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<span id="openzim-page-title" class="mw-page-title-main"><span class="mw-page-title-main">Toothpaste</span></span>
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<p><b>Toothpaste</b> is a paste or gel <a href="Dentifrice" title="Dentifrice">dentifrice</a> that is used with a <a href="Toothbrush" title="Toothbrush">toothbrush</a> to clean and maintain the aesthetics of <a href="Human_tooth" title="Human tooth">teeth</a>. Toothpaste is used to promote <a href="Oral_hygiene" title="Oral hygiene">oral hygiene</a>: it is an abrasive that aids in removing <a href="Dental_plaque" title="Dental plaque">dental plaque</a> and food from the teeth, assists in suppressing <a href="Halitosis" class="mw-redirect" title="Halitosis">halitosis</a>, and delivers <a href="Active_ingredient" title="Active ingredient">active ingredients</a> (most commonly <a href="Fluoride" title="Fluoride">fluoride</a>) to help prevent tooth decay (<a href="Dental_caries" class="mw-redirect" title="Dental caries">dental caries</a>) and gum disease (<a href="Gingivitis" title="Gingivitis">gingivitis</a>).<sup id="cite_ref-ADA-toothpaste_1-0" class="reference"><a href="#cite_note-ADA-toothpaste-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Due to variations in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of <a href="Tooth_decay" title="Tooth decay">tooth decay</a> during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide.<sup id="cite_ref-Marthaler-2004_2-0" class="reference"><a href="#cite_note-Marthaler-2004-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid15513419_3-0" class="reference"><a href="#cite_note-pmid15513419-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Large amounts of swallowed toothpaste can be poisonous.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Common colors for toothpaste include white (sometimes with colored stripes or green tint) and blue.
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<div class="mw-heading mw-heading2"><h2 id="History">History</h2></div>
<div class="mw-heading mw-heading3"><h3 id="Early_toothpastes">Early toothpastes</h3></div>
<p>Since 5000 BCE, the <a href="Egyptians" title="Egyptians">Egyptians</a> made a tooth powder, which consisted of powdered ashes of ox hooves, myrrh, powdered and burnt eggshells, and <a href="Pumice" title="Pumice">pumice</a>. The <a href="Ancient_Greece" title="Ancient Greece">Greeks</a>, and then the <a href="Ancient_Rome" title="Ancient Rome">Romans</a>, improved the recipes by adding abrasives such as crushed bones and oyster shells.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In the 9th century, Iraqi musician and fashion designer <a href="Ziryab" title="Ziryab">Ziryab</a> invented a type of toothpaste, which he popularized throughout <a href="Al-Andalus" title="Al-Andalus">Islamic Spain</a>. The exact ingredients of this toothpaste are unknown, but it was reported to have been both "functional and pleasant to taste".<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> 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 <a href="Neem_tree" class="mw-redirect" title="Neem tree">neem-tree</a> twigs and <i><a href="Miswak" title="Miswak">miswak</a></i>. During Japan's <a href="Edo_period" title="Edo period">Edo period</a>, inventor <a href="Hiraga_Gennai" title="Hiraga Gennai">Hiraga Gennai's</a> <i>Hika rakuyo</i> (1769) contained advertisements for <i>Sosekiko</i>, a "toothpaste in a box."<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Toothpastes or powders came into general use in the 19th century.
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<div class="mw-heading mw-heading3"><h3 id="Tooth_powder">Tooth powder</h3></div>
<p>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.
</p><p><a href="Arm_%26_Hammer_(brand)" class="mw-redirect" title="Arm & Hammer (brand)">Arm & Hammer</a> marketed a baking soda-based toothpowder in the United States until approximately 2000, and <a href="Colgate-Palmolive" title="Colgate-Palmolive">Colgate</a> currently markets toothpowder in India and other countries.
</p>
<div class="mw-heading mw-heading3"><h3 id="Modern_toothpaste">Modern toothpaste</h3></div>
<p>An 18th-century American and British toothpaste recipe called for burned bread. Another formula around this time called for <a href="Dragon's_blood" title="Dragon's blood">dragon's blood</a> (a resin), cinnamon, and burned <a href="Alum" title="Alum">alum</a>.
</p><p>In 1873 the Colgate company began the mass production of aromatic toothpaste in jars.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup>
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<p>By 1900, a paste made of <a href="Hydrogen_peroxide" title="Hydrogen peroxide">hydrogen peroxide</a> and <a href="Baking_soda" class="mw-redirect" title="Baking soda">baking soda</a> was recommended for use with toothbrushes. Pre-mixed toothpastes were first marketed in the 19th century, but did not surpass the popularity of tooth-powder until <a href="World_War_I" title="World War I">World War I</a>.
</p><p>Together with <a href="Willoughby_D._Miller" title="Willoughby D. Miller">Willoughby D. Miller</a>, <a href="Newell_Sill_Jenkins" title="Newell Sill Jenkins">Newell Sill Jenkins</a> developed the first toothpaste containing <a href="Disinfectants" class="mw-redirect" title="Disinfectants">disinfectants</a>, branded as <a href="Kolynos" title="Kolynos">Kolynos</a>.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The name is a combination of two Greek words, meaning "beautifier" and "disease preventer".<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Numerous attempts to produce the toothpaste by pharmacists in Europe proved uneconomic. After returning to the US, he continued experimenting with Harry Ward Foote (1875–1942), professor of chemistry at <a href="Sheffield_Scientific_School" title="Sheffield Scientific School">Sheffield Chemical Laboratory</a> of <a href="Yale_University" title="Yale University">Yale University</a>.<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> After 17 years of development of Kolynos and clinical trials, Jenkins retired and transferred the production and distribution to his son Leonard A. Jenkins, who brought the first toothpaste tubes on the market on April 13, 1908. Within a few years the company expanded in North America, Latin America, Europe and the Far East. A branch operation opened in London in 1909. In 1937, Kolynos was produced in 22 countries and sold in 88 countries. Kolynos has been sold mainly in South America and in Hungary. Colgate-Palmolive took over the production of <a href="American_Home_Products" class="mw-redirect" title="American Home Products">American Home Products</a> in 1995 at a cost of one billion US dollars.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup>
</p><p><a href="Fluoride" title="Fluoride">Fluoride</a> was first added to toothpastes in the 1890s. Tanagra, containing <a href="Calcium_fluoride" title="Calcium fluoride">calcium fluoride</a> as the active ingredient, was sold by Karl F. Toellner Company, of <a href="Bremen" title="Bremen">Bremen</a>, Germany, based upon the early work of chemist Albert Deninger.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> An analogous invention by Roy Cross, of <a href="Kansas_City%2C_Missouri" title="Kansas City, Missouri">Kansas City, Missouri</a>, was initially criticized by the American Dental Association (ADA) in 1937. Fluoride toothpastes developed in the 1950s received the ADA's approval. To develop the first ADA-approved fluoride toothpaste, <a href="Procter_%26_Gamble" title="Procter & Gamble">Procter & Gamble</a> started a research program in the early 1940s. In 1950, Procter & Gamble developed a joint research project team headed by <a href="Joseph_C._Muhler" title="Joseph C. Muhler">Joseph C. Muhler</a> at <a href="Indiana_University_(Bloomington)" class="mw-redirect" title="Indiana University (Bloomington)">Indiana University</a> to study new toothpaste with fluoride. In 1955, Procter & Gamble's <a href="Crest_(toothpaste)" title="Crest (toothpaste)">Crest</a> launched its first <a href="Clinically_proven" class="mw-redirect" title="Clinically proven">clinically proven</a> fluoride-containing toothpaste. On August 1, 1960, the ADA reported that "Crest has been shown to be an effective anticavity (decay preventative) dentifrice that can be of significant value when used in a conscientiously applied program of oral hygiene and regular professional care."
