Xylitol








Miswak

None

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol








Sensitive Fluoride

1500

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol








Sensitive Fluoride-free

None

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol








Triple Action Fluoride

1500

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol








Triple Action Fluoride-free

None

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol








Whitening Fluoride

1500

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol








Whitening Fluoride-free

None

Tea tree

Menthol

Peppermint






Limonene







Sorbitol

Xylitol











Aquafresh by GlaxoSmithKline (Telephone 020 8047 2500)

Active Cavity Protection Fluoride

1400




Aroma NS

Citral


CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




Active Fresh Breath Fluoride

1400




Aroma NS

Citral


CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




Active 12 Hour Protection Fluoride

1400




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin




Active Whitening Fluoride

1450




Aroma NS

CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




Complete Care Fluoride

1450




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin









Aquafresh by GlaxoSmithKline (Telephone 020 8047 2500) continued

Complete Care Extra Fresh Fluoride

1450




Aroma NS

Citral


CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




Complete Care Whitening Fluoride

1450




Aroma NS

CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




High Definition White Illuminating Mint Fluoride

1450




Aroma NS

CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




High Definition White Tingling Mint Fluoride

1450




Aroma NS

CAPB

SLS


Limonene

PEG-6




Sorbitol

Saccharin




Little Teeth 3-5 Years Fluoride

1450




Aroma NS

CAPB

Limonene







Sorbitol

Saccharin




Milk Teeth 0-2 Years Fluoride

1000




Aroma NS

CAPB










Sorbitol

Saccharin




My Big Teeth 6+ Years Fluoride

1450




Aroma NS

CAPB

Limonene







Sorbitol

Saccharin




Triple Protection Fresh & Minty Fluoride

1450




Aroma NS

SLS

Limonene

PEG-6




Sorbitol

Saccharin




Ultimate + Whitening Fluoride

1450




Aroma NS

SLS

Limonene

Linalool


PEG-6




Sorbitol

Saccharin







Arm and Hammer by Church and Dwight UK (Telephone 01303 858700)

Advance White

1450




Aroma NS

SLS







Tetra-sodium PP

Sorbitol

Saccharin




Advance White Intense Fresh

1450




Aroma NS

SLS

Limonene




Tetra-sodium PP

Sorbitol

Saccharin




Advance White Sensitive

1450




Aroma NS

SLS

Limonene







Sorbitol

Saccharin




Enamel Pro Repair Sensitive

1100




Aroma NS

SLS

Limonene

PEG/PPG-38/8 copolymer

PEG/PPG 166-66 copolymer

PEG-8








Saccharin










Arm and Hammer by Church and Dwight UK (Telephone 01303 858700) continued

Enamel Pro Repair Whitening

1100




Aroma NS

SLS

Limonene

PEG/PPG-38/8 copolymer PEG/PPG 166-66 copolymer

PEG-8








Saccharin




Max Booster

250




Aroma NS




Eugenol

Limonene



PEG/PPG-38/8 copolymer

PEG/PPG 166-66 copolymer

PEG-8








Saccharin




Original Coolmint

1100




Aroma NS

SLS

Limonene

PEG-8







Saccharin

Sucrose octaacetate






Truly Radiant

1450




Aroma NS

SLS

Limonene

PEG/PPG 166-66 copolymer

PEG-8


Polyethylene







Saccharin







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

Dentist’s Choice Gum & Whitening Expert

1000




Doublemint

SLS

Limonene







Sorbitol

Xylitol


Saccharin




Natural White

1000

Triclosan

Doublemint

SLS

Limonene

PEG-32




Sorbitol

Xylitol


Saccharin




Natural White Gentle Sensitive

1000




Doublemint

SLS

Limonene







Sorbitol

Xylitol


Saccharin




Natural Whitening Expert

None




Herbalmint

SLS




PEG-1500




Sorbitol

Xylitol


Saccharin




Perfect White

1400




Freshmint

CAPB

SLS


Limonene

PEG-32

Tetra-sodium PP

Sorbitol

Saccharin







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



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