What are the excipients in toothpastes? - SPS...Big Teeth 6 -8 years 1450 Aroma NS CAPB Limonene...

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Medicines Q&As

What are the excipients in toothpastes?

Prepared by a UK Medicines Information (UKMi) team for NHS healthcare professionals Before using this Q&A, read the disclaimer at https://www.sps.nhs.uk/articles/about-ukmi-medicines-qas/

Date prepared: June 2019

Background Toothpastes contain a large number of excipients including fluoride, abrasives, detergents, binding agents, humectants, preservatives, colouring agents, antiseptics and flavourings (1). There are reports that some of these excipients cause adverse oral reactions such as cheilitis (due to allergic or irritant contact dermatitis – ACD and ICD), peri-oral eczema, stomatitis, lichenoid reactions, mucosal desquamation, burning mouth syndrome or burning tongue sensation, loss of taste and dry mouth; also hand dermatitis and systemic reactions such as anaphylaxis, rhinitis and breathing difficulties (1-44). There are no data on frequency of toothpaste allergy in the general population (2). However, in case reports and series of patients investigated for cheilitis, the frequency of allergic reactions to toothpastes ranges from 0% to 47%, with a rate of 10% in the largest series involving 202 patients (2,3). Excipients implicated are flavourings (and their active compounds) – spearmint (carvone), peppermint (menthol), fennel (anethole) and cinnamon or cassia oil (cinnamic aldehyde) (1,4-10). Also the antibacterial, triclosan (11,12), foaming agents such as cocamidopropyl betaine (13,14) and sodium lauryl sulphate (15-17), and preservatives such as parabens (4), polyethylene glycol (13,18) sodium benzoate (19), olaflur (amine fluoride) (20,21) and tin in stannous fluoride (22,23). Pyrophosphates in tartar-control toothpastes have caused ICD with ulceration, sloughing, erythema, fissuring and a burning sensation (24,25). Tartar-control toothpastes containing pyrophosphates can be a particular problem as they contain higher concentrations of flavourings and detergents to mask the bitter taste of these compounds and increase their solubility (24,25). Essential oils (tea tree oil and propolis) (4,39), fragrances (limonene and linalool) (40,41) and Salvadora persica, a shrub commonly known as Miswak or the „toothbrush tree‟ (42) have also been reported to cause allergy. There are no reports of ACD or stomatitis from fluoride in toothpaste with positive patch test to fluoride, and no reported evidence to support claims that fluoride is allergenic (2). For patients who experience adverse effects that are thought to be due to their toothpaste, changing to another product that does not contain the suspected excipient results in complete resolution of symptoms within a few weeks or months (4,14,17,20-25,28,29,31,32,43,46). A systematic review of four cross-over studies (n=124) showed a statistically significant reduction in number of aphthous ulcers (stomatitis) when participants were using sodium lauryl sulphate-free toothpastes as compared to sodium lauryl sulphate-containing toothpastes (mean difference -1.05 ulcers) (45). There was also a significant reduction in duration of ulcers (mean difference -1.99 days), number of episodes (-0.56) and ulcer pain. If ACD is suspected, patch testing can be helpful in identifying the likely allergen (47,48), but careful technique is needed to avoid false-positive and false-negative reactions (2).

Answer

The following table is a list of toothpastes widely available in the UK and the excipients they contain that are associated with irritant or allergic reactions affecting the mouth and lips, or systemic adverse effects.

It can be used to choose a suitable product that does not contain excipients suspected to be the cause of adverse reactions.

The table also includes fluoride content, and other excipients which may be undesirable.

Table key: CAPB cocamidopropyl betaine; NS detail not specified; PEG polyethylene glycol; PPM parts per million; PP pyrophosphate; SLS sodium lauryl sulphate

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Medicines Q&As

Toothpaste name Fluoride (ppm)

Excipients associated with adverse reactions (see Limitations and Bibliography) Other undesirable excipients

Anti-bacterial

Flavouring Foaming agent

Fragrance Preservative/ Solvent

Pyrophosphate Other

AloeDent by Optima Health & Nutrition (01274 526 360)

Charcoal None Tea tree Menthol Peppermint

Limonene Benzyl alcohol Potassium sorbate Sodium benzoate

Children‟s Fluoride-free

None Tea tree Aroma NS

Coconut None Tea tree Menthol Peppermint


Miswak None Tea tree Menthol Peppermint

Limonene Miswak

Pomegranate None Tea tree Menthol Peppermint


Pro Sensitive Enamel & Cavity Protection

1500 Tea tree Menthol Peppermint


Pro Sensitive Extreme Whitening Protection



Sensitive Fluoride 1500 Tea tree Menthol Peppermint

Limonene

Sensitive Fluoride-free None Tea tree Menthol Peppermint

Limonene

Smokers None Tea tree Menthol Peppermint


Spearmint None Tea tree Menthol Peppermint Spearmint



Medicines Q&As



Anti-bacterial



Pyrophosphate Other

AloeDent by Optima Health & Nutrition (01274 526 360) continued

Triple Action Fluoride 1500 Tea tree Menthol Peppermint

Limonene

Triple Action Fluoride-free

None Tea tree Menthol Peppermint

Limonene

Whitening Fluoride 1500 Tea tree Menthol Peppermint

Limonene

Whitening Fluoride-free


Limonene

Aquafresh by GlaxoSmithKline (0800 783 8881)

Active White 1450 Aroma NS SLS Limonene PEG-6

Big Teeth 6-8 years 1450 Aroma NS CAPB Limonene

Cavity Prevention 1450 Aroma NS SLS Limonene PEG-6

Complete Care Original

1450 Aroma NS SLS Limonene PEG-6

Complete Care Extra Fresh

1450 Aroma NS Citral

CAPB SLS

Limonene PEG-6

Complete Care Whitening

1450 Aroma NS CAPB SLS

Limonene PEG-6

Extreme Clean Pure Breath

1400 Aroma NS SLS PEG-6

Fresh & Minty 1450 Aroma NS SLS Limonene PEG-6/PEG-8

Intense Clean Deep Action


Limonene PEG-6

Intense Clean Lasting Fresh


Limonene PEG-6


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Aquafresh by GlaxoSmithKline (0800 783 8881) continued