</p><p>In 1980, the Japanese company, Sangi Co., Ltd., launched APADENT, the world's first remineralizing toothpaste to use a nano-form of hydroxyapatite, the main component of tooth enamel, rather than fluoride, to remineralize areas of mineral loss below the surface of tooth enamel (incipient caries lesions). After many years of laboratory experiments and field trials,<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> its hydroxyapatite ingredient was approved as an active anti-caries agent by the Japanese Ministry of Health in 1993, and given the name Medical Hydroxyapatite to distinguish it from other forms of hydroxyapatite used in toothpaste, such as dental abrasives.
</p><p>In 2006, BioRepair appeared in Europe with the first European toothpaste containing synthetic <a href="Hydroxylapatite" class="mw-redirect" title="Hydroxylapatite">hydroxylapatite</a> as an alternative to fluoride for the remineralization and reparation of <a href="Tooth_enamel" title="Tooth enamel">tooth enamel</a>. The "biomimetic hydroxylapatite" is intended to protect the teeth by creating a new layer of synthetic enamel around the tooth instead of hardening the existing layer with fluoride that chemically changes it into <a href="Fluorapatite" title="Fluorapatite">fluorapatite</a>.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="Usefulness">Usefulness</h2></div>
<p>Toothpastes are generally useful to maintain dental health. Toothpastes containing fluoride are effective at preventing tooth decay.<sup id="cite_ref-Marthaler-2004_2-1" class="reference"><a href="#cite_note-Marthaler-2004-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Walsh-2019_18-0" class="reference"><a href="#cite_note-Walsh-2019-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Toothpastes may also help to control and remove plaque build-up, promoting healthy gums. A 2016 systematic review indicated that using toothpaste when brushing the teeth does not necessarily impact the level of plaque removal.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> However, the active ingredients in toothpastes are able to prevent dental diseases with regular use.<sup id="cite_ref-Lippert-2013_20-0" class="reference"><a href="#cite_note-Lippert-2013-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup>
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<div class="mw-heading mw-heading2"><h2 id="Ingredients">Ingredients</h2></div>
<p>Toothpastes are derived from a variety of components, the three main ones being abrasives, fluoride, and detergent.
</p>
<div class="mw-heading mw-heading3"><h3 id="Abrasives">Abrasives</h3></div>
<p>Abrasives constitute 8-20% of a typical toothpaste.<sup id="cite_ref-Lippert-2013_20-1" class="reference"><a href="#cite_note-Lippert-2013-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> These insoluble particles are designed to help remove plaque from the teeth.<sup id="cite_ref-Aspinall-2021_21-0" class="reference"><a href="#cite_note-Aspinall-2021-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> The removal of plaque inhibits the accumulation of tartar (<a href="Calculus_(dental)" title="Calculus (dental)">calculus</a>) helping to minimize the risk of gum disease.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> Representative abrasives include particles of <a href="Aluminum_hydroxide" class="mw-redirect" title="Aluminum hydroxide">aluminum hydroxide</a> (Al(OH)<sub>3</sub>), <a href="Calcium_carbonate" title="Calcium carbonate">calcium carbonate</a> (CaCO<sub>3</sub>), <a href="Magnesium_carbonate" title="Magnesium carbonate">magnesium carbonate</a> (MgCO<sub>3</sub>), <a href="Sodium_bicarbonate" title="Sodium bicarbonate">sodium bicarbonate</a>, various <a href="Calcium_hydrogen_phosphate" class="mw-redirect" title="Calcium hydrogen phosphate">calcium hydrogen phosphates</a>, various <a href="Silica" class="mw-redirect" title="Silica">silicas</a> and <a href="Zeolite" title="Zeolite">zeolites</a>, and <a href="Hydroxyapatite" title="Hydroxyapatite">hydroxyapatite</a> (Ca<sub>5</sub>(PO<sub>4</sub>)<sub>3</sub>OH).
</p><p>After the <a href="Microbead-Free_Waters_Act_of_2015" title="Microbead-Free Waters Act of 2015">Microbead-Free Waters Act of 2015</a>, the use of <a href="Microbeads" class="mw-redirect" title="Microbeads">microbeads</a> in toothpaste has been discontinued in the US,<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> however since 2015 the industry has shifted toward instead using <a href="FDA" class="mw-redirect" title="FDA">FDA</a>-approved "rinse-off" <a href="Metallised_film" title="Metallised film">metallized-plastic</a> <a href="Glitter" title="Glitter">glitter</a> as their primary <a href="Abrasive_agent" class="mw-redirect" title="Abrasive agent">abrasive agent</a>.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Some brands contain powdered white <a href="Mica" title="Mica">mica</a>, which acts as a mild abrasive, and also adds a cosmetic glittery shimmer to the paste. 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 <a href="Dental_plaque" title="Dental plaque">plaque</a> and Calculus.<sup id="cite_ref-Weinert-2005_27-0" class="reference"><a href="#cite_note-Weinert-2005-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup>
</p><p>Abrasives, like the dental polishing agents used in dentists' offices, also cause a small amount of enamel erosion which is termed "polishing" action. The abrasive effect of toothpaste is indicated by its <a href="Relative_dentin_abrasivity" class="mw-redirect" title="Relative dentin abrasivity">RDA</a> value. Toothpastes with RDA values above 250 are potentially damaging to the surfaces of teeth. The <a href="American_National_Standards_Institute" title="American National Standards Institute">American National Standards Institute</a> and <a href="American_Dental_Association" title="American Dental Association">American Dental Association</a> considers toothpastes with an RDA below 250 to be safe and effective for a lifetime of use.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup>
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<div class="mw-heading mw-heading3"><h3 id="Fluorides">Fluorides</h3></div>
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</style><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="Fluoride_therapy" title="Fluoride therapy">Fluoride therapy</a></div>
<p><a href="Fluoride" title="Fluoride">Fluoride</a> in various forms is the most popular and effective active ingredient in toothpaste to prevent cavities.<sup id="cite_ref-Aspinall-2021_21-1" class="reference"><a href="#cite_note-Aspinall-2021-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Fluoride is present in small amounts in plants, animals, and <a href="History_of_water_fluoridation" class="mw-redirect" title="History of water fluoridation">some natural water sources</a>. The additional fluoride in toothpaste has beneficial effects on the formation of dental enamel and bones. <a href="Sodium_fluoride" title="Sodium fluoride">Sodium fluoride</a> (NaF) is the most common source of fluoride, but <a href="Stannous_fluoride" class="mw-redirect" title="Stannous fluoride">stannous fluoride</a> (SnF<sub>2</sub>), and <a href="Sodium_monofluorophosphate" title="Sodium monofluorophosphate">sodium monofluorophosphate</a> (Na<sub>2</sub>PO<sub>3</sub>F) are also used.<sup id="cite_ref-Aspinall-2021_21-2" class="reference"><a href="#cite_note-Aspinall-2021-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> At similar fluoride concentrations, toothpastes containing stannous fluoride have been shown to be more effective than toothpastes containing sodium fluoride for reducing the incidence of dental caries and <a href="Acid_erosion" class="mw-redirect" title="Acid erosion">dental erosion</a>,<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> as well as reducing <a href="Gingivitis" title="Gingivitis">gingivitis</a>.