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ageenan, cellulose, and xanthan gum.
• Surfactants are detergents and cause the
dentifrice to foam. Examples include
sodium lauryl sulphate (SLS), sodium
lauroyl sarcosinate, and cocoamidopropyl
betaine. Together with the dentifrice
abrasive, they play a role in the removal
of dental plaque by loosening it from the
tooth surface, and suspending it in an
emulsion that is then removed physically
during brushing. This is the same
manner in which detergents used for
other purposes work. If a dentifrice is
high-foaming, it contains a higher level
of surfactants than a low-foaming
dentifrice.
The labelling should be checked to
see which surfactant(s) is/are included in
a dentifrice before recommending it to
patients who experience recurrent aphthous
ulcers suspected of being associated with
SLS sensitivity. 1 Some studies have found a
decreased incidence of recurrent aphthous
ulcers in patients using an SLS-free dentifrice
while others have not, and one study
found a lower level of recurrent aphthous
ulcers with a low-SLS dentifrice than with
a regular SLS or SLS-free dentifrice. 2,3
Although the association between the use
of SLS and recurrent aphthous ulcers is not
definitive, if a patient is sensitive to SLS
then either a low-SLS or SLS-free dentifrice
can be recommended. Similarly, if patients
indicate that they have intolerance or sensitivity
to benzoates or other substances, the
labelling should be checked to see whether
or not the dentifrice being selected or used
contains the ingredient in question and if so
an alternative found.
‘Sensory inactive ingredients’
‘Sensory inactive ingredients’ are added
to dentifrices to make them appeal to the
senses. Sweeteners and flavoring agents
make the taste pleasant, encouraging
dentifrice use. Noncariogenic sweeteners
used in dentifrices include sodium saccharin,
sodium cyclamate, and Acesulfame-K.
These noncariogenic sweeteners are not
January 2012
A Guide to Dentifrices
metabolized by cariogenic bacteria, thus
providing sweetening without resulting
in cariogenic acid attacks. Polyols used in
dentifrices as sweeteners include xylitol and
sorbitol. Note that packaging may state
‘contains xylitol’ and based on this wording,
which is also seen on other dental product
packaging, it is tempting to conclude that
the xylitol provides anti-caries protection.
However, unless present in a dentifrice at
an appropriate level for anti-caries efficacy,
the xylitol is present for its sweetening effect
only (or as a humectant).
Flavorings were traditionally mint variants;
they also include cinnamon, vanilla
and fruit. Coloring agents make the dentifrice
visually appealing. They are also added
as market differentiators – for example, a
colored stripe in a white dentifrice. FD&C
#1 and #5 dyes are used in dentifrices as
coloring agents; although dentifrices are not
intended for consumption, these dyes are
food additives and safe if consumed. Dentifrices
may have the appearance of clear colored
gels or opaque pastes – for an opaque
appearance, titanium dioxide is included as
one of the dentifrice ingredients. (Table 1)
Sensitivity to flavorings (especially cinnamaldehyde)
and colorings used in dentifrices
and foods is relatively common and should
be considered. 4,5 FD&C #5 (tartrazine,
a yellow dye) is another example of an
ingredient that an individual may have an
intolerance or sensitivity to, 6 and for which
the labelling should be checked if this is the
case.
Abrasives
Abrasives are present in dentifrices to
facilitate the removal of biofilm (dental
plaque) and stain. Without any abrasive,
effective removal of stain would not occur.
Patient compliance with brushing is inadequate,
7 and the ‘mouthfeel’ and cleaning
provided by a dentifrice can actually aid
compliance. This was demonstrated in 1 in
vivo study where some participants using a
dentifrice without any abrasive dropped out
of the study. 8
5