Intense Clean Whitening


Limonene PEG-6

Little Teeth 3-5 years 1450 Aroma NS CAPB Limonene

Mild & Minty 1450 Aroma NS SLS Limonene PEG-6

Milk Teeth 0-2 years 1000 Aroma NS CAPB

Triple Protection 1450 Aroma NS SLS Limonene PEG-6/PEG-8

White & Shine 1450 Aroma NS CAPB SLS

Limonene

Arm and Hammer by Church and Dwight UK (0800 121 6080)

No details available from the manufacturer or their website

Australian Tea Tree by Optima Health & Nutrition (01274 526 360)

Tea Tree None Tea tree Menthol Peppermint

Limonene

Ballot-Flurin by Ballot-Flurin Apiculteurs ([email protected])

Smile None Propolis Peppermint Alcohol

Beverly Hills Formula by Purity Laboratories (00 353 1842 6611 – ROI)

Natural White Activated Charcoal Sensitive

1400 Aroma NS SLS Propylene glycol Tetrasodium PP

Natural White Dual Action

1400 Aroma NS SLS Limonene PEG-32

Natural White Total Protection Whitening

1400 Triclosan Aroma NS

SLS PEG-32

mailto:[email protected]


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Beverly Hills Formula by Purity Laboratories (00 353 1842 6611 – ROI) continued

Perfect White Black


Perfect White Black Sensitive


Perfect White Gold 1400 Aroma NS SLS Propylene glycol Tetrasodium PP

Perfect White Optic Blue

1400 Mint SLS Propylene glycol Tetrasodium PP

Professional White Black Pearl

1400 Aroma NS Menthol

SLS Propylene glycol Tetrasodium PP

Sensitive Whitening Expert


Biotène by GlaxoSmithKline (0800 783 8881)

Dry Mouth 1450 Aroma NS CAPB Limonene PEG-6

Fresh Mint 1450 Flavour NS CAPB PEG-8

BlanX by Coswell (Acdoco 0161 359 4130)

Advance Whitening 890 Aroma NS Eugenol Limonene

Benzyl alcohol Sodium benzoate

Black Charcoal 1450 Aroma NS SLS Limonene Benzyl alcohol Sodium benzoate

Classic White 890 Aroma NS Eugenol Limonene


Intensive Stain Removal

890 Anethole Aroma NS Menthol Peppermint

Eugenol Limonene



Medicines Q&As



Anti-bacterial



Pyrophosphate Other

BlanX by Coswell (Acdoco 0161 359 4130) continued

O3X Pro Shine 1450 Aroma NS SLS Limonene Benzyl alcohol Sodium benzoate

Pro Fresh White 950 Aroma NS Menthol


Pro Glossy White 950 Aroma NS Benzyl salicylate Linalool


Pro Pure White 950 Anethole Aroma NS Menthol Peppermint

Eugenol Benzyl alcohol Sodium benzoate

White Shock Instant White

950 Aroma NS SLS Benzyl alcohol Sodium benzoate

White Shock Power White Treatment


White Shock White & Protect


Brilliant by Lornamead (01225 768491)


Brush-Baby by Brush-Baby Ltd (01962 676593)

Teething 0-2 500 Aroma NS CAPB PEG-40

Applemint 0-3 1000 Aroma NS Citral

CAPB Limonene PEG-40

Fluoride-Free Strawberry Infant and Toddler 0-2

Aroma NS CAPB PEG-40


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Brush-Baby by Brush-Baby Ltd (01962 676593) continued

Mild Spearmint 6+ 1350 Aroma NS Citral


Tutti Frutti 3-6 1350 Aroma NS Citral


Clinomyn by Trimb Healthcare (0800 046 1977)

Clinomyn 1450 Aroma NS SLS Limonene Propylene glycol

Colgate by Colgate-Palmolive (00800 321 321 32 ROI)

Advanced White 1450 Aroma NS SLS Limonene PEG-12

Advanced White Charcoal Whitening


Limonene PEG-12 Tetrapotassium PP

Anti-Tartar plus Whitening

1450 Aroma NS SLS Limonene PEG-12 Tetrasodium PP

Cavity Protection 1450 Aroma NS SLS Tetrasodium PP

Cavity Protection Fresh Mint

1450 Aroma NS SLS Limonene Benzyl alcohol

Cool Stripe 1450 Aroma NS SLS PEG-12

Dare to Love Limited Edition

1000 Menthol Flavour NS

CAPB SLS

PEG-12

Deep Clean Whitening with Baking Soda

1450 Aroma NS SLS Limonene

Duraphat 2800 (prescription only)

2800 Mint SLS Macrogol 600


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Colgate by Colgate-Palmolive (00800 321 321 32 ROI) continued

Duraphat 5000 (prescription only)

5000 Anethole Carvone Menthol Peppermint Spearmint

SLS Macrogol 600 Sodium benzoate

Tetrapotassium PP

Enamel Strength 1450 Aroma NS CAPB SLS

Limonene PEG-12 Tetrasodium PP

Fresh Confidence Blue Burst

1450 Aroma NS SLS

Fresh Confidence Refreshing Green

1450 Aroma NS SLS

Fresh Gel 1450 Aroma NS SLS Limonene PEG-12

Icy Blast Whitening 2in1 (and mouthwash)