<sup id="cite_ref-Parkinson-2020_34-0" class="reference"><a href="#cite_note-Parkinson-2020-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hu-2019_35-0" class="reference"><a href="#cite_note-Hu-2019-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Mankodi-2005_36-0" class="reference"><a href="#cite_note-Mankodi-2005-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Archila-2004_37-0" class="reference"><a href="#cite_note-Archila-2004-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Clark-Perry-2020_38-0" class="reference"><a href="#cite_note-Clark-Perry-2020-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> Some stannous fluoride-containing toothpastes also contain ingredients that allow for better stain and calculus removal.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> A systematic review revealed stabilised stannous fluoride-containing toothpastes had a positive effect on the reduction of plaque, gingivitis and staining, with a significant reduction in <a href="Calculus_(dental)" title="Calculus (dental)">calculus</a> and halitosis compared to other toothpastes.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Furthermore, numerous clinical trials have shown gluconate chelated stannous fluoride toothpastes possess superior protection against dental erosion and <a href="Dentin_hypersensitivity" title="Dentin hypersensitivity">dentine hypersensitivity</a> compared to other fluoride-containing and fluoride-free toothpastes.<sup id="cite_ref-West-2021_41-0" class="reference"><a href="#cite_note-West-2021-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup>
</p><p>Much of the toothpaste sold in the United States has 1,000 to 1,100 parts per million fluoride. In European countries, such as the UK or Greece, the fluoride content is often higher; a sodium fluoride content of 0.312% w/w (1,450 <a href="Parts_per_million" class="mw-redirect" title="Parts per million">ppm</a> fluoride) or stannous fluoride content of 0.454% w/w (1,100 ppm fluoride) is common. All of these concentrations are likely to prevent <a href="Tooth_decay" title="Tooth decay">tooth decay</a>, according to a 2019 <a href="Cochrane_review" class="mw-redirect" title="Cochrane review">Cochrane review</a>.<sup id="cite_ref-Walsh-2019_18-1" class="reference"><a href="#cite_note-Walsh-2019-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Concentrations below 1,000 ppm are not likely to be preventive, and the preventive effect increases with concentration.<sup id="cite_ref-Walsh-2019_18-2" class="reference"><a href="#cite_note-Walsh-2019-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Clinical trials support the use of high fluoride (5,000 ppm fluoride) dentifrices, for prevention of root caries in elderly adults by reducing the amount of plaque accumulated, decreasing the number of <a href="Streptococcus_mutans" title="Streptococcus mutans">mutans streptococci</a> and <a href="Lactobacillus" title="Lactobacillus">lactobacilli</a> and possibly promoting calcium fluoride deposits to a higher degree than after the use of traditional fluoride containing dentifrices.<sup id="cite_ref-Walsh-2019_18-3" class="reference"><a href="#cite_note-Walsh-2019-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup>
</p><p>Most toothpaste products have a shelf life of about two years, after which the fluoride and antibacterial properties may become less effective. While expired toothpaste is generally safe to use, regulatory bodies like the FDA require expiration dates on fluoride-containing toothpaste to ensure optimal effectiveness.
</p>
<div class="mw-heading mw-heading3"><h3 id="Surfactants">Surfactants</h3></div>
<p>Many, although not all, toothpastes contain <a href="Sodium_dodecyl_sulfate" title="Sodium dodecyl sulfate">sodium lauryl sulfate (SLS)</a> or related <a href="Surfactant" title="Surfactant">surfactants</a> (detergents). SLS is found in many other personal care products as well, such as <a href="Shampoo" title="Shampoo">shampoo</a>, and is mainly a <a href="Foaming_agent" title="Foaming agent">foaming agent</a>, which enables uniform distribution of toothpaste, improving its cleansing power.<sup id="cite_ref-Weinert-2005_27-1" class="reference"><a href="#cite_note-Weinert-2005-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Other_components">Other components</h3></div>
<div class="mw-heading mw-heading4"><h4 id="Antibacterial_agents">Antibacterial agents</h4></div>
<p><a href="Triclosan" title="Triclosan">Triclosan</a>, an antibacterial agent, is a common toothpaste ingredient in the United Kingdom. Triclosan or <a href="Zinc_chloride" title="Zinc chloride">zinc chloride</a> prevent gingivitis and, according to the American Dental Association, helps reduce <a href="Dental_tartar" class="mw-redirect" title="Dental tartar">tartar</a> and <a href="Bad_breath" title="Bad breath">bad breath</a>.<sup id="cite_ref-ADA-toothpaste_1-1" class="reference"><a href="#cite_note-ADA-toothpaste-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-FDA-Triclosan_42-0" class="reference"><a href="#cite_note-FDA-Triclosan-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> A 2006 review of clinical research concluded there was evidence for the effectiveness of 0.30% triclosan in reducing plaque and gingivitis.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> Another Cochrane review in 2013 has found that triclosan achieved a 22% reduction in plaque, and in gingivitis, a 48% reduction in <a href="Bleeding_on_probing" title="Bleeding on probing">bleeding gums</a>. However, there was insufficient evidence to show a difference in fighting <a href="Periodontitis" class="mw-redirect" title="Periodontitis">periodontitis</a> and there was no evidence either of any harmful effects associated with the use of triclosan toothpastes for more than 3 years. The evidence relating to plaque and gingivitis was considered to be of moderate quality while for periodontitis was low quality.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> Recently, triclosan has been removed as an ingredient from well-known toothpaste formulations. This may be attributed to concerns about adverse effects associated with triclosan exposure. Triclosan use in cosmetics has been positively correlated with triclosan levels in human tissues, plasma and breast milk, and is considered to have potential neurotoxic effects.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> Long-term studies are needed to substantiate these concerns.
</p><p><a href="Chlorhexidine" title="Chlorhexidine">Chlorhexidine</a> is another antimicrobial agent used in toothpastes; however, it is more commonly added in <a href="Mouthwash" title="Mouthwash">mouthwash</a> products.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> <a href="Sodium_laureth_sulfate" title="Sodium laureth sulfate">Sodium laureth sulfate</a>, a foaming agent, is a common toothpaste ingredient that also possesses some antimicrobial activities.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> There are also many commercial products available in the market containing different <a href="Essential_oil" title="Essential oil">essential oils</a>, herbal ingredients (e.g. <a href="Chamomile" title="Chamomile">chamomile</a>, <a href="Neem" class="mw-redirect" title="Neem">neem</a>, <a href="Chitosan" title="Chitosan">chitosan</a>, <a href="Aloe_vera" title="Aloe vera">aloe vera</a>), and natural or plant extracts (e.g. <a href="Hinokitiol" title="Hinokitiol">hinokitiol</a>). These ingredients are claimed by the manufacturers to fight plaque, bad breath and prevent <a href="Gum_disease" class="mw-redirect" title="Gum disease">gum disease</a>. A 2020 systematic metareview found that herbal toothpastes are as effective as non-herbal toothpastes in reducing dental plaque at shorter period of follow-up (4 weeks).<sup id="cite_ref-Janakiram-2020_48-0" class="reference"><a href="#cite_note-Janakiram-2020-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> However, this evidence comes from low-quality studies.
