Is Toothpaste Actually Harmful?

SLS is the chemical that makes your toothpaste foam. It has no cleaning benefit — the foam is purely for the sensation of cleanliness. However, SLS is an irritant to the oral mucosa (the lining of your mouth). Multiple clinical studies have linked SLS-containing toothpastes to increased incidence of aphthous ulcers (mouth sores). SLS disrupts the mucosal layer that normally protects your mouth from pathogens, temporarily leaving your oral tissue more vulnerable. If you regularly get mouth ulcers, SLS toothpaste is a likely contributor.

The fluoride debate is complex. Fluoride at appropriate doses does inhibit tooth decay. However, India is unique: many states have naturally occurring fluoride levels in groundwater that already exceed safe limits (1.5 mg/L WHO guideline). Adding fluoride through toothpaste creates excess accumulation, linked to dental fluorosis (white streaks on teeth in children) and in extreme cases, skeletal fluorosis. The problem is that toothpaste manufacturers do not account for regional water fluoride levels. In Gujarat specifically, parts of Bhavnagar district have fluoride levels above safe thresholds — making additional fluoride from toothpaste a real concern for local residents.

Triclosan was added to toothpastes as an antibacterial agent. It has since been banned from soap and hand wash products in the US, EU and several other jurisdictions due to evidence linking it to endocrine disruption (interfering with thyroid hormones and reproductive hormones). Yet some toothpaste brands — including those still sold in India — continue to include it. Triclosan also contributes to antibiotic resistance by creating selective pressure on oral bacteria. The FDA removed it from soap products in 2016. The oral care market has been slower to respond.

Toothpaste needs to taste palatable — so manufacturers add saccharin and sorbitol. Saccharin is a synthetic sweetener with an acceptable daily intake limit. While quantities in toothpaste are below harmful thresholds, daily swallowing by children (who rarely spit completely) and sensitivity in some individuals is a concern. Sorbitol, a sugar alcohol, can ferment in the gut when swallowed in quantity, causing digestive discomfort.

Titanium dioxide gives toothpaste its brilliant white colour and is also used as a whitening agent. The European Food Safety Authority has classified titanium dioxide as no longer safe for consumption as a food additive (the classification was updated in 2021). France has banned it in food products. Nanoparticle forms of TiO2 used in some toothpastes have raised additional concerns about cellular uptake and mucosal absorption. Its use in toothpaste remains legal in most countries, but the trajectory of regulatory opinion is concerning.

Some whitening and deep-clean toothpastes contain tiny plastic beads (microbeads) as abrasive exfoliants. These have been documented to become trapped under the gum line, where they harbour bacteria and contribute to gum disease. Microbeads also enter water systems and accumulate in the food chain. They are banned in rinse-off cosmetics in many countries but their use in toothpaste is inconsistently regulated. Check your toothpaste ingredient list for polyethylene (PE) — if it is there, you are brushing with plastic.