Limonene Tetrasodium PP

Junior Smiles Kids 3-5 years


Kids Mild Mint Flavour 6-9 years


Kids Minions Mild Flavour 4-6 years

1450 Aroma NS

SLS PEG-12

Kids Natural Fruit Flavour Baby 0-2 years

1000 Aroma NS

SLS Benzyl alcohol PEG-12

Kids Natural Fruit Flavour 3-5 years

1450 Aroma NS

SLS Benzyl alcohol PEG-12

Max Fresh Intense Foam


CAPB SLS

PEG-12

Max Fresh Cooling Crystals


CAPB SLS

Limonene PEG-12


Medicines Q&As



Anti-bacterial



Pyrophosphate Other


Max Fresh Cooling Crystals Travel


CAPB SLS

Limonene PEG-12

Max Fresh with Mouthwash


CAPB SLS


Max Fresh Mouthwash Beads


CAPB SLS


Maximum Cavity Protection Fresh Mint

1450 Aroma NS SLS Benzyl alcohol Tetrasodium PP

Maximum Cavity Protection Kids 3+ Years

1450 Aroma NS SLS Benzyl alcohol Tetrasodium PP

Maximum Cavity Protection Whitening

1450 Aroma NS SLS Limonene Benzyl alcohol Tetrasodium PP

MaxWhite Charcoal Whitening



MaxWhite Crystal Mint 1450 Aroma NS CAPB SLS


MaxWhite Expert Anti-Stain Whitening

1450 Aroma NS SLS Limonene PEG-12 PEG/PPG 116/66 copolymer Propylene glycol

Calcium PP Tetrasodium PP

MaxWhite Expert Complete Whitening

1450 Aroma NS SLS PEG-12 PEG/PPG 116/66 copolymer Propylene glycol


MaxWhite Expert Original Pearl Mint

1450 Aroma NS SLS Limonene PEG-12 PEG/PPG 116/66 copolymer Propylene glycol



Medicines Q&As



Anti-bacterial



Pyrophosphate Other


MaxWhite Expert Shine Glossy Mint

1450 Aroma NS SLS Eugenol Benzyl alcohol PEG-12 PEG/PPG 116/66 copolymer Propylene glycol


MaxWhite Luminous Whitening


PEG-12

Tetrapotassium PP

MaxWhite One Luminous Whitening


PEG-12

Tetrapotassium PP

MaxWhite One Whitening



MaxWhite Optic Whitening


Eugenol Limonene

PEG-12 Tetrapotassium PP

MaxWhite Protect Whitening


Eugenol PEG-12 Tetrapotassium PP

MaxWhite Shine Crystals Whitening


Eugenol Limonene

PEG-12 Tetrasodium PP

MaxWhite White Crystals Crystal



MaxWhite Whitening Crystals



Natural Extracts Charcoal


Eugenol Benzyl alcohol PEG-12

Tetrasodium PP

Natural Extracts Radiant White Seaweed Salt

1000 Aroma NS

CAPB SLS

Eugenol PEG-12

Tetrasodium PP

Natural Extracts Ultimate Fresh Lemon

1000 Aroma NS Citral

CAPB SLS

Eugenol Limonene

Benzyl alcohol PEG-12

Tetrasodium PP


Medicines Q&As



Anti-bacterial



Pyrophosphate Other


Sensitive Pro-Relief 1450 Aroma NS SLS Limonene Benzyl alcohol Tetrasodium PP

Sensitive Pro-Relief Enamel Repair


Sensitive Pro-Relief Extra Strength


Sensitive Pro-Relief Multi-Protection


Sensitive Pro-Relief Repair and Prevent

1450 Aroma NS CAPB Limonene Benzyl alcohol Tetrasodium PP

Sensitive Pro-Relief Smart White


Sensitive Pro-Relief Whitening


Sensitive Sensifoam Multi Protection


Eugenol Limonene

PEG-12 Tetrapotassium PP

Sensitive Sensifoam Whitening


Eugenol

PEG-12

Smiles Junior 6+ years 1450 Aroma NS SLS PEG-12

Smiles Junior Kids 0-2 years

1000 Anethole Aroma NS

SLS PEG-12

Total Active Fresh 1450 Aroma NS CAPB SLS

Eugenol Benzyl alcohol Tetrasodium PP

Total Advanced Deep Clean


Benzyl alcohol Tetrasodium PP

Total Advanced Enamel Health



Total Advanced Gum Health




Medicines Q&As



Anti-bacterial



Pyrophosphate Other


Total Advanced Pure Breath



Total Daily Repair 1450 Aroma NS CAPB SLS


Total Original 1450 Aroma NS CAPB SLS


Total Plaque Protection



Total Visible Proof 1450 Aroma NS CAPB SLS


Total Whitening 1450 Aroma NS CAPB SLS


Triple Action Original 1450 Aroma NS SLS PEG-12

Whitening & Fresh Breath


Whitening (and mouthwash)


Limonene Tetrasodium PP

Corsodyl by GlaxoSmithKline (0800 783 8881)

Extra Fresh 1400 Aroma NS Peppermint Wild Mint

CAPB Limonene Linalool

Alcohol

Extra Fresh Complete Protection


Limonene

Original 1400 Peppermint Wild Mint


Alcohol


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Corsodyl by GlaxoSmithKline (0800 783 8881) continued

Ultra Clean 1450 Aroma NS CAPB Limonene

Whitening 1400 Peppermint Wildmint


Alcohol

CREST by Procter and Gamble (0800 731 1792)


CURAPROX by Curaden UK Ltd (01480 862 084)

BE YOU. candy lover 950 Aroma NS Menthol

CAPB Limonene Cetyl alcohol Glucose

BE YOU. challenger 950 Aroma NS Menthol

CAPB Eugenol Limonene

Cetyl alcohol Glucose

BE YOU. daydreamer 950 Anise alcohol Aroma NS Geraniol Menthol

CAPB Eugenol Limonene Linalool


BE YOU. explorer 950 Aroma NS Menthol

CAPB Limonene


BE YOU. pure happiness

950 Aroma NS Geraniol Menthol



BE YOU. rising star 950 Aroma NS Menthol



Black Is White 950 Aroma NS CAPB Limonene Sodium benzoate Potassium sorbate

Vitamin E Sucrose


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

CURAPROX by Curaden UK Ltd (01480 862 084) continued

Enzycal 950 Aroma NS Sodium benzoate

Enzycal 1450 1450 Aroma NS Sodium benzoate

Enzycal Zero None Aroma NS Sodium benzoate

White Is Black 950 Aroma NS CAPB Limonene Sodium benzoate Potassium sorbate

Vitamin E Sucrose

Dr Bronner’s by Dr Bronner‟s ([email protected])

Anise All-One None Wildmint (menthol)

Vitamin E

Cinnamon All-One None Cassia oil (cinnamon) Wildmint (menthol)

Vitamin E

Peppermint All-One None Peppermint Wildmint (menthol)

Vitamin E

Dr Organic by Dr Organic (01792 646 475)

Activated Charcoal Extra Whitening



Aloe Vera Whitening 1000 Menthol Peppermint

Limonene Potassium benzoate Sodium benzoate

Coconut Oil Whitening 1000 Tea tree Menthol Peppermint




Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Dr Organic by Dr Organic (01792 646 475) continued

Dead Sea Mineral 1000 Tea tree Aroma NS Menthol Peppermint


Pomegranate Healthy Gums


Limonene Potassium sorbate Sodium benzoate

Tea Tree Fresh Breath Purifying


Limonene Potassium sorbate Sodium benzoate

Earth’s Best by Jason Natural Care (0845 072 5825)

Apple & Pear 6 months to 3 years

None SLS

Strawberry & Banana 6 months to 3 years

None SLS

Eucryl by Thornton & Ross (01484 842 217)