</p><p>The stannous (<a href="Tin" title="Tin">tin</a>) ion, commonly added to toothpastes as stannous fluoride or <a href="Tin(II)_chloride" title="Tin(II) chloride">stannous chloride</a>, has been shown to have antibacterial effects in the mouth. Research has shown that stannous fluoride-containing toothpaste inhibits extracellular polysaccharide (<a href="Extracellular_polysaccharide" class="mw-redirect" title="Extracellular polysaccharide">EPS</a>) production in a multispecies <a href="Biofilm" title="Biofilm">biofilm</a> greater than sodium fluoride-containing toothpaste.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> This is thought to contribute to a reduction in plaque and gingivitis when using stannous fluoride-containing toothpastes when compared to other toothpastes, and has been evidenced through numerous clinical trials.<sup id="cite_ref-Parkinson-2020_34-1" class="reference"><a href="#cite_note-Parkinson-2020-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Hu-2019_35-1" class="reference"><a href="#cite_note-Hu-2019-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Mankodi-2005_36-1" class="reference"><a href="#cite_note-Mankodi-2005-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Archila-2004_37-1" class="reference"><a href="#cite_note-Archila-2004-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Clark-Perry-2020_38-1" class="reference"><a href="#cite_note-Clark-Perry-2020-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> In addition to its antibacterial properties, stabilised stannous fluoride toothpastes have been shown to protect against dental erosion and dentine hypersensitivity, making it a multifunctional component in toothpaste formulations.<sup id="cite_ref-West-2021_41-1" class="reference"><a href="#cite_note-West-2021-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading4"><h4 id="Flavorants">Flavorants</h4></div>
<p>Toothpaste comes in a variety of <a href="Food_coloring" title="Food coloring">colors</a> and <a href="Flavor_(taste)" class="mw-redirect" title="Flavor (taste)">flavors</a>, intended to encourage use of the product. The three most common flavorants are <a href="Peppermint" title="Peppermint">peppermint</a>, <a href="Spearmint" title="Spearmint">spearmint</a>, and <a href="Wintergreen" title="Wintergreen">wintergreen</a>. Toothpaste flavored with peppermint-anise oil is popular in the Mediterranean region. These flavors are provided by the respective oils, e.g. peppermint oil.<sup id="cite_ref-Weinert-2005_27-2" class="reference"><a href="#cite_note-Weinert-2005-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> More exotic flavors include Anethole <a href="Anise" title="Anise">anise</a>, <a href="Apricot" title="Apricot">apricot</a>, <a href="Bubblegum" class="mw-redirect" title="Bubblegum">bubblegum</a>, <a href="Cinnamon" title="Cinnamon">cinnamon</a>, <a href="Fennel" title="Fennel">fennel</a>, <a href="Lavender" class="mw-redirect" title="Lavender">lavender</a>, <a href="Neem" class="mw-redirect" title="Neem">neem</a>, <a href="Ginger" title="Ginger">ginger</a>, <a href="Vanilla" title="Vanilla">vanilla</a>, <a href="Lemon" title="Lemon">lemon</a>, <a href="Orange_(fruit)" title="Orange (fruit)">orange</a>, and <a href="Pine" title="Pine">pine</a>. Alternatively, unflavored toothpastes exist.
</p>
<div class="mw-heading mw-heading4"><h4 id="Remineralizing_agents">Remineralizing agents</h4></div>
<p>Chemical repair (<a href="Remineralisation_of_teeth" title="Remineralisation of teeth">remineralization</a>) of early tooth decay is promoted naturally by <a href="Saliva" title="Saliva">saliva</a>.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> However, this process can be enhanced by various remineralisation agents.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Fluoride promotes remineralization, but is limited by bioavailable calcium.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) is a toothpaste ingredient containing bioavailable calcium that has been widely researched to be the most clinically effective remineralization agent that enhances the action of saliva and fluoride.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Philip-2019_56-0" class="reference"><a href="#cite_note-Philip-2019-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Peptide-based systems, hydroxyapatite nanocrystals and a variety of <a href="Calcium_phosphate" title="Calcium phosphate">calcium phosphates</a> have been advocated as remineralization agents; however, more clinical evidence is required to substantiate their effectiveness.<sup id="cite_ref-Philip-2019_56-1" class="reference"><a href="#cite_note-Philip-2019-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading4"><h4 id="Miscellaneous_components">Miscellaneous components</h4></div>
<p>Agents are added to suppress the tendency of toothpaste to dry into a powder. Included are various sugar alcohols, such as <a href="Glycerol" title="Glycerol">glycerol</a>, <a href="Sorbitol" title="Sorbitol">sorbitol</a>, or <a href="Xylitol" title="Xylitol">xylitol</a>, or related derivatives, such as <a href="1%2C2-propylene_glycol" class="mw-redirect" title="1,2-propylene glycol">1,2-propylene glycol</a> and <a href="Polyethyleneglycol" class="mw-redirect" title="Polyethyleneglycol">polyethyleneglycol</a>.<sup id="cite_ref-Field_57-0" class="reference"><a href="#cite_note-Field-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> <a href="Strontium_chloride" title="Strontium chloride">Strontium chloride</a> or <a href="Potassium_nitrate" title="Potassium nitrate">potassium nitrate</a> is included in some toothpastes to reduce sensitivity. Two systemic meta-analysis reviews reported that <a href="Arginine" title="Arginine">arginine</a>, and calcium sodium phosphosilicate – CSPS containing toothpastes are also effective in alleviating dentinal hypersensitivity respectively.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> Another randomized clinical trial found superior effects when both formulas were combined.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup>
</p><p>Sodium polyphosphate is added to minimize the formation of tartar.
</p><p>Chlorohexidine mouthwash has been popular for its positive effect on controlling plaque and gingivitis,<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> however, a systemic review studied the effects of Chlorhexidine toothpastes and found insufficient evidence to support its use, tooth surface discoloration was observed as a side effect upon using it, which is considered a negative side effect that can affect patients' compliance.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup>
</p><p><a href="Sodium_hydroxide" title="Sodium hydroxide">Sodium hydroxide</a>, also known as lye or caustic soda, is listed as an inactive ingredient in some toothpaste, for example Colgate Total.
</p>
<div class="mw-heading mw-heading3"><h3 id="Xylitol">Xylitol</h3></div>
<p>A systematic review reported two out of ten studies by the same authors on the same population showed toothpastes with xylitol as an ingredient were more effective at preventing dental caries in permanent teeth of children than toothpastes containing fluoride alone. Furthermore, xylitol has not been found to cause any harmful effects. However, further investigation into the efficacy of toothpastes containing xylitol is required as the currently available studies are of low quality and high risk of bias.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="Safety">Safety</h2></div>
<div class="mw-heading mw-heading3"><h3 id="Fluoride">Fluoride</h3></div>
<p>Fluoride-containing toothpaste can be acutely toxic if swallowed in large amounts,<sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Delivering_Better_Oral_Health_2007_65-0" class="reference"><a href="#cite_note-Delivering_Better_Oral_Health_2007-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> but instances are exceedingly rare and result from prolonged and excessive use of toothpaste (i.e. several tubes per week).<sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> Approximately 15 mg/kg body weight is the acute lethal dose, even though as small amount as 5 mg/kg may be fatal to some children.<sup id="cite_ref-Kidd-2016_67-0" class="reference"><a href="#cite_note-Kidd-2016-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup>
</p><p>The risk of using fluoride is low enough that the use of full-strength toothpaste (1350–1500 ppm fluoride) is advised for all ages. However, smaller volumes are used for young children, for example, a smear of toothpaste until three years old.<sup id="cite_ref-Delivering_Better_Oral_Health_2007_65-1" class="reference"><a href="#cite_note-Delivering_Better_Oral_Health_2007-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> A major concern of <a href="Dental_fluorosis" title="Dental fluorosis">dental fluorosis</a> is for children under 12 months ingesting excessive fluoride through toothpaste. Nausea and vomiting are also problems which might arise with topical fluoride ingestion.<sup id="cite_ref-Kidd-2016_67-1" class="reference"><a href="#cite_note-Kidd-2016-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Diethylene_glycol">Diethylene glycol</h3></div>
<p>The inclusion of sweet-tasting but toxic <a href="Diethylene_glycol" title="Diethylene glycol">diethylene glycol</a> in Chinese-made toothpaste led to a recall in 2007 involving multiple toothpaste brands in several nations.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> The world outcry made Chinese officials ban the practice of using diethylene glycol in toothpaste.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Triclosan">Triclosan</h3></div>
