Gimmicky over-the-counter toothpastes may be risking patients' dental health.

According to a new review published today in the British Dental Journal, consumers should be warned that ‘gimmicky’ over-the-counter charcoal-based toothpastes or powders do not whiten teeth and may have the potential for increasing health risks such as abrasions. The review casts serious doubts about the marketing and benefits of such products.

Dentists are also urged to educate their patients about unproven oral health benefit claims and the possible health risks associated with the use of charcoal pastes and powders, which could also potentially increase risk of developing tooth decay from use of non-fluoridated or possibly because the charcoal can inactivate the fluoride products inside the toothpaste.

Charcoal-based toothpastes and powders are promoted worldwide to consumers as fashionable oral health products, intended for tooth brushing, extrinsic stain removal and, mainly ‘tooth whitening’.

The 2019 review ‘Charcoal-containing dentifrices’by Greenwall et al1 provides an up-to-date overview of current knowledge and understanding of charcoal toothpastes and powders, considering all available evidence from 15 previous reviews and studies to assess claims made by the manufacturers of these products. The new study’sconclusion is that charcoal-based products may be over-reliant on marketing gimmicks and ‘folklore’ to substantiate their claimsand that consumers must be educated better on ingredients before using them, especially if there is potential for increased abrasivity.2

As part of the overall review, reference is made to a 2017 literature analysis by Brooks et al[1].,based on 118 articles and a database of detailed data on 50 charcoal-based toothpastes. The product information considered indicated that as few as 8.0% of the pastes contained fluoride. More than 50% were claimed to have therapeutic benefits and 96% were claimed to have tooth whitening capabilities. Other claims included remineralisation, strengthening or fortification of the teeth (30%), low abrasiveness (28%), a capacity for detoxification (46%), antibacterial or antiseptic properties (44%) and antifungal benefits (12%).

Consumer-appealing terms such as eco-friendly, ecological, herbal, natural, organic and pure, appeared in the product advertisements for 88% of the products, with 54% using at least two such terms. Only 10% included some form of dental professional endorsement. None of these claims have yet to be proven.

Regarding whitening capabilities, dental experts regard the high absorbency of charcoal to contain insufficient availability of any free radical bleaching agent in a charcoal-based paste or powder capable of chemically reducing intrinsic staining present in enamel and bony tissue.

In addition, ‘possible health risks’ associated with the use of charcoal-based toothpastes may also be related to the possible inclusion of human carcinogenic polyaromatic hydrocarbons in charcoal (i.e. a group of chemicals that occur naturally in coal, crude oil, and gasoline) and the use of bentonite clay in some charcoal-based pastes which hold the plaque, bacteria and stained material in the pores of the charcoal (or clay). When brushed away, supposedly it leaves the tooth surfaces free of any deposits. However, as with many of the claims made for charcoal-based toothpastes and powders, there is insufficient supporting scientific data.

Dr Linda Greenwall, lead author of the new study and member of the British Dental Bleaching Society, says: 'It’s imperative that consumers check the ingredients on the packaging of charcoal-based products before usage to ensure they include fluoride, calcium and phosphate to strengthen and protect tooth enamel. Tooth pastes need to contain therapeutic ingredients to strengthen and protect teeth and reduce gingivitis. Not all charcoal toothpastes are the same and some could potentially be causing lasting damage to a person’s teeth. Toothpastes should contain fluoride to have additional health benefits for the teeth.

'The most worrying aspect about the marketing of charcoal pastes and powders, appears to be a strong emphasis on the benefits which appeal to consumers, which have yet to be disproved. This "scientifically claimed until proved wrong" approach is favoured over substantiated, evidence-based promotion.'

Dr Joseph Greenwall-Cohen, co-author of the study and member of the British Dental Bleaching Society, explains: 'Many people are seduced into thinking that these charcoal-based products are "healthy" due to clever marketing tactics and claims. However, these are completely unfounded as there is no evidence whatsoever that proves this. Just because these toothpastes are fashionable, does not mean they are healthy for you.'

Patients seeking to whiten their teeth by means of toothbrushing may be better advised to consider using one of the well-known brands of regular fluoride-based toothpaste formulated to have a whitening effect and to brush their teeth effectively, removing plaque and extrinsic staining and giving the teeth a whiter appearance.

[1]

B_r_o_o_k_s_ _J_ _K_,_ _B_a_s_h_i_r_e_l_a_h_i_ _N_,_ _R_e_y_n_o_l_d_s_ _M_ _A_._ _C_h_a_r_c_o_a_l_ _a_n_d_ _c_h_a_r_c_o_a_l_-_b_a_s_e_d_ _d_e_n_t_i_f_r_i_c_e_s_:_ _A_ _l_i_t_e_r_a_t_u_r_e_ _r_e_v_i_e_w_._ _J Am Dent Assoc 2_0_1_7_;_ _148: 6_6_1_–6_7_0_._

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