Freshmint 1122 Flavour NS SLS Limonene

Euthymol by Johnson & Johnson (01628 822 222)

Original None Menthol Methyl salicylate

SLS


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Green People by The Green People Company Ltd (01403 740350)

Citrus & Aloe Vera None Citral Limonene Linalool

Fennel & Propolis None Propolis Cinammon Fennel

Eugenol Limonene

Minty Cool None Peppermint Spearmint

Limonene Linalool

Organic Children Mandarin & Aloe Vera

None Limonene Linalool

Organic Children Mandarin & Aloe Vera with Fluoride

Yes Limonene Linalool

Potassium sorbate Sodium benzoate

Organic Children Spearmint & Aloe Vera

None Peppermint Spearmint

Limonene

Peppermint & Aloe Vera

None Peppermint Limonene Linalool

Jack N’ Jill by Jack and Jill Kids ([email protected])

Natural Calendula Banana Flavour

None Potassium sorbate

Natural Calendula Blackcurrant Flavour


Natural Calendula Blueberry Flavour

None

Potassium sorbate

Natural Calendula Flavour Free


Natural Calendula Raspberry Flavour




Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Jack N’ Jill by Jack and Jill Kids ([email protected]) continued

Natural Calendula Strawberry Flavour


Janina Ultrawhite Whitening by Brodie & Stone (0207 299 7400)

Activated Charcoal 1500 Wildmint SLS Limonene Linalool

Methylparaben Tetrasodium PP

Diamond Formula Extra Strength

1500 Wildmint SLS Limonene


Maxiwhite Super Strength

1500 Wildmint SLS Limonene

Ethylparaben Methylparaben

Tetrasodium PP

Sensitive 1500 Wildmint SLS Limonene


24k Gold 1500 Aroma NS SLS Limonene Propylene glycol Tetrasodium PP

Jason by Jason Natural Care (0845 072 5825)

Healthy Mouth Tartar Control

None Tea tree Menthol

Kids Only Orange None Flavour NS Potassium sorbate Sodium benzoate

Alcohol

Kids Only Strawberry None Flavour NS Benzyl alcohol Potassium sorbate Sodium benzoate

Nutrismile Enamel Defence

None Menthol Peppermint

Oral Comfort Sensitive Teeth

None Flavour NS Menthol Peppermint

Vitamin E



Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Jason by Jason Natural Care (0845 072 5825) continued

Powersmile Enzyme Brightening Gel


Powersmile Whitening None Peppermint

Sea Fresh Strengthening

None Spearmint

Simply Coconut Refreshing

None Tea tree Flavour NS Peppermint Spearmint Wintergreen

Simply Coconut Soothing

None Tea tree Flavour NS Peppermint

Alcohol

Simply Coconut Strengthening

None Flavour NS PeppermintSpearmint

Simply Coconut Whitening

None Flavour NS Alcohol

Kingfisher by Kingfisher Natural Toothpaste (01603 630 484)

Aloe Vera, Tea Tree and Fennel Fluoride free

None Tea tree Fennel Limonene

Aloe Vera, Tea Tree and Mint Fluoride free

None Tea tree Fennel Peppermint

Limonene

Baking Soda Fluoride free

None Peppermint Spearmint

Limonene

Charcoal Fluoride Free None Fennel Peppermint

Limonene

Fennel Fluoride Free None Anethole Fennel

Limonene


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Kingfisher by Kingfisher Natural Toothpaste (01603 630 484) continued

Fennel with Fluoride 1450 Anethole Fennel

Limonene

Mint Fluoride Free None Fennel Peppermint

Limonene

Mint with Fluoride 1450 Fennel Peppermint

Limonene

Strawberry Fluoride-Free

None Aroma NS Fennel

Limonene

MacLeans by GlaxoSmithKline (0800 783 8881)

Fresh Mint 1400 Aroma NS SLS Limonene PEG-6

Whitening 1450 Aroma NS CAPB SLS

Limonene PEG-6

White & Shine 1450 Aroma NS CAPB SLS

Limonene

Manuka Honey & Propolis by Savant Health (0113 388 5230)

Manuka Oil None Propolis Menthol Limonene

Tea Tree Oil None Propolis Tea tree

Menthol SLS Limonene

Mentadent by Unilever (0800 010 109)

Sensitive Yes Triclosan Aroma NS Limonene

SLS PEG-32

SR Yes Aroma NS Limonene

SLS PEG-32


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Mentadent by Unilever (0800 010 109) continued

P Yes Triclosan Aroma NS Eugenol Limonene

SLS PEG-32

Mr Blanc Teeth by Mr Blanc Teeth Ltd (0113 360 6546)

Bamboo Charcoal Whitening

None Aroma NS Menthol

SLS Sodium benzoate

Pro Whitening Yes Flavour NS Menthol

Sodium PP

NFco. by The Natural Family Co. ([email protected])

Blak None Australian River Mint Wildmint

Potassium sorbate

Original & Classic None Australian River Mint Wildmint

Potassium sorbate

Propolis & Myrrh None Propolis Australian River Mint Wildmint

Potassium sorbate

Sensitive None Australian River Mint Wildmint

Potassium sorbate

Whitening None Australian River Mint Wildmint

Potassium sorbate



Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Oral-B by Procter and Gamble (0800 731 1792)

3D White Artic Fresh 1100 Aroma NS SLS Limonene Disodium PP

3D White Deluxe Anti-Tobacco Fresh

1450 Aroma NS SLS Limonene Disodium PP

3D White Deluxe Tea & Coffee

1450 Aroma NS SLS Limonene Disodium PP

3D White Deluxe Vitalising Fresh

Yes Aroma NS SLS Limonene Disodium PP

3D White Luxe Anti Tobacco

1450 Anise alcohol Aroma NS

CAPB SLS

Limonene PEG-6 Potassium sorbate Sodium benzoate

3D White Luxe Diamond Strong



3D White Luxe Glamorous White

Yes Aroma NS CAPB SLS


3D White Luxe Instant Pearl Glow

Yes Anise alcohol Aroma NS

CAPB SLS


3D White Luxe Perfection

Yes Anise alcohol Aroma NS

CAPB SLS


3D White Soft Mint Yes Aroma NS SLS Limonene Disodium PP

3D White Whitening Therapy Enamel Care



3D White Whitening Therapy Whitening Sensitive



Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Oral-B by Procter and Gamble (0800 731 1792) continued