<p>Reports have suggested triclosan, an active ingredient in many kinds of toothpastes, can combine with <a href="Chlorine" title="Chlorine">chlorine</a> in tap water to form <a href="Chloroform" title="Chloroform">chloroform</a>.<sup id="cite_ref-pmid15926568_70-0" class="reference"><a href="#cite_note-pmid15926568-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> An animal study revealed the chemical might modify hormone regulation, and many other lab researches proved bacteria might be able to develop resistance to triclosan in a way which can help them to resist antibiotics also.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Polyethylene_glycol_–_PEG">Polyethylene glycol – PEG</h3></div>
<p><a href="Polyethylene_glycol" title="Polyethylene glycol">PEG</a> is a common ingredient in some of the formulas of toothpastes; it is a hydrophilic <a href="Polymer" title="Polymer">polymer</a> that acts as a <a href="Dispersant" title="Dispersant">dispersant</a> in toothpastes. Also, it is used in many cosmetic and pharmaceutical formulas, for example: ointments, osmotic <a href="Laxative" title="Laxative">laxatives</a>, some of the <a href="Nonsteroidal_anti-inflammatory_drug" title="Nonsteroidal anti-inflammatory drug">nonsteroidal anti-inflammatory drugs</a>, other medications and household products.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> However, 37 cases of PEG <a href="Hypersensitivity" title="Hypersensitivity">hypersensitivity</a> (delayed and immediate) to PEG-containing substances have been reported since 1977,<sup id="cite_ref-Wenande-2016_73-0" class="reference"><a href="#cite_note-Wenande-2016-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> suggesting that they have unrecognized allergenic potential.<sup id="cite_ref-Wenande-2016_73-1" class="reference"><a href="#cite_note-Wenande-2016-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Miscellaneous_issues_and_debates">Miscellaneous issues and debates</h3></div>
<p>With the exception of toothpaste intended to be used on pets such as dogs and cats, and toothpaste used by <a href="Astronaut" title="Astronaut">astronauts</a>, most toothpaste is not intended to be swallowed, and doing so may cause <a href="Nausea" title="Nausea">nausea</a> or <a href="Diarrhea" title="Diarrhea">diarrhea</a>. Tartar fighting toothpastes have been debated.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> Sodium lauryl sulfate (SLS) has been proposed to increase the frequency of <a href="Mouth_ulcer" title="Mouth ulcer">mouth ulcers</a> in some people, as it can dry out the protective layer of oral tissues, causing the underlying tissues to become damaged.<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> In studies conducted by the university of Oslo on <a href="Recurrent_aphthous_ulcer" class="mw-redirect" title="Recurrent aphthous ulcer">recurrent aphthous ulcers</a>, it was found that SLS has a denaturing effect on the oral <a href="Mucous_membrane" title="Mucous membrane">mucin</a> layer, with high affinity for proteins, thereby increasing epithelial permeability.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup> In a double-blind cross-over study, a significantly higher frequency of <a href="Aphthous_stomatitis" title="Aphthous stomatitis">aphthous ulcers</a> was demonstrated when patients brushed with an SLS-containing versus a detergent-free toothpaste. Also patients with <a href="Oral_lichen_planus" class="mw-redirect" title="Oral lichen planus">Oral Lichen Planus</a> who avoided SLS-containing toothpaste benefited.<sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-78" class="reference"><a href="#cite_note-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Alteration_of_taste_perception">Alteration of taste perception</h3></div>
<p>After using toothpaste, <a href="Orange_juice" title="Orange juice">orange juice</a> and other fruit juices are known to have an unpleasant taste if consumed shortly afterwards. <a href="Sodium_dodecyl_sulfate" title="Sodium dodecyl sulfate">Sodium lauryl sulfate</a>, used as a surfactant in toothpaste, alters taste perception. It can break down <a href="Phospholipid" title="Phospholipid">phospholipids</a> that inhibit taste receptors for sweetness, giving food a bitter taste. In contrast, apples are known to taste more pleasant after using toothpaste.<sup id="cite_ref-79" class="reference"><a href="#cite_note-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> 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 <a href="Menthol" title="Menthol">menthol</a> added for flavor may also take part in the alteration of taste perception when binding to lingual <a href="Thermoreceptor" title="Thermoreceptor">cold receptors</a>.
</p>
<div class="mw-heading mw-heading3"><h3 id="Whitening_toothpastes">Whitening toothpastes</h3></div>
<p>Many toothpastes make whitening claims. Abrasion is the principal way that toothpaste removes stains, and toothpastes that are not marketed as whitening can still remove stains by abrasion.<sup id="cite_ref-The_New_York_Times-2022_80-0" class="reference"><a href="#cite_note-The_New_York_Times-2022-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> Some of these toothpastes contain peroxide, the same ingredient found in tooth bleaching gels. Whitening toothpaste cannot alter the natural color of teeth or reverse discoloration by penetrating surface stains or decay. To remove surface stains, whitening toothpaste may include abrasives to gently polish the teeth or additives such as <a href="Sodium_tripolyphosphate" class="mw-redirect" title="Sodium tripolyphosphate">sodium tripolyphosphate</a> to break down or dissolve stains. When used twice a day, whitening toothpaste typically takes two to four weeks to make teeth appear whiter. Whitening toothpaste is generally safe for daily use, but excessive use might damage tooth enamel.<sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup> A recent systematic review in 2017 concluded that nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing extrinsic stains, irrespective of whether or not a chemical discoloration agent was added.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> However, the whitening process can permanently reduce the strength of the teeth, as the process scrapes away a protective outer layer of enamel.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading3"><h3 id="Herbal_and_natural_toothpastes">Herbal and natural toothpastes</h3></div>
<p>Herbal toothpastes are marketed to consumers who wish to avoid some of the artificial ingredients commonly found in regular toothpastes. The ingredients found in so-called natural toothpastes vary widely but often include <a href="Baking_soda" class="mw-redirect" title="Baking soda">baking soda</a>, <a href="Aloe" title="Aloe">aloe</a>, <a href="Eucalyptus_oil" title="Eucalyptus oil">eucalyptus oil</a>, <a href="Myrrh" title="Myrrh">myrrh</a>, <a href="Camomile" class="mw-redirect" title="Camomile">camomile</a>, <a href="Calendula" title="Calendula">calendula</a>, neem, <a href="Toothbrush_tree" class="mw-redirect" title="Toothbrush tree">toothbrush tree</a>, plant extract (strawberry extract), and essential oils. Many herbal toothpastes do not contain fluoride or <a href="Sodium_lauryl_sulfate" class="mw-redirect" title="Sodium lauryl sulfate">sodium lauryl sulfate</a>.<sup id="cite_ref-Janakiram-2020_48-1" class="reference"><a href="#cite_note-Janakiram-2020-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup>
</p><p>A 2020 meta-analysis showed some evidence for the efficacy of herbal toothpaste, albeit from poor quality studies.<sup id="cite_ref-Janakiram-2020_48-2" class="reference"><a href="#cite_note-Janakiram-2020-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> According to a study by the <a href="Delhi_Institute_of_Pharmaceutical_Sciences_and_Research" title="Delhi Institute of Pharmaceutical Sciences and Research">Delhi Institute of Pharmaceutical Sciences and Research</a>, many of the herbal toothpastes being sold in India were adulterated with <a href="Nicotine" title="Nicotine">nicotine</a>.<sup id="cite_ref-it01_84-0" class="reference"><a href="#cite_note-it01-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup>
</p><p><a href="Charcoal" title="Charcoal">Charcoal</a> has also been incorporated in toothpaste formulas; however, there is no evidence to determine its safety and effectiveness, and the American Dental Association does not recommend its use.<sup id="cite_ref-The_New_York_Times-2022_80-1" class="reference"><a href="#cite_note-The_New_York_Times-2022-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="Government_regulation">Government regulation</h2></div>
<p>In the United States toothpaste is regulated by the U.S. <a href="Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> as a <a href="Cosmetics" title="Cosmetics">cosmetic</a>, except for ingredients with a medical purpose, such as fluoride, which are regulated as <a href="Drug" title="Drug">drugs</a>.<sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup> Drugs require scientific studies and FDA approval in order to be legally marketed in the United States, but cosmetic ingredients do not require pre-approval, except for color additives. The FDA does have labelling and requirements and bans certain ingredients.<sup id="cite_ref-86" class="reference"><a href="#cite_note-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="Striped_toothpaste">Striped toothpaste</h2></div>
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<p>Striped toothpaste was invented by Leonard Marraffino in 1955. The patent (US patent <span><a rel="nofollow" class="external text" href="https://patents.google.com/patent/US2789731">2,789,731</a></span>, issued 1957) was subsequently sold to <a href="Unilever" title="Unilever">Unilever</a>, which 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.
