Toothpaste: ingredients you need to know

It's been a while since an experiment was launched for the TV series Pfahlbauer von Pfyn : For this programme, broadcast on Swiss television in 2007, a few people lived like they were in the Stone Age for four weeks. Brushing their teeth was not part of the programme. After the experiment, the participants also underwent dental check-ups. The results? The dental plaque of the men and women had certainly increased, yet the health of their gums had clearly improved.

So can we do without brushing our teeth? It's not that simple.

Replacing toothpaste: stone age diet keeps mouth healthy

Dentists Johan Wölber and Christian Tennert have studied this finding scientifically. In their study, they were able to demonstrate that a diet low in carbohydrates, but rich in omega-3s, vitamins C and D and fibre, has a positive effect on oral health. In the study, the diet helped to reduce gum inflammation and periodontitis by almost 50 per cent.

With regard to the question of what maintains teeth healthy, one scientific fact is clearly established: "Only regular dental and oral hygiene, sufficient availability of fluoride and a tooth-healthy diet can prevent the appearance of cariogenic plaque", write the authors in the specialist article Von Generalisten und Spezialisten : Die Rolle der Bakterien in der erweiterten ökologischen Plaquehypothese.

Toothpaste: which ingredients are good and which are harmful?

When you have to brush your teeth, toothpaste is essential. How do you find a good toothpaste? And what do traditional toothpastes contain? Taking a look at the composition is a good idea: in general, the packaging of cosmetic products for dental care indicates the names according to INCI, i.e. the nomenclature of cosmetic ingredients or "International Nomenclature of Cosmetic Ingredients". You should especially keep an eye on these ingredients:

Cleansing and polishing agents: watch out for the RDA value and titanium oxide

Microparticles are generally based on silica and calcium-containing compounds. They ensure the removal of dental plaque and biofilm, i.e. harmful bacteria, their metabolic products as well as food residues. These particles therefore have an abrasive effect. However, care must be taken not to damage the enamel that protects the teeth. And this can indeed be a problem. The hardness of enamel varies from person to person, just as it does from tooth to tooth.

In the case of whitening toothpastes, for example, the cleaning body is rather hard, because the special paste is supposed to remove the external discolourations that have deposited in the dental film. The exogenous pellicle, a layer that forms on the surface of the enamel, is a very thin layer of organic matter comprising proteins, lipids and other organic components of saliva.

If you suffer from bare dental necks, you should avoid whitening toothpastes and their harder cleaning agents. Similarly, if you put a lot of pressure on your teeth when brushing, it's best to use a toothpaste that's not very abrasive so as not to further erode the enamel. What's more, using an electric toothbrush already exerts more pressure. So it's best to use a low-abrasion toothpaste.

But how do you recognise such a toothpaste? The RDA value (relative dentin abrasivity) recommended in dentistry is between 30 and 80. If you use an electric toothbrush, dentists consider an RDA value of 30 to 50 to be sufficient. Please note that tooth whitening creams have an RDA value of between 100 and 150 and are not recommended for daily use. Such creams should only be used occasionally. In Europe, toothpastes with an RDA of up to 250 are even permitted. However, people who want to preserve their tooth enamel for the long term should not touch them.

If your toothpaste tube doesn't have an RDA number on it, just do an internet search or ask the manufacturer directly; or check this list updated in 2021 to see if your toothpaste is on it.

The following synthetic cleaning agents (link in German) and their INCI designations may be found in toothpaste:

• sodium bicarbonate;
• dicalcium phosphate dihydrate ;
• calcium carbonate; <Calcium pyrophosphate;<hydroxyapatite;<hydrated silica;<perlite;<alumina.

The abrasives include aluminium oxide (INCI: alumina) and titanium dioxide (INCI: titanium dioxide). Their abrasion is medium to heavy. Titanium dioxide is also classified as a potential health hazard. As a food additive, it has been banned in the EU since 2022. However, the substance may still be contained in toothpastes in the form of white pigment (CI 77891).