Complete Cavity 1450 Aroma NS SLS Eugenol Limonene

Complete Extra White Yes Aroma NS SLS Eugenol Limonene Linalool

Complete Instant Fresh


Complete Longlasting Clean plus Mouthwash


Complete Tartar 1450 Aroma NS SLS Limonene Disodium PP

Gum & Enamel Repair Extra Fresh

Yes Aroma NS Cinnamal

SLS Limonene PEG-6 Propylene glycol

Stannous fluoride

Gum & Enamel Repair Gentle Clean

Yes Aroma NS SLS Limonene PEG-6 Propylene glycol

Stannous fluoride

Gum & Enamel Repair Gentle Whitening

Yes Aroma NS Cinnamal

SLS Limonene PEG-6 Propylene glycol

Stannous fluoride

Gum & Enamel Repair Original

1450 Aroma NS SLS PEG-6 Propylene glycol

Stannous fluoride

Pro-Expert Deep Clean 1450 Aroma NS SLS PEG-6 Propylene glycol

Stannous fluoride

Pro-Expert Fresh Breath

1450 Aroma NS SLS Limonene Stannous fluoride

Pro-Expert Gum Care 1450 Aroma NS SLS Limonene Potassium sorbate Sodium benzoate

Stannous fluoride

Pro-Expert Professional Protection

1450 Aroma NS Cinnamal

SLS Eugenol PEG-6 Propylene glycol

Stannous fluoride

Pro-Expert Sensitive Protect

1450 Aroma NS SLS Potassium benzoate Sodium benzoate

Stannous fluoride


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Oral-B by Procter and Gamble (0800 731 1792) continued

Pro-Expert Healthy Whitening


Stannous fluoride

Pro-Expert Strong Enamel


Stannous fluoride

Baby Winnie the Pooh Caution: there are two formulations of this product



Kids Cars 1450 Aroma NS Cinnamal

CAPB Limonene Benzyl alcohol Sodium benzoate

Kids Frozen 1450 Aroma NS Cinnamal

CAPB Limonene Benzyl alcohol Sodium benzoate

Junior 1450 Aroma NS SLS

Junior Star Wars 1450 Aroma NS SLS

Pearl Drops by Church and Dwight UK (0800 121 6080)

Instant Natural White Charcoal Innovation

Yes Aroma NS PEG-12

Lasting Flawless White 1360 Aroma NS SLS

Limonene PEG-8 PEG/PPG 116-66 copolymer Polyethylene

Luminous Bright White Pro-Shine Complex

1300 Aroma NS CAPB Limonene PEG-12 Alcohol

Pure Natural White White Clay Extract

1360 Aroma NS Limonene PEG-12

Strong Polished White Perlite Minerals

1300 Aroma NS SLS Limonene PEG-12 Alcohol


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Pro Teeth Whitening Co. by Pro Teeth Whitening Co (0207 117 2868)

Activated Charcoal Whitening

None Aroma NS Potassium sorbate Sodium benzoate

Night Time Formula Moisturising

1000 Aroma NS Sodium benzoate Vitamin E Glucose

Day Time Formula Charcoal Whitening

1000 Aroma NS Potassium sorbate Sodium benzoate

Rapid White by Lornamead (01225 768 491)


Regenerate by Unilever (0800 010 109)

Advanced Yes Aroma NS SLS Limonene PEG-8 PEG-60

Sainsbury’s by Sainsbury‟s (0800 636 262)

Basics 1450 Aroma NS SLS Limonene

OraCare+ Baby Gentle Mint Fluoride


OraCare+ Extreme Freshmint


OraCare+ Gum Health 1450 Aroma NS Cinnamal

SLS Limonene

OraCare+ Kids Fruity Berry Fluoride

1450 Aroma NS SLS

OraCare+ Kids Mild Mint Fluoride


OraCare+ Sensitive 1450 Aroma NS Cinnamal

SLS Limonene


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Sainsbury’s by Sainsbury‟s (0800 636 262) continued

OraCare+ Whitening 1450 Aroma NS SLS Limonene

Schmidt’s by Schmidt‟s (0800 587 6673)

Activated Charcoal with Wondermint

None Tea tree Aroma NS Sodium benzoate Vitamin E

Coconut + Lime None Tea tree Aroma NS Benzyl alcohol Sodium benzoate

Vitamin E

Wondermint None Tea tree Aroma NS Sodium benzoate Vitamin E

Sensodyne by GlaxoSmithKline (0800 783 8881)

Complete Protection 1450 Aroma NS CAPB Limonene PEG-8

Complete Protection Extra Fresh

1450 Aroma NS CAPB Limonene PEG-8

Daily Care Deep Clean Gel


Limonene PEG-6

Daily Care Extra Fresh 1450 Aroma NS CAPB Limonene

Daily Care Gentle Whitening Caution: there are two formulations of this product

1450 Aroma NS CAPB PEG-6

1400 Aroma NS CAPB PEG-6

Daily Care Original 1450 Aroma NS CAPB Limonene

Mild Mint 1450 Aroma NS SLS

Pronamel Daily Protection

1450 Anise alcohol Aroma NS

CAPB Limonene PEG-6

Pronamel Extra Freshness



Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Sensodyne by GlaxoSmithKline (0800 783 8881) continued

Pronamel for Children 6-12 years


Pronamel Gentle Whitening


Pronamel Intensive Enamel Repair


Pronamel Multi-Action 1450 Aroma NS CAPB Eugenol Limonene

Pronamel Strong and Bright Enamel


Rapid Relief 1450 Aroma NS CAPB SLS

Limonene PEG-8 Stannous fluoride

Rapid Relief Extra Fresh



Rapid Relief Whitening



Repair & Protect 1450 Aroma NS CAPB Limonene PEG-8

Repair & Protect Extra Fresh


Repair & Protect Whitening


Sensitivity & Gum 1450 Aroma NS CAPB SLS


Sensitivity & Gum Whitening



True White Mint 1450 Aroma NS CAPB Limonene PEG-6

True White Extra Fresh 1450 Aroma NS CAPB Limonene PEG-6


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Tesco by Tesco (0800 50 5555)

Baby Steps 0-2 1000 Aroma NS SLS Limonene PEG-32

Big Steps 6+ 1450 Aroma NS SLS Limonene PEG-32

Essentials Cavity Protection

Yes Aroma NS SLS

Kids Strawberry Ice Cream Flavour Stripey


Little Steps 3-5 1450 Aroma NS SLS Limonene PEG-32

Pro Formula Complete Care

Yes Aroma NS SLS Limonene

Pro Formula Complete Charcoal


Pro Formula Complete Gum Health

Yes Aroma NS SLS PEG-32 Vitamin E

Pro Formula Complete Sensitive


UltraDEX by Periproducts (01344 578 004)