</p>
<p>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, but they are sufficiently <a href="Viscosity" title="Viscosity">viscous</a> 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 thereby issues out through small holes (in the side of the pipe) onto the main carrier material as it is passing those holes.
</p><p>In 1990, Colgate-Palmolive was granted a patent (USPTO <span><a rel="nofollow" class="external text" href="https://patents.google.com/patent/US4969767">4,969,767</a></span>) for two differently colored stripes. In this scheme, the inner pipe has a cone-shaped plastic guard around it, and about halfway up its length. Between the guard and the nozzle-end of the tube is a space for the material for one color, which 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.
</p><p>In 2016, <a href="Colgate_(toothpaste)" title="Colgate (toothpaste)">Colgate</a>-Palmolive was granted a patent (USPTO <span><a rel="nofollow" class="external text" href="https://patents.google.com/patent/US20160228347">U.S. patent 20,160,228,347</a></span>) for suitable sorts of differently colored toothpastes to be filled directly into tubes to produce a striped mix without any separate compartments. This required adjustment of the different components' behavior (<a href="Rheology" title="Rheology">rheology</a>) so that stripes are produced when the tube is squeezed.<sup id="cite_ref-87" class="reference"><a href="#cite_note-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup>
</p><p>Striped toothpaste should not be confused with layered toothpaste. Layered toothpaste requires a multi-chamber design (e.g. USPTO <span><a rel="nofollow" class="external text" href="https://patents.google.com/patent/US5020694">5,020,694</a></span>), in which two or three layers extrude out of the nozzle. This scheme, like that of pump dispensers (USPTO <span><a rel="nofollow" class="external text" href="https://patents.google.com/patent/US4461403">4,461,403</a></span>), is more complicated (and thus, more expensive to manufacture) than either the Marraffino design or the Colgate designs.
</p><p>The iconic depiction of a wave-shaped blob of toothpaste sitting on a toothbrush is called a "nurdle".<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">[</span>88<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="Dispensing">Dispensing</h2></div>
<div role="note" class="hatnote navigation-not-searchable">Main article: <a href="Tube_(container)" title="Tube (container)">Tube (container)</a></div>
<div role="note" class="hatnote navigation-not-searchable">Main article: <a href="Toothpaste_pump_dispenser" title="Toothpaste pump dispenser">Toothpaste pump dispenser</a></div><p>
Toothpaste is usually dispensed via a collapsible tube or with a more rigid pump. Several traditional and innovative designs have been developed.<sup id="cite_ref-89" class="reference"><a href="#cite_note-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup> The dispenser must be matched to the flow properties of the toothpaste.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">[</span>90<span class="cite-bracket">]</span></a></sup> </p>
<p>In 1880, Doctor <a href="Washington_Sheffield" title="Washington Sheffield">Washington Sheffield</a> of <a href="New_London%2C_CT" class="mw-redirect" title="New London, CT">New London, CT</a> manufactured toothpaste into a collapsible tube, <a href="Sheffield_Pharmaceuticals" title="Sheffield Pharmaceuticals">Dr. Sheffield's Creme Dentifrice</a>. He had the idea after his son traveled to Paris and saw painters using paint from tubes. In <a href="York" title="York">York</a> in 1896, Colgate-Palmolive Dental Cream was packaged in collapsible tubes imitating Sheffield. The original collapsible toothpaste tubes were made of <a href="Lead" title="Lead">lead</a>.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91"><span class="cite-bracket">[</span>91<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-92" class="reference"><a href="#cite_note-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup>
</p>
<div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2></div>
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<ul><li><a href="Dental_floss" title="Dental floss">Dental floss</a></li>
<li><a href="Mouthwash" title="Mouthwash">Mouthwash</a></li>
<li><a href="Fluoride_therapy" title="Fluoride therapy">Fluoride therapy</a></li>
<li><a href="List_of_toothpaste_brands" title="List of toothpaste brands">List of toothpaste brands</a></li></ul>
<div class="mw-heading mw-heading2"><h2 id="References">References</h2></div>
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<ol class="references">
<li id="cite_note-ADA-toothpaste-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-ADA-toothpaste_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-ADA-toothpaste_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text">American Dental Association Description of Toothpaste<style data-mw-deduplicate="TemplateStyles:r1238218222">
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<li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://medlineplus.gov/ency/article/002745.htm">"Toothpaste overdose"</a>. <i>National Library of Medicine</i>. National Institutes of Health.</cite></span>
</li>
<li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="https://www.bbc.co.uk/dna/h2g2/A2818686">The History of Toothpaste and Toothbrushes</a>. Bbc.co.uk. Retrieved on April 4, 2013.</span>
</li>
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<div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2></div>
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<ul><li><cite id="CITEREFHartman2018" class="citation news cs1">Hartman M (March 16, 2018). <a rel="nofollow" class="external text" href="https://www.marketplace.org/2018/03/16/business/mouth-full-mint-cleaner-teeth-no-thanks">"I've always wondered: how mint flavoring became associated with clean teeth"</a>. I've Always Wondered (story series). <i><a href="Marketplace_(radio_program)" title="Marketplace (radio program)">Marketplace</a></i>. <a href="American_Public_Media" title="American Public Media">American Public Media</a><span class="reference-accessdate">. Retrieved <span class="nowrap">March 16,</span> 2018</span>.</cite> On the history of toothpaste.</li>
<li><cite id="CITEREFDuhigg2012" class="citation book cs1">Duhigg C (2012). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=xQ1_z5_kj6sC&pg=PT52">"Chapter 2: The Craving Brain: How to Create New Habits: Part I"</a>. <a rel="nofollow" class="external text" href="https://archive.org/details/powerofhabitwhyw00duhi"><i>The Power of Habit: Why We Do What We Do in Life and Business</i></a>. New York: Random House. <a href="ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <bdi>978-1400069286</bdi>. <a href="OCLC_(identifier)" class="mw-redirect" title="OCLC (identifier)">OCLC</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/oclc/731918383">731918383</a>.</cite> On the history of the marketing of toothpaste.</li>
<li><cite id="CITEREFLoveren2013" class="citation book cs1">Loveren, Cornelis van (2013). <i>Toothpastes</i>. Monographs in Oral Science. Vol. 23. Basel: <a href="Karger_Publishers" title="Karger Publishers">Karger</a>. <a href="Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1159%2Fisbn.978-3-318-02207-0">10.1159/isbn.978-3-318-02207-0</a>. <a href="ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <bdi>978-3-318-02207-0</bdi>.</cite></li></ul>
</div>
<div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div>
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<div class="side-box-text plainlist">Wikimedia Commons has media related to <span style="font-weight: bold; font-style: italic;"><a href="https://commons.wikimedia.org/wiki/Category:Toothpaste" class="extiw external" title="commons:Category:Toothpaste">Toothpaste</a></span>.</div></div>
