Conceptual Framework

Introduction
Toothpaste is a paste or gel dentifrice used with a toothbrush as an accessory to clean and maintain
the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it acts as an abrasive
that aids in removing the dental plaque and food from the teeth, assists in the elimination and/or
masking of halitosis, and delivers active ingredients such as fluoride or xylitol to help prevent tooth
and gum disease (gingivitis). It is important to note that most of the cleaning is done by the
mechanical use of the toothbrush, and not by the toothpaste. Most toothpastes contain trace
amounts of chemicals that may be toxic when ingested; toothpaste is not intended to be swallowed.

Early toothpastes

Toothpastes or powders did not come into general use until the 19th century. The Greeks, and
then the Romans, improved the recipes for toothpaste by adding abrasives such as crushed
bones and oyster shells.[2] In the 9th century, the Persian musician and fashion designer
Ziryab is known to have invented a type of toothpaste, which he popularized throughout
Islamic Spain.[3] The exact ingredients of this toothpaste are currently unknown,[4] but it was
reported to have been both "functional and pleasant to taste".[3] It is not known whether these
early toothpastes were used alone, were to be rubbed onto the teeth with rags, or were to be
used with early toothbrushes such as neem tree twigs or miswak.

[edit] Tooth powder

Tooth powders for use with toothbrushes came into general use in the 19th century in Britain.
Most were homemade, with chalk, pulverized brick, or salt as ingredients. An 1866 Home
Encyclopedia recommended pulverized charcoal, and cautioned that many patented tooth
powders that were commercially marketed did more harm than good.

Ingredients and flavors

[edit] Active ingredients

Fluoride in various forms is the most popular active ingredient in toothpaste to prevent
cavities. Although it occurs in small amounts in plants, animals, and some natural water
sources, and has effects on the formation of dental enamel and bones, it is not considered to
be a dietary essential and no deficiency signs are known. Sodium fluoride (NaF) is the most
common form; some brands use sodium monofluorophosphate (Na2PO3F) or olaflur. Much of
the toothpaste sold in the United States has 1000 to 1100 parts per million fluoride ion from
one of these active ingredients, in the UK the fluoride content is often higher, a NaF of 0.32%
w/w (1,450 ppm fluoride) is not uncommon. This consistency leads some to conclude that
cheap toothpaste is just as good as expensive toothpaste. When the magazine Consumer
Reports rated toothpastes in 1998, 30 of the 38 were judged excellent. Application of fluoride
also prevents moisture build-up in some surfaces.[citation needed] Other ingredients are less
commonly used, including Hydroxyapatite nanocrystals and calcium phosphate for
remineralization,[7] and strontium chloride or potassium nitrate to reduce sensitivity.

Triclosan, an antibacterial agent, is an active ingredient in some toothpastes, used to prevent

gingivitis.[8][9] Triclosan is a common toothpaste ingredient in the UK.

[edit] Other ingredients

Toothpaste is sold in many brands

In addition to fluoride, the other fundamental ingredient in most toothpastes is an abrasive.

[citation needed]
Studies have shown that abrasives in toothpaste reduce the time needed to remove
plaque from the teeth by approximately 50%. Abrasives, like the dental polishing agents used
in dentist's offices, also cause a small amount of enamel erosion which is termed "polishing"
action. Some brands contain powdered white mica which acts as a mild abrasive, and also
adds a cosmetically-pleasing glittery shimmer to the paste. Many may contain frustules of
dead diatoms as a mild abrasive. The removal of plaque and calculus prevents caries and
periodontal disease. The polishing of teeth removes stains from tooth surfaces, but has not
been shown to improve dental health over and above the effects of the removal of plaque and
calculus.

Many, though not all, toothpastes contain sodium lauryl sulfate (SLS) or another of the
sulfate family. SLS is found in other personal care products as well, such as shampoo, and is
largely a foaming agent although it also acts as a powerful antimicrobial. Due to the anionic
charge of SLS, mouthwashes containing cetylpyridinium chloride (which has a cationic
charge and thus neutralises SLS) should not be used straight after brushing. SLS may cause a
greater frequency of mouth ulcers in some people as it can dry out the protective layer of oral
tissues causing the underlying tissues to become damaged.[10]
Ingredients such as baking soda, enzymes, vitamins, herbs, calcium, calcium sodium
phosphosilicate, mouthwash, and/or hydrogen peroxide are often combined into base mixes
and marketed as being beneficial. Toothpaste is formulated as to dissolve in the alkaline pH
of human saliva. Some manufacturers add antibacterial agents, for example triclosan[8] or zinc
chloride, to prevent gingivitis. According to the American Dental Association, triclosan also
helps reduce tartar and bad breath.[8] Bases such as sodium hydroxide are also used to
neutralize acids.