Original 1000 Menthol Peppermint Spearmint

Limonene

Whitening 1000 Menthol Peppermint Spearmint

Limonene


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Urtekram Organic by Urtekram (01403 786 460)

Aloe Vera None Limonene Linalool

Children Original None Fennel Limonene

Children Tuttifrutti None Aroma NS Limonene

Eucalyptus None Limonene

Fresh Mint Whitening None Menthol Peppermint Spearmint Wildmint

Limonene

Mint & Green Tea None Peppermint Spearmint

Limonene Linalool

Mint with Fluoride 1000 Menthol Peppermint Spearmint Wildmint

Limonene

Strong Mint Sensitive None Menthol Peppermint Spearmint Wildmint

Limonene

Tea tree None Tea tree Limonene

Weleda by Weleda UK (0115 944 8200)

Calendula None Aroma NS Limonene Alcohol

Children‟s Tooth Gel None Aroma NS Limonene

Plant Gel None Aroma NS Limonene Alcohol

Ratanhia None Aroma NS Limonene Alcohol

Salt None Aroma NS Peppermint

Limonene Linalool

Alcohol


Medicines Q&As



Anti-bacterial



Pyrophosphate Other

Wisdom by Wisdom Toothbrush Ltd (01440 714 800)

Daily Enamel Repair 1450 Aroma NS CAPB

Daily Gum Health 1450 Aroma NS

SLS Limonene PEG-8 PEG-40 hydrogena-ted castor oil Sodium benzoate

Express Relief Sensitive


Limonene PEG-8

Fresh Effect Whitening 1350 Aroma NS SLS Limonene

Quantum Enamel Protect Gum Health Protect

1450 Triclosan Aroma NS SLS

Sensitive Whitening 1350 Aroma NS SLS Limonene Potassium sorbate Sodium benzoate

Smokers 1450 Aroma NS Menthol

PEG-8

Step by Step 0-3 years Cavity & Enamel Defence

1000 Aroma NS SLS Limonene Methylparaben

Step by Step 4+ years Cavity & Enamel Defence


UV Pro Whitening Expert Shine

1450 Aroma NS CAPB

UV Pro Whitening Instant

1450 Aroma NS SLS

Xtra Clean Ultimate Cavity Protection


SLS Limonene Sodium benzoate


Medicines Q&As

Summary

Toothpastes contain excipients that can cause adverse reactions affecting the mouth and lips, and systemic hypersensitivity.

Excipients most commonly implicated are flavourings such as spearmint, peppermint, fennel, cinnamon and cassia oil, but preservatives, foaming agents, antibacterials, pyrophosphates and essential oils can also cause adverse reactions.

This Medicines Q&A lists toothpastes widely available in the UK and the excipients they contain which have been associated with adverse reactions or may be undesirable.

Limitations 1. This is not an exhaustive list of all toothpastes available in the UK. Not all supermarkets‟ or stores‟ own-branded products are included. 2. Only excipients reported as relatively common allergens (1-4,40), or one of the 26 allergenic substances listed within annex III of the European Commission‟s (EC) Cosmetics Regulation (49) (shown in italics in the table below), or an excipient identified as causing local irritation following topical administration in EC guidelines on labelling of medicinal products for human use (50,51) (shown in bold in the table below) are included in the table plus a few selected excipients which some people may find undesirable. These include:

Alcohol alcohol (ethanol)

Antibacterials propolis, tea tree oil (melaleuca oil), triclosan

Flavourings anethole, anise alcohol, aroma NS, carvone, cassia oil, cinnamal, cinnamic aldehyde, cinnamon, citral, doublemint, fennel (foeniculum vulgare), flavour NS, herbalmint, levomenthol, menthol, mint, peppermint (mentha piperita), spearmint (mentha viridis), wildmint (mentha arvensis), wintergreen (methyl salicylate)

Foaming agents CAPB, SLS

Fragrances eugenol, limonene, linalool

Others arachis oil (peanut oil), colophony, sesame oil, soya oil, hydrogenated soya oil, stannous fluoride, vitamin E (α-tocopherol)

Preservatives benzyl alcohol, benzoic acid (E210), macrogols, parabens, PEG, polyethylene, potassium benzoate (E212), propylene glycol, sodium benzoate (E211), sorbic acid (E200) and salts

Pyrophosphates bisodium PP, calcium PP, tetrapotassium PP, tetrasodium PP

Natural sweeteners

beta-D glucose, fructose, glucose, invert sugar, sucrose

EC fragrance allergens (if not listed in the rows above)

alpha-isomethyl ionone, amyl cinnamal, amylcinnamyl alcohol, cinnamyl alcohol, benzyl benzoate, benzyl cinnamate, benzyl salicylate, butylphenyl methylpropional, citronellol, coumarin, evernia furfuracea, evernia prunastri, farnesol, geraniol, hexylcinnamal, hydroxycitronellal, hydroxyisohexyl 3-cyclohexane carboxaldehyde, isoeugenol, methyl 2-octynoate.

EC local irritants (if not listed in the rows above)

balsam of Peru, benzalkonium chloride, bronopol, butylated hydroxyanisole (E320), butylated hydroxytoluene (E321), cetostearyl alcohol, cetyl alcohol, chlorocresol, dimethyl suphoxide, formaldehyde, macrogolglycerol hydroxystearate (castor oil polyoxyl hydrogenated), macrogolglycerol ricinoleate (castor oil polyoxyl), organic mercury compounds (thiomersal, phenylmercuric nitrate/acetate/borate), parahydroxybenzoates and their esters, e.g. ethyl p-hydroxybenzoate (E214), sodium ethyl p-hydroxybenzoate (E215), propyl p-hydroxybenzoate, sodium propyl p-hydroxybenzoate, methyl p-hydroxybenzoate (E218), sodium methyl p-hydroxybenzoate (E219), stearyl alcohol, wool fat (lanolin)

Note: Aroma NS and Flavour NS: manufacturers do not have to name ingredients on product labelling if the concentration falls below the threshold stated in the Cosmetics Regulation, even if they are one of the 26 EC allergens. The thresholds are 0.001% for leave-on products and 0.01% for rinse-off products (49,52).