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<ul><li><a rel="nofollow" class="external text" href="https://web.archive.org/web/20110112232012/http://dentalplaque.wikispaces.com/Toothpaste">Chemistry of Plaque Prevention with Toothpaste</a></li>
<li><a rel="nofollow" class="external text" href="http://www.fluoride-history.de/p-dentifrice.htm">Fluoride toothpaste history</a></li></ul>
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</style><div id="Routes_of_administration,_dosage_forms650" style="font-size:114%;margin:0 4em"><a href="Route_of_administration" title="Route of administration">Routes of administration</a>, <a href="Dosage_form" title="Dosage form">dosage forms</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Oral_administration" title="Oral administration">Oral</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Human_gastrointestinal_tract" class="mw-redirect" title="Human gastrointestinal tract">Digestive tract</a> (<a href="Enteral_administration" title="Enteral administration">enteral</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Solid" title="Solid">Solids</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Tablet_(pharmacy)" title="Tablet (pharmacy)">Tablet</a></li>
<li><a href="Capsule_(pharmacy)" title="Capsule (pharmacy)">Capsule</a></li>
<li><a href="Pastille" title="Pastille">Pastille</a></li>
<li><a href="Time_release_technology" class="mw-redirect" title="Time release technology">Time release technology</a></li>
<li><a href="Osmotic-controlled_release_oral_delivery_system" title="Osmotic-controlled release oral delivery system">Osmotic delivery system</a></li></ul>
</div></td><td class="noviewer navbox-image" rowspan="2" style="width:1px;padding:0 0 0 2px"><div><span typeof="mw:File"></span><br><span typeof="mw:File"></span></div></td></tr><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Liquid" title="Liquid">Liquids</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Decoction" title="Decoction">Decoction</a></li>
<li><a href="Elixir" title="Elixir">Elixir</a></li>
<li><a href="Electuary" title="Electuary">Electuary</a></li>
<li><a href="Emulsion" title="Emulsion">Emulsion</a></li>
<li><a href="Effervescent_tablet" title="Effervescent tablet">Effervescent powder or tablet</a></li>
<li><a href="Herbal_tea" title="Herbal tea">Herbal tea</a></li>
<li><a href="Hydrogel" title="Hydrogel">Hydrogel</a></li>
<li><a href="Molecular_encapsulation" class="mw-redirect" title="Molecular encapsulation">Molecular encapsulation</a></li>
<li><a href="Powder" title="Powder">Powder</a></li>
<li><a href="Softgel" title="Softgel">Softgel</a></li>
<li><a href="Solution_(chemistry)" title="Solution (chemistry)">Solution</a></li>
<li><a href="Suspension_(chemistry)" title="Suspension (chemistry)">Suspension</a></li>
<li><a href="Syrup" title="Syrup">Syrup</a></li>
<li><a href="Tincture" title="Tincture">Tincture</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Oral_mucosa" title="Oral mucosa">Oral mucosa</a> (<a href="Buccal_administration" title="Buccal administration">buccal</a>, <a href="Sublabial_administration" title="Sublabial administration">sublabial</a>, <a href="Sublingual_administration" title="Sublingual administration">sublingual</a>, <a href="Supralingual_administration" title="Supralingual administration">supralingual</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Solid" title="Solid">Solids</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Orally_disintegrating_tablet" title="Orally disintegrating tablet">Orally disintegrating tablet</a></li>
<li><a href="Thin_film_drug_delivery" class="mw-redirect" title="Thin film drug delivery">Film</a></li>
<li><a href="Lollipop#Medicinal_use" title="Lollipop">Lollipop</a></li>
<li><a href="Drop_(liquid)" title="Drop (liquid)">Sublingual drops</a></li>
<li><a href="Throat_lozenge" title="Throat lozenge">Lozenges</a></li>
<li><a href="Effervescent" class="mw-redirect" title="Effervescent">Effervescent</a> tablet</li>
<li><a href="Chewing_gum" title="Chewing gum">Chewing gum</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Liquid" title="Liquid">Liquids</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Mouthwash" title="Mouthwash">Mouthwash</a></li>
<li><a href="Topical" class="mw-redirect" title="Topical">Ointment</a></li>
<li>Spray</li></ul>
</div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Respiratory_tract" title="Respiratory tract">Respiratory tract</a> (<a href="Inhalation" title="Inhalation">inhalation</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Solid" title="Solid">Solids</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Dry-powder_inhaler" title="Dry-powder inhaler">Dry-powder inhaler</a></li>
<li><a href="Smoking" title="Smoking">Smoking</a></li></ul>
</div></td><td class="noviewer navbox-image" rowspan="3" style="width:1px;padding:0 0 0 2px"><div><span typeof="mw:File"></span><br><span aria-hidden="true" style="visibility:hidden;color:transparent;">0</span><br><span aria-hidden="true" style="visibility:hidden;color:transparent;">0</span></div></td></tr><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Liquid" title="Liquid">Liquids</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Anesthetic_vaporizer" class="mw-redirect" title="Anesthetic vaporizer">Anesthetic vaporizer</a></li>
<li><a href="Heated_humidified_high-flow_therapy" title="Heated humidified high-flow therapy">Heated humidified high-flow therapy</a></li>
<li><a href="List_of_medical_inhalants" title="List of medical inhalants">Medical inhalants</a></li>
<li><a href="Metered-dose_inhaler" title="Metered-dose inhaler">Metered-dose inhaler</a> (MDI)</li>
<li><a href="Nebulizer" title="Nebulizer">Nebulizer</a></li>
<li><a href="Vaporizer_(inhalation_device)" title="Vaporizer (inhalation device)">Vaporizer</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:5em;white-space:normal;"><a href="Gas" title="Gas">Gas</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Oxygen_mask" title="Oxygen mask">Oxygen mask</a> and <a href="Nasal_cannula" title="Nasal cannula">Nasal cannula</a></li>
<li><a href="Oxygen_concentrator" title="Oxygen concentrator">Oxygen concentrator</a></li>
<li><a href="Anaesthetic_machine" title="Anaesthetic machine">Anaesthetic machine</a></li>
<li><a href="List_of_medical_inhalants" title="List of medical inhalants">Medical inhalants</a></li>
<li><a href="Relative_analgesia_machine" title="Relative analgesia machine">Relative analgesia machine</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Ophthalmic_drug_administration" title="Ophthalmic drug administration">Ophthalmic</a>,<br><a href="Ear" title="Ear">otic</a>, <a href="Nasal_administration" title="Nasal administration">nasal</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Nasal_spray" title="Nasal spray">Nasal spray</a></li>
<li><a href="Ear_drop" title="Ear drop">Ear drops</a></li>
<li><a href="Eye_drop" title="Eye drop">Eye drops</a></li>
<li><a href="Topical" class="mw-redirect" title="Topical">Ointment</a></li>
<li><a href="Hydrogel" title="Hydrogel">Hydrogel</a></li>
<li><a href="Insufflation_(medicine)" title="Insufflation (medicine)">Insufflation</a></li>
<li><a href="Bioadhesive" title="Bioadhesive">Mucoadhesive microdisc</a></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Genitourinary_system" title="Genitourinary system">Urogenital</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<li><a href="Topical" class="mw-redirect" title="Topical">Ointment</a></li>
<li><a href="Pessary" title="Pessary">Pessary</a></li>
<li><a href="Vaginal_ring" title="Vaginal ring">Vaginal ring</a></li>
<li><a href="Douche" title="Douche">Douche</a></li>
<li><a href="Intrauterine_device" title="Intrauterine device">Intrauterine device</a> (IUD)</li>
<li><a href="Extra-amniotic_administration" title="Extra-amniotic administration">Extra-amniotic infusion</a></li>
