Composition of modern toothpastes: From chemical components to clinical recommendations (narrative review)

Abstract

All toothpaste manufacturers promise comprehensive protection for teeth and/or gums, but often the advertising slogans conceal a complex world of chemical compounds that are not always safe, effective, or understandable to consumers. Patients and doctors often have only a general idea of the composition of toothpastes and do not sufficiently understand the differences between the active ingredients. The purpose of this review is to detail information on the active ingredients of toothpastes and their effectiveness for various oral conditions, assess the real benefits and risks of each component, and propose criteria for choosing the optimal product based on the individual needs of the patient.
Materials and methods.
A narrative review was conducted in accordance with the quality criteria of the SANRA (Scale for the Assessment of Narrative Review Articles) scale. A search for relevant publications was conducted in seven databases (PubMed, EMBASE, MEDLINE, Springer, Wiley Online Library, Scopus, eLIBRARY) using 28 keywords and phrases in English and Russian. The search period spanned 51 years. Of 342 publications, 93 studies were included in the review.
Results.
Fluoride bioavailability was found to depend on chemical compatibility with abrasives. Stannous fluoride demonstrates advantages over other fluorides in terms of antimicrobial and antierosive effects, while its clinical superiority in remineralization requires further study. In one moderately strong in situ study, CPP-ACP generated the highest levels of bioavailable calcium among the forms tested; however, existing randomized trials generally do not support the clinical superiority of calcium phosphate systems over fluoride. Nanohydroxyapatite shows conflicting results and is not FDA-approved as an anticaries agent. Xylitol may be part of a comprehensive caries prevention strategy, but is not an alternative to fluoride. The relative dentin abrasivity index (RDA) is a purely laboratory parameter that should be considered as one variable in a multifactorial clinical wear process, but not as the sole criterion for toothpaste safety. Sodium lauryl sulfate (SLS) has limited proven adverse effects, primarily in patients with recurrent aphthous stomatitis, while for the majority of users, convincing data on clinically significant harm have not been obtained. For moisturizing ingredients used for xerostomia, the evidence base remains weak: available studies have small sample sizes, a high risk of bias, and do not allow us to isolate the benefits of any specific ingredient.
Conclusions.
Fluoride should be an essential component of toothpaste for most patients. The fluoride content stated on the label does not always fully reflect its effectiveness due to formulation differences affecting the bioavailability of the active ingredients. The choice of the optimal toothpaste should be based on individual patient risk criteria, the type of active ingredients, their bioavailability, and the level of evidence for efficacy.