Toothpaste comes in a variety of colorings, and flavors. The more usual flavorings are some
variation on mint (spearmint, peppermint, regular mint, etc.). Other more exotic flavors
include: anise, apricot, bubblegum, cinnamon, fennel, lavender, neem, ginger, vanilla, lemon,
orange, pine. More unusual are flavors include peanut butter, iced tea, and even whisky.
Unflavored toothpaste does exist, however, most are flavored and sweetened. Because sugar
promotes growth of bacteria that cause tooth decay, artificial sweeteners such as sorbitol or
saccharin are generally used instead. The inclusion of sweet-tasting but toxic diethylene
glycol in Chinese-made toothpaste led to a multi-nation and multi-brand toothpaste recall in
2007.

[edit] Critics

[edit] Toxicity

With the exception of toothpaste intended to be used on pets such as dogs and cats, and
toothpaste used by astronauts, most toothpaste is not intended to be swallowed, and doing so
may cause nausea or diarrhea; fluoride toothpaste can be either acutely toxic if swallowed in
large amounts, or chronically toxic if swallowed in any amount consistently. If a large
amount of toothpaste is swallowed at once, medical attention should be sought immediately.
[11]
Extended consumption of large volumes of fluoride toothpaste can result in fluorosis.
Though the main reason why the NHS advises supervised brushing up to 6 years is to ensure
proper brushing, keeping an eye on toothpaste consumption, and thus the risk of fluorosis.[12]
It is worthy of note that the risk of using fluoride is low enough that the use of 'full-strength'
toothpaste (1350-1500ppm fluoride) is advised for all ages (though smaller volumes are used
for young children; a 'smear' of toothpaste until 3 years).[12] There are several non-fluoride
toothpaste options available in the market for those who choose not to use fluoride. Natural
toothpaste can contain peppermint oil, myrrh, plant extract (strawberry extract), special oils
and cleansing agents. Case reports of plasma cell gingivitis have been reported with the use
of herbal toothpaste containing cinnamon.[13] Reports have suggested that triclosan, an active
ingredient in many toothpastes, can combine with chlorine in tap water to form chloroform ,
[14]
which the United States Environmental Protection Agency classifies as a probable human
carcinogen. An animal study revealed that the chemical might modify hormone regulation,
and many other lab researches proved that bacteria might be able to develop resistance to
triclosan in a way, which can help them to resist antibiotics also.[15]

Some experts believe the chemicals used in 'tartar fighting' toothpastes are toxic to the cells in
the mouth (oral mucosa). The theory is the ingredients initiate an autoimmune response
referred to as aphthous ulcers. These ulcers last 7-10 days and have no cure. According to
textbooks on oral pathology, 20% of the population are suseptible to this reactive disorder.
[citation needed]
Striped toothpaste

The red area represents the material used for stripes, and the rest is the main toothpaste material.
The two materials are not in separate compartments; they are sufficiently viscous that they will not
mix. Applying pressure to the tube causes the main material to issue out through the pipe.
Simultaneously, some of the pressure is forwarded to the stripe-material, which is then pressed onto
the main material through holes in the pipe.

Striped toothpaste was invented by a New Yorker named Leonard Lawrence Marraffino in
1955. The patent (US patent 2,789,731, issued 1957) was subsequently sold to Unilever, who
marketed the novelty under the 'Stripe' brand-name in the early 1960s. This was followed by
the introduction of the 'Signal' brand in Europe in 1965 (UK patent 813,514). Although
'Stripe' was initially very successful, it never again achieved the 8% market share that it
cornered during its second year.

Marraffino's design, which remains in use for single-color stripes, is simple. The main
material, usually white, sits at the crimp end of the toothpaste tube and makes up most of its
bulk. A thin pipe, through which that carrier material will flow, descends from the nozzle to
it. The stripe-material (this was red in 'Stripe') fills the gap between the carrier material and
the top of the tube. The two materials are not in separate compartments. The two materials
are sufficiently viscous that they will not mix. When pressure is applied to the toothpaste
tube, the main material squeezes down the thin pipe to the nozzle. Simultaneously, the
pressure applied to the main material causes pressure to be forwarded to the stripe material,
which then issues out through small holes (in the side of the pipe) onto the main carrier
material as it is passing those holes.

In 1990 Colgate-Palmolive was granted a patent (USPTO 4,969,767) for two differently-
colored stripes. In this scheme, the inner pipe has a cone-shaped plastic guard around it, and
about half way up its length. Between the guard and the nozzle-end of the tube is then a space
for the material for one color, which then issues out of holes in the pipe. On the other side of
the guard is space for second stripe-material, which has its own set of holes.