<li><a href="Urinary_bladder" class="mw-redirect" title="Urinary bladder">Intravesical infusion</a></li>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Rectal_(medicine)" class="mw-redirect" title="Rectal (medicine)">Rectal</a> (<a href="Enteral_administration" title="Enteral administration">enteral</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Topical" class="mw-redirect" title="Topical">Ointment</a></li>
<li><a href="Suppository" title="Suppository">Suppository</a></li>
<li><a href="Enema" title="Enema">Enema</a>
<ul><li><a href="Solution_(chemistry)" title="Solution (chemistry)">Solution</a></li>
<li><a href="Hydrogel" title="Hydrogel">Hydrogel</a></li></ul></li>
<li><a href="Murphy_drip" title="Murphy drip">Murphy drip</a></li>
<li><a href="Nutrient_enema" title="Nutrient enema">Nutrient enema</a></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="Dermis" title="Dermis">Dermal</a> (<a href="Topical_medication" title="Topical medication">topical</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em">
<li><a href="Topical" class="mw-redirect" title="Topical">Ointment</a></li>
<li><a href="Topical_cream" class="mw-redirect" title="Topical cream">Topical cream</a></li>
<li><a href="Topical_gel" class="mw-redirect" title="Topical gel">Topical gel</a></li>
<li><a href="Liniment" title="Liniment">Liniment</a></li>
<li><a href="Paste_(rheology)" title="Paste (rheology)">Paste</a></li>
<li><a href="Thin_film_drug_delivery" class="mw-redirect" title="Thin film drug delivery">Film</a></li>
<li><a href="Dimethyl_sulfoxide" title="Dimethyl sulfoxide">DMSO</a> solution</li>
<li><a href="Iontophoresis" title="Iontophoresis">Iontophoresis</a></li>
<li><a href="Hydrogel" title="Hydrogel">Hydrogel</a></li>
<li><a href="Liposome" title="Liposome">Liposomes</a></li>
<li><a href="Transfersome" title="Transfersome">Transfersome vesicles</a></li>
<li><a href="Cream_(pharmaceutical)" class="mw-redirect" title="Cream (pharmaceutical)">Cream</a></li>
<li><a href="Lotion" title="Lotion">Lotion</a></li>
<li><a href="Lip_balm" title="Lip balm">Lip balm</a></li>
<li><a href="Shampoo" title="Shampoo">Medicated shampoo</a></li>
<li><a href="Dermal_patch" title="Dermal patch">Dermal patch</a></li>
<li><a href="Transdermal_patch" title="Transdermal patch">Transdermal patch</a></li>
<li><a href="Transdermal_spray" title="Transdermal spray">Transdermal spray</a></li>
<li><a href="Jet_injector" title="Jet injector">Jet injector</a></li></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0;"><div class="plainlist"><ul><li><a href="Parenteral" class="mw-redirect" title="Parenteral">Parenterals</a></li><li><a href="Injection_(medicine)" title="Injection (medicine)">Injections</a></li><li><a href="Infusion_pump" title="Infusion pump">infusions</a></li></ul></div><br><small><i>(into tissue/blood)</i></small></div></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Human_skin" title="Human skin">Skin</a> (<a href="Transdermal" title="Transdermal">transdermal</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em">
<li><a href="Intradermal_injection" title="Intradermal injection">Intradermal</a></li>
<li><a href="Subcutaneous_injection" class="mw-redirect" title="Subcutaneous injection">Subcutaneous</a>
<ul><li><a href="Injector_pen" title="Injector pen">Injector pen</a></li></ul></li>
<li><a href="Transdermal_implant" title="Transdermal implant">Transdermal implant</a></li>
</div></td><td class="noviewer navbox-image" rowspan="4" style="width:1px;padding:0 0 0 2px"><div><span typeof="mw:File"></span></div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Human_anatomy#Major_organ_systems" title="Human anatomy">Organs</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Intracavernous_injection" title="Intracavernous injection">Intracavernous</a></li>
<li><a href="Intravitreal_administration" title="Intravitreal administration">Intravitreal</a></li>
<li><a href="Intra-articular_injection" class="mw-redirect" title="Intra-articular injection">Intra-articular</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Central_nervous_system" title="Central nervous system">Central nervous system</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="padding:0"><div style="padding:0 0.25em">
<ul><li>Intracerebral</li>
<li><a href="Intrathecal_administration" title="Intrathecal administration">Intrathecal</a></li>
<li><a href="Epidural_administration" title="Epidural administration">Epidural</a></li></ul>
</div></td></tr><tr><th scope="row" class="navbox-group" style="width:10em;white-space:normal;"><a href="Circulatory_system" title="Circulatory system">Circulatory</a>,<br><a href="Human_musculoskeletal_system" title="Human musculoskeletal system">musculoskeletal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="padding:0"><div style="padding:0 0.25em">
<ul><li><a href="Intravenous" class="mw-redirect" title="Intravenous">Intravenous</a></li>
<li><a href="Intracardiac_injection" title="Intracardiac injection">Intracardiac</a></li>
<li><a href="Intramuscular_injection" title="Intramuscular injection">Intramuscular</a></li>
<li><a href="Intraosseous_infusion" title="Intraosseous infusion">Intraosseous</a></li>
<li><a href="Intraperitoneal_injection" title="Intraperitoneal injection">Intraperitoneal</a></li>
<li><a href="Nanocell" title="Nanocell">Nanocell injection</a></li>
<li><a href="Patient-controlled_analgesia" title="Patient-controlled analgesia">Patient-controlled analgesia</a> pump</li>
<li><a href="PIC_line" class="mw-redirect" title="PIC line">PIC line</a></li></ul>
</div></td></tr></tbody></table><div></div></td></tr></tbody></table></div>
<div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1038841319">
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</style></div><div role="navigation" class="navbox authority-control" aria-labelledby="Authority_control_databases_frameless&#124;text-top&#124;10px&#124;alt=Edit_this_at_Wikidata&#124;link=https&#58;//www.wikidata.org/wiki/Q35855#identifiers&#124;class=noprint&#124;Edit_this_at_Wikidata949" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><div id="Authority_control_databases_frameless&#124;text-top&#124;10px&#124;alt=Edit_this_at_Wikidata&#124;link=https&#58;//www.wikidata.org/wiki/Q35855#identifiers&#124;class=noprint&#124;Edit_this_at_Wikidata949" style="font-size:114%;margin:0 4em">Authority control databases </div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">National</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><ul><li><span class="uid"><span class="rt-commentedText tooltip tooltip-dotted" title="Zahnpasta"><a rel="nofollow" class="external text" href="https://d-nb.info/gnd/4190510-6">Germany</a></span></span></li><li><span class="uid"><a rel="nofollow" class="external text" href="https://id.loc.gov/authorities/sh96010366">United States</a></span></li><li><span class="uid"><a rel="nofollow" class="external text" href="https://id.ndl.go.jp/auth/ndlna/00562879">Japan</a></span></li><li><span class="uid"><a rel="nofollow" class="external text" href="https://www.nli.org.il/en/authorities/987007534890105171">Israel</a></span></li></ul></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><ul><li><span class="uid"><a rel="nofollow" class="external text" href="https://lux.collections.yale.edu/view/concept/95ff7401-b51e-4d6b-8077-23d9b2f7cfc1">Yale LUX</a></span></li></ul></div></td></tr></tbody></table></div></div><!--htdig_noindex--><div><div class="zim-footer">
This article is issued from <a class="external text" title="Last edited on 2025-08-02" href="https://en.wikipedia.org/wiki/?title=Toothpaste&oldid=1303819019">Wikipedia</a>. The text is available under <a class="external text" href="https://creativecommons.org/licenses/by-sa/4.0/deed.en">Creative Commons Attribution-Share Alike 4.0</a> unless otherwise noted. Additional terms may apply for the media files.
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