Medicines Q&As

3. Absence of any other excipient from the table in this Medicines Q&A (other than those listed above) does not mean it is not included within a toothpaste. Also, we cannot guarantee that the toothpaste has not been in contact with the excipient during the manufacturing process. If further information is required, check with the manufacturer. 4. Within the table, excipients have been categorised according to their most common use but many have additional uses and may be suitable for inclusion within another category – where this is the case, they have been listed only once. The source of excipients has not been stated. 5. Formulations may be subject to change, but the information contained in this document is accurate at the time of publication. Excipient content has been confirmed with the manufacturer or by checking the manufacturer‟s website. References

1. Francalanci S, Sertoli A, Giorgini S et al. Multicentre study of allergic contact cheilitis from

toothpastes. Contact Dermatitis 2000; 43: 216-222. 2. de Groot A. Contact allergy to (ingredients of) toothpastes. Dermatitis 2017; 28: 95-114. 3. Lim SW and Goh CL. Epidemiology of eczematous cheilitis at a tertiary dermatological referral

centre in Singapore. Contact Dermatitis 2000; 43: 322-326. 4. Otto S and Zirwas MJ. Toothpaste allergy diagnosis and management. J Clin Aesth Dermatol

2010. [Internet] [cited 16/8/17]. Available from www.jcadonline.com/toothpaste-allergy-diagnosis-and-management/.

5. Goh CL. Contact cheilitis – a review. Exog Dermatol 2003; 2: 173-177. 6. Kroona L. Use test with l-carvone in toothpaste on sensitized individuals. Contact Dermatitis

2018; 79: 47-48. 7. Griggs J, Almohanna H, Ahmed A et al. “Fresh breath” on toothpaste: Peppermint as cause of

cheilitis. Dermatitis 2019; 30: 74-75. 8. Aschenbeck KA and Hylwa SA. Brushing your way to allergic contact dermatitis: Anethole allergy.

Dermatitis 2017; 28: 219-220. 9. Horst N, Leysen J, Mellaerts T et al. Allergic contact cheilitis from anethole-containing

toothpastes: A practical solution. J Eur Acad Dermatol Venereol 2017; 31: e374-375. 10. Madineni AR and Thompson DA. Lichenoid oral eruption: A case of contact allergy to a

cinnamon-flavoured toothpaste. Br J Dermatol 2016; 175 (Suppl. S1): 182-183. 11. Robertshaw H and Leppard B. Contact dermatitis to triclosan in toothpaste. Contact Dermatitis

2007; 57: 383-384. 12. Ozkaya E and Bozkurt PK. An unusual case of triclosan-induced immunological contact urticaria.

Contact Dermatitis 2013; 68: 121-123. 13. Moreau J and Kaplan B. Toothpaste-associated labial allergic contact dermatitis. Allergy 2013; 68

(Suppl. 97): 598. 14. Agar N and Freeman S. Cheilitis caused by contact allergy to cocamidopropyl betaine in „2-in-1

toothpaste and mouthwash‟. Austral J Dermatol 2005; 46: 15-17. 15. Lee A-Y, Yoo S-H, Oh J-G and Kim Y-G. 2 cases of allergic contact cheilitis from sodium lauryl

sulfate in toothpaste. Contact Dermatitis 2000; 42: 111. 16. Anjum N, Jarrett R, Haworth A et al. Is sodium lauryl sulphate a true allergen or just an irritant in

granulomatous cheilitis? Br J Dermatol 2011: 165 (Suppl.1): 80-81. 17. Brown RS, Smith L and Glascoe AL. Inflammatory reaction of the anterior dorsal tongue

presumably to sodium lauryl sulphate within toothpastes: A triple case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125: e17-21.

18. Ito M, Watanabe D, Kobayashi M et al. Acute hypersensitivity to dentifrice. Contact Dermatitis 2006; 54: 225.

19. Munoz FJ, Bellido J, Moyano JC et al. Perioral contact urticaria from sodium benzoate in toothpaste. Contact Dermatitis 1996; 35: 51.

20. de Groot A, Tupker R, Hissink D et al. Allergic contact cheilitis caused by olaflur in toothpaste. Contact dermatitis 2016; 76: 61-62.

21. Foti C, Romita P, Ficco D et al. Allergic contact cheilitis to amine fluoride in a toothpaste. Dermatitis 2014; 25: 209.

22. Enamandram M, Das S and Chaney KS. Cheilitis and urticaria associated with stannous fluoride in toothpaste. J Am Acad Dermatol 2014; 71: e75-76.

http://www.jcadonline.com/toothpaste-allergy-diagnosis-and-management/http://www.jcadonline.com/toothpaste-allergy-diagnosis-and-management/


Medicines Q&As

23. Toma N, Horst N, Dandelooy J et al. Contact allergy caused by stannous fluoride in toothpaste. Contact Dermatitis 2018, 78: 304-306.

24. Beacham BE, Kurgansky D and Gould WM. Circumoral dermatitis and cheilitis caused by tartar control dentifrices. J Am Acad Dermatol 1990; 22: 1029-1032.

25. DeLattre VF. Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes: report of a case and literature review. J Periodontol 1999; 70: 803-807.

26. Andersson M and Hindsen M. Rhinitis because of toothpaste and other menthol-containing products. Allergy 2007; 62: 336-337.

27. Scully C. Reaction to cinnamon. Br Dent J 2006; 201: 489. 28. Poon TSC and Freeman S. Cheilitis caused by contact allergy to anethole in spearmint flavoured

toothpaste. Austral J Dermatol 2006; 47: 300-301. 29. Corazza M, Levratti A and Virgili A. Allergic contact cheilitis due to carvone in toothpastes.

Contact Dermatitis 2002; 46: 366-367. 30. Skrebova N, Brocks K and Karlsmark T. Allergic contact cheilitis from spearmint oil. Contact

Dermatitis 1998; 39: 35-36. 31. Worm M, Jeep S, Sterry W and Zuberbier T. Perioral contact dermatitis caused by L-carvone in

toothpaste. Contact Dermatitis 1998; 38: 338. 32. Franks A. Contact allergy to anethole in toothpaste associated with loss of taste. Contact

Dermatitis 1998; 38: 354. 33. Kirton V and Wilkinson DS. Contact sensitivity to toothpaste. BMJ 1973; 2: 115-116. 34. Paiva M, Piedade A and Gaspar A. Toothpaste-induced anaphylaxis caused by mint (Mentha)

allergy. Allergy 2010; 65: 1201. 35. Hansson C, Bergendorff O and Wallengren J. Contact urticaria caused by carvone in toothpaste.

