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Choosing a Toothpaste: What’s the Big Deal?

Course Number: 565

What Exactly is Dentifrice?

Modern dentifrices have their early origins in various attempts over the centuries at creating creams or powders to remove tooth debris and combat foul breath. In The History of Toothpaste, 19 author Frank Lippert recounts how ancient Egyptian history records a dental cream concoction of egg shells, pumice, myrrh, and powdered oxen hooves. The Romans may have been the first to incorporate malodor-concealing flavoring in the form of bark and charcoal, but overall, primitive toothpastes were poor tasting and overly abrasive. By the 18th century, tooth powders were more common, but they too were highly abrasive due to ingredients such as crushed earthenware. The next 100 years would bring the addition of ingredients like bicarbonate of soda, borax, glycerin, strontium, and chalk. 19

The first mass-produced toothpaste in a jar (Colgate & Co.) arrived in 1873, and by 1892, toothpaste had been packaged in a tube. 19 Toothpaste brands like Kolynos (for teeth that “gleam like pearls”), Ipana (for a “smile of beauty”), and Pepsodent (“you’ll wonder where the yellow went.”) joined Colgate as popular, well-known toothpastes through the early 1940s.20 A monumental breakthrough that would revolutionize the utility of dentifrices was the incorporation of fluoride for the reduction of tooth decay in the mid 1950s. Researchers like Klein and Palmer21 and later Dean22 conducted epidemiological studies in the 1930s that confirmed that fluoride levels in water supplies were associated with a lower incidence of dental caries. The public health significance of this newfound revelation was profound, given that the state of dental health in the US was described by some as “deplorable” at the inception of WWII.23 Clinical exploration of fluoride’s topical benefits in a dentifrice would follow, although formulation would prove challenging (e.g., Bibby et al.’s chalk-based paste that inactivated fluoride).24 Then a team led by Dr. Joseph Muhler at Indiana University – in conjunction with Procter & Gamble (P&G) – developed and clinically tested fluoride toothpaste which was shown to provide a mean caries reduction of 49% in children.25 This first commercially successful fluoride dentifrice – Crest® with Fluoristan™ (1000ppm stannous fluoride) – was launched nationally in 1956, and was awarded the American Dental Association’s Seal of Approval in 1960.26 Today there are about five major toothpaste manufacturers globally and numerous smaller distributors and private label makers. The extensive number of distinct dentifrices (brand, indication, size) available worldwide varies regionally and is ever-changing.

CE565 - Content - What Exactly is Dentifrice? - Figure 1

Figure 2.

Original Crest toothpaste, with the ADA Seal of Acceptance.