Striped toothpaste should not be confused with layered toothpaste. Layered toothpaste
requires a multi-chamber design (e.g. USPTO 5,020,694), in which two or three layers then
extrude out of the nozzle. This scheme, like that of pump dispensers (USPTO 4,461,403), is
more complicated (and thus, more expensive to manufacture) than either the Marraffino
design or the Colgate design.
[edit] Herbal toothpastes

Herbal toothpaste from Croatia

Herbal toothpastes are made from natural ingredients and some are even certified as organic.
Many consumers have started to switch over to natural toothpastes in order to avoid synthetic
and artificial flavors that are commonly found in regular toothpastes.[16] Due to the increased
demand of natural products, most of the toothpaste manufacturers now produce herbal
toothpastes. This type of toothpaste does not contain dyes or artificial flavors and this is one
of the most common reasons that people claim when switching from regular toothpaste to
herbal toothpaste[citation needed].

Some people would rather use herbal toothpaste for their oral hygiene for a variety of
reasons. Many are apparently opting for them because they are not tested on animals. Others,
keen to protect the environment or who are sensitive to the ingredients in traditional
toothpastes, are attracted to the fact that they contain no artificial colors or flavorings.[17]
People who use homeopathic medicines are also attracted to toothpastes that do not contain
mint because practitioners claim the herb may interfere with the effectiveness of their
treatment[citation needed]. Herbal toothpastes are also fluoride-free, which appears to be another
common reason why some people prefer this type of toothpaste over the regular one.

Also, people who have allergies or other health concerns may want to consider herbal or
organic tooth paste formulations, which are widely available in natural food stores and
through reputable Internet sites. These can be a good choice for people who are allergic to
mint or to sodium laurel sulfate, a foaming agent that is included in most commercial
toothpaste brands.[18]

Typical ingredients in herbal and organic toothpastes include herbs with established historical
uses, such as myrrh to help kill plaque-causing bacteria; chamomile to decrease gum
inflammation; Echinacea to stimulate the immune system; sage and rhatany to lessen
bleeding; and essential oils, such as peppermint, to add flavor and relieve pain and
inflammation. Other common ingredients in these products include ginger, clove and tea tree
oils. Some brands also include fluoride, but most do not. Occasionally, mint flavorings can
irritate the skin lining, the mouth and gums, so many homeopathic or natural toothpastes are
mint-free.[18] Different brands use however different types of plants for the herbal toothpaste
but some common ingredients are eucalyptus, myrrh, Chamomile, Sage and some other less
known plants such as Lavang, Choti ilaychi, Saunf, Neem, Babool, Khadir. Herbal
toothpastes also contain oils such as oils of coriander, ginger, lemon, and spearmint.
Eucalyptus is however one of the most common ingredients found in herbal toothpastes,
mainly due to its properties of whitening and prevents stained teeth. Myrrh is used to prevent
gingivitis and bad breath and Chamomile and Sage are said to be helpful in soothing mouth
ulcers, toothaches and inflamed gums.[19]

Although many natural health practitioners are recommending herbal toothpastes, many of
the health claims made for them have not been clinically proven. Only one range of herbal
toothpastes has had its health claims approved by the BDHF - Kingfisher. However, health
practitioners state that the lack of clinical trials should not necessarily put people off using
herbal toothpastes as they are very expensive and most of the manufacturers do not have the
financial means to carry them out.[citation needed] Dentists disagree that the regular toothpastes
would pose a threat for one's health, as the chemicals found in these toothpastes are found in
too small amounts to cause a health problem. Dentists recommend that people who are
regularly using organic or herbal toothpaste are aware that the abrasives in some are not
strong enough to clean one's teeth properly and they are advised to check with their dentist to
make sure the toothpaste is doing its job. It is widely believed that brushing twice a day is
sufficient to manage plaque - regardless of the type of toothpaste used.

People can also make their own herbal toothpaste with the help of the recipes that may be
found all over the Internet. However, no one proved their efficiency nor their safety of use.
Common ingredients of the home-made natural toothpaste are kaolin powder, baking soda,
myrrh powder, raspberry leaf and herbs, spearmint, yellow dock and sage and essential oils.
Anyhow, when using a toothpaste that has not been proven to be efficient in preventing
periodontal diseases it is important to have regular checkups made with a dentist. These
ingredients are however safe for one's health, but the efficiency of the toothpaste must be
confirmed by a specialist in order to prevent different problems concerning the oral hygiene.

[edit] Alteration of taste perception

After using toothpaste, orange juice and other juices do not taste pleasant. This is due to the
chemical interaction between stannous fluoride, a tin compound, in toothpaste and the acetic
acid in the juices.[20] Sodium lauryl sulfate alters taste perception. It can break down
phospholipids that inhibit taste receptors for bitterness, giving food a bitter taste. It is also
thought to inhibit sweet receptors. In contrast, apples are known to taste more pleasant after
using toothpaste.[21] Distinguishing between the hypotheses that the bitter taste of orange juice
results from stannous fluoride or from sodium lauryl sulfate is still an unresolved issue and it
is thought that the menthol added for flavor may also take part in the alteration of taste
perception when binding to lingual cold receptors.