Contact Dermatitis 2011; 65: 362-364. 36. Masterpol KS, Gottlieb AB and Scheinman PL. Systemic contact dermatitis presenting as lichen

planus of the lip. Dermatitis 2010; 21: 218-219. 37. Bourgeois P and Goossens A. Allergic contact cheilitis caused by menthol in toothpaste and

throat medication: a case report. Contact Dermatitis 2016; 75: 113-115. 38. Isaac-Renton M, Li MK and Parsons LM. Cinammon spice and everything not nice: Many features

of intraoral allergy to cinnamic aldehyde. Dermatitis 2015; 26: 116-121. 39. Scheman A, Jacob S, Zirwas M et al. Contact Allergy: Alternatives for the 2007 North American

Contact Dermatitis Group (NACDG) standard screening tray. Dis Mon 2008; 54: 7-156. 40. Buckley DA. Fragrance ingredient labelling in products on sale in the U.K. Br J Dermatol 2007;

157: 295-300. 41. Trokoudes D and McFadden J. Cheilitis secondary to limonene contained in toothpaste. Contact

Dermatitis 2016; 75 (Suppl. 1): 72-73. 42. Chaubal TV, Bapat RA and Bapat PR. Allergic contact stomatitis caused Salvadora persica in

toothpaste. Contact Dermatitis 2017; 77: 325-326. 43. Van Baelen A, Kerre S and Goossens A. Allergic contact cheilitis and hand dermatitis caused by

a toothpaste. Contact Dermatitis 2016; 74: 187-189. 44. Berton F, Stacchi C, Bussani R et al. Toothpaste-induced oral mucosal desquamation. Dermatitis

2016, 28: 162-163. 45. Alli BY, Erinoso OA and Olawuyi AB. Effect of sodium lauryl sulphate on recurrent aphthous

stomatitis: A systematic review. J Oral Pathol Med, 2019; 48: 358-364. 46. Ghosh SK and Bandyopadhyay D. Concurrent allergic contact dermatitis of the index fingers and

lips from toothpaste: Report of three cases. J Cutan Med Surg 2011; 15: 356-357. 47. Lewis MAO and Jordan RCK. A colour handbook of oral medicine. 1

st edition. London: Manson

Publishing; 2004: p83. 48. DermNet NZ. Contact reactions to toothpaste and other oral hygiene products [Internet]. 2010

[cited 16/8/17]. Available from www.dermnetnz.org/reactions/toothpaste-reactions.html. 49. European Commission. Regulation (EC) No 1223/2009 of the European Parliament and of the

Council of 30 November 2009 on cosmetic products (recast) [Internet]. 2009 [cited 16/8/17]. Available from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:342:0059:0209:en:PDF.

50. European Commission. Volume 2C Guidelines. Medicinal products for human use: safety, environment and information. Excipients in the label and package leaflet of medicinal products for human use. Reference SANTE-2017-11668. March 2018 [cited 28/09/19]. Available at: https://ec.europa.eu/health/sites/health/files/files/eudralex/vol-2/c/guidelines_excipients_march2018_en.pdf

http://www.dermnetnz.org/reactions/toothpaste-reactions.htmlhttp://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:342:0059:0209:en:PDFhttp://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:342:0059:0209:en:PDFhttps://ec.europa.eu/health/sites/health/files/files/eudralex/vol-2/c/guidelines_excipients_march2018_en.pdfhttps://ec.europa.eu/health/sites/health/files/files/eudralex/vol-2/c/guidelines_excipients_march2018_en.pdf


Medicines Q&As

51. European Commission. Annex to the European Commission guideline on „Excipients in the labelling and package leaflet of medicinal products for human use‟ (SANTE-2017-11668). Reference EMA/CHMP/302620/2017 corr.1. October 2017 [cited 28/09/19]. Available at: www.ema.europa.eu/documents/scientific-guideline/annex-european-commission-guideline-excipients-labelling-package-leaflet-medicinal-products-human_en.pdf

52. Cosmetics Europe. Guidelines on cosmetic product labelling [Internet]. 2011 [cited 5/10/19]. Available from www.cosmeticseurope.eu/download/YWI1VGk0RWtBNG8yOU9Td1FOZlhhUT09

Bibliography The following sources were used to assemble the tables of toothpastes and excipients:

• Manufacturer‟s websites. Accessed April-July 2019. • Personal communication with manufacturers by email or telephone. May-October 2019. • European Commission CosIng database http://ec.europa.eu/growth/tools-databases/cosing/

Accessed June 2019. Quality Assurance Prepared by Joanne McEntee and Helen Edmondson. North West Medicines Information Centre. Date Prepared April to September 2019 Checked by Eimear Maguire. North West Medicines Information Centre. Date of check November 2019 Search strategy (updated June 2019) 1. Embase 1974 to date - Toothpaste/ AND (Excipient/ OR exp Hypersensitivity/)

2. Medline 1950 to date - Toothpaste/ AND (Excipient/ OR exp Hypersensitivity/); exp Dentifrices/

AND (exp Excipient/ OR exp Hypersensitivity/)

3. In-house databases and resources

4. Internet search (www.google.co.uk – toothpaste allergy)

5. Professional bodies (www.bda.org – toothpaste or allergy)

6. Clinical experts – contacted January 2011 when developing the first issue of this Medicines Q&A:

Dr Lesley Longman, Senior Lecturer/Honorary Consultant in Special Care and Restorative Dentistry, and Clinical and Teaching Lead for Sedation and Special Care Dentistry, School of Dental Sciences, Liverpool.

Dr Anne Field, Clinical Director and Consultant/Honorary Professor in Oral Medicine, Liverpool University Dental Hospital, Liverpool.

Dr Clodagh King, Consultant Dermatologist, Broadgreen Hospital, Liverpool.
http://www.ema.europa.eu/documents/scientific-guideline/annex-european-commission-guideline-excipients-labelling-package-leaflet-medicinal-products-human_en.pdfhttp://www.ema.europa.eu/documents/scientific-guideline/annex-european-commission-guideline-excipients-labelling-package-leaflet-medicinal-products-human_en.pdfhttp://www.cosmeticseurope.eu/download/YWI1VGk0RWtBNG8yOU9Td1FOZlhhUT09http://ec.europa.eu/growth/tools-databases/cosing/http://www.google.co.uk/http://www.bda.org/

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