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Toothpaste Ingredients and Oral Microbiome Effects
Discover how toothpaste ingredients, including surfactants and antimicrobials, affect the oral microbiome and overall oral health. We analyze key studies on the impact of changing formulas.
SCIENCE
Luigi Cellini
10/9/20264 min read
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Toothpastes and the oral microbiome: what really changes when we change the formula?
Surfactants, antimicrobial ingredients and bacterial balance: what science has investigated and what questions remain open.
The mouth is not a sterile environment
Our mouth hosts a complex community of microorganisms that live alongside saliva, teeth, gums and mucous membranes. This community, known as the oral microbiome, is not made up exclusively of harmful bacteria.
Many microorganisms are a normal part of a healthy ecosystem. The problem is not simply their presence, but the imbalances that can favour certain diseases.
Therefore, when studying an oral hygiene product, it is useful to ask an additional question alongside the usual "does it eliminate bacteria?": how does it interact with the microbial ecosystem of the mouth?
Toothpastes are formulations, not isolated ingredients
A toothpaste may contain cleaning agents, abrasives, humectants, surfactants, flavourings and substances with preventive or antimicrobial functions.
Each ingredient serves a purpose, but the effect of the product also depends on its concentration, its combination with other components and the way it is used.
This makes it difficult to draw general conclusions about all toothpastes from a study carried out with a single formulation.
It also means that a result observed with an isolated ingredient in the laboratory cannot be automatically transferred to the daily use of a complete product.
Sodium lauryl sulfate (SLS): what do we know?
Sodium lauryl sulfate, known as SLS, is a surfactant used in some toothpastes to help disperse the components and produce foam.
Its possible effects on the oral mucosa have been the subject of research, particularly in people with recurrent aphthous stomatitis, a condition characterised by the repeated appearance of mouth ulcers.
A systematic review published in 2019 brought together four crossover clinical trials with a total of 124 participants. The overall results favoured the use of SLS-free toothpastes across various indicators related to mouth ulcers, although the authors noted the need for further, higher-quality studies.
It is important to interpret this finding correctly: the evidence relates mainly to people with recurrent mouth ulcers, and does not demonstrate that SLS harms the entire population equally.
Furthermore, an individual clinical trial found improvements in the duration of lesions and pain, but no significant differences in their number or frequency. The results, therefore, are not entirely consistent.
A scoping review published in 2022 also examined possible effects of SLS on the mucous membranes, such as irritation and desquamation, and highlighted the limitations of the available evidence.
Do antimicrobial ingredients alter the microbiome?
The relationship between antimicrobial substances and the oral microbiome is more complex than it might appear.
Reducing certain microorganisms can be beneficial in certain circumstances. However, a variation in bacterial composition does not by itself demonstrate either a benefit or a harm to health.
A randomised clinical trial studied the use of oral hygiene products containing tin compounds over three years, comparing them with control formulations.
Analysis of the salivary microbiome found a relatively stable community, although differences were observed in some bacterial groups. The researchers did not detect a widespread transformation of the microbial ecosystem.
Another related analysis, focusing on viable salivary microorganisms, also found limited overall differences between the groups studied.
These results are important because they show that the presence of ingredients with antimicrobial activity does not necessarily imply a profound and persistent alteration of the oral microbiome.
At the same time, the studies had small samples and analysed specific products and conditions. They do not allow universal conclusions to be drawn about all formulations.
What happens when a person changes toothpaste?
This is one of the most interesting questions and also one of the most difficult to answer.
Changing toothpaste can simultaneously modify several factors: surfactants, active ingredients, flavourings, abrasives and other characteristics of the formulation.
To know what effect that change really produces, it would be necessary to compare complete products in controlled studies, measure the microbiome before and after, and also evaluate clinical indicators of oral health.
In addition, it would be worth distinguishing temporary changes from persistent ones.
Detecting a difference between bacterial communities is not enough to claim that one formulation is healthier than another.
Saliva, dental plaque and mucosal surfaces are not identical environments either. A result obtained from saliva samples may not fully describe what happens on the teeth or next to the gums.
What we still need to investigate
The available research allows new questions to be formulated:
Which microbiome changes persist after using a different formulation for months or years?
Which effects correspond to specific ingredients and which to the complete product?
How do microbiological changes relate to clinical outcomes, such as caries, gingival inflammation or mucosal discomfort?
Are there groups of people who respond differently to the same formulation?
Answering these questions requires comparative studies, sufficient follow-up and methods capable of linking microbial changes to real oral health.
What does all this mean for BlancoDent?
BlancoDent proposes a powdered dental hygiene formulation, different from conventional pastes in its presentation and composition.
The research cited in this article helps to explain why it is reasonable to study oral hygiene ingredients and formulations from an ecological perspective, and not exclusively for their ability to reduce microorganisms.
However, these studies have not been carried out with BlancoDent.
Therefore, they do not allow us to claim that BlancoDent improves, restores or protects the oral microbiome compared with other products.
To demonstrate this, specific studies on the complete formulation would be necessary.
Conclusion
Oral hygiene is not about indiscriminately eliminating all microorganisms from the mouth. The aim is to maintain conditions compatible with the health of teeth, gums and mucous membranes.
The scientific evidence shows that certain ingredients can influence the mucous membranes and microbial communities, but their effects depend on the context, the formulation and the characteristics of each person.
The question is not whether a toothpaste modifies the microbiome, but what modifications it produces, for how long, and with what consequences for health.
That distinction is essential in order to interpret the research without turning interesting hypotheses into premature certainties.
Scientific references
1. Alli BY, Erinoso OA, Olawuyi AB (2019).
Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: A systematic review.
Journal of Oral Pathology & Medicine, 48(5), 358–364.
https://doi.org/10.1111/jop.12845
2. Shim YJ et al. (2012).
Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a randomized controlled clinical trial.
Oral Diseases.
https://pubmed.ncbi.nlm.nih.gov/22435470/
3. Side effects of sodium lauryl sulfate applied in toothpastes: A scoping review (2022).
https://pubmed.ncbi.nlm.nih.gov/35506963/
4. Anderson AC et al. (2020).
Influence of the long-term use of oral hygiene products containing stannous ions on the salivary microbiome – a randomized controlled trial.
Scientific Reports, 10, 9546.
https://doi.org/10.1038/s41598-020-66412-z
5. Long-Term Use of Oral Hygiene Products Containing Stannous and Fluoride Ions: Effect on Viable Salivary Bacteria (2021).
Antibiotics, 10(5), 481.
https://pubmed.ncbi.nlm.nih.gov/33921981/
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