On your toothpaste tube, you should also look for the presence of polyethylene (PE) and polypropylene (PP). As microplastics, these nanoparticles are suspected of being able to accumulate in human tissue. The dental industry had already renounced these abrasive particles years ago, however, pastes or gels containing controversial microplastics have recently reappeared.

Fluoride: an important ingredient in your toothpaste

Called "sodium fluoride", "sodium monofluorophosphate" or "olaflur", fluoride is one of the most important components of your toothpaste. Professor Stefan Fickl, a dentist, writes in his book Auf den Zahn gefühlt (in German): "In principle, it can be said that there is only one substance that has shown an immense effect on caries over the last few decades: fluoride."The substance "strengthens tooth enamel and also acts where it has not been applied directly (i.e. between the teeth)."

And don't worry about its alleged toxicity: fluoride is a salt, not to be confused with toxic fluorinated gases. It's also hard to get intoxicated by the fluoride in toothpaste, writes Stefan Fickl: "A 70-kilogram adult would have to ingest at least 350 milligrams of fluoride in a single sitting to feel the first signs of intoxication; that's the amount present in two or three tubes of toothpaste. I think it's difficult to achieve this without vomiting first."

If you're still looking for an alternative to fluoride, the expert advises: "Toothpastes containing hydroxyapatite were able to show, in a clinical study carried out at several German university sites, that they protected as well against caries as conventional fluoride toothpastes."However, there is only one study to date, compared with nearly 300 on the effectiveness of fluor.

Detergents and foaming agents: SLS is suspected

Surfactants lather and wash, removing deposits from teeth. They also ensure that the important components of a toothpaste, such as fluoride, are distributed over the teeth when brushing. There's no objection to this in principle. However, you should do without the aggressive foaming agent sodium lauryl sulphate. It is generally declared under its INCI name "sodium lauryl sulphate" or SLS. This surfactant is considered highly irritating to the skin and is suspected of causing allergies and canker sores (painful sores inside the mouth). A good alternative surfactant is cocamidopropyl betaine (cocamidopropyl betaine, in INCI nomenclature).

Antibacterial and anti-inflammatory agents: avoid triclosan

To prevent the proliferation of undesirable bacteria in the mouth and to prevent cavities or gingivitis, substances such as triclosan, chlorhexidine (chlorhexidine digluconate, CHX), compoundss such as zinc lactate, zinc chloride or stannous pyrophosphate. Triclosan is considered a potential carcinogen and could contribute to antibiotic resistance. Initial evidence also points to an involvement of triclosan in intestinal diseases, as the Ärzteblatt writes.

The German Federal Institute for Risk Research (BfR) refers to the increasing use of triclosan in everyday products such as household cleaners, toothpastes, deodorants, soaps and textiles. Triclosan is used appropriately as a biocide in disinfectants in doctors' surgeries and hospitals. The BfR recommends limiting the use of triclosan to what is strictly necessary in the medical field. This does not include toothpaste.

If you opt for toothpaste containing other antibacterial substances and children also use the toothpaste, it should be zinc-free. In fact, maximum daily intakes of zinc are significantly lower for children than for adults.

Binders and thickeners: alternatives to PEG derivatives

These components maintain the creamy consistency of the toothpaste and are responsible for the pleasant brushing sensation when the foam is formed. Watch out for indications such as polyethylene glycol derivatives (e.g. PEG-6): these substances make the oral mucosa more permeable, allowing harmful substances to enter the body more easily. PEG derivatives are suspected carcinogens. However, there are as yet no clear clinical studies to prove this. If you nevertheless want to use alternatives, make sure that the toothpaste contains ingredients that do not pose a problem, such as xanthan gum or carrageenan.

Preservatives: parabens are not mandatory

As with food, the same applies to toothpaste: it would be preferable not to use preservatives. But when it comes to preservation, you can't always do without them. Components such as sorbic acid and benzyl alcohol are considered to pose no problem. However, caution is called for with parabens, i.e. methylparaben and propylparaben, recognisable by their INCI names sodium methylparaben and propylparaben. They can have a hormone-like effect on the body and are considered allergenic and possibly carcinogenic; undesirable and unnecessary in the case of toothpaste.