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2016 FI

1.439
© Thomson Reuters, Journal Citation Reports, 2016

Indexed in:

Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME Cancerlit, Bibliomed, CabHealth, Scisearch, HealthStar, Scopus, Prous, Science Intergews, Science Citation Index Expanded.

Metrics

  • Impact Factor: 1.439(2016)
  • 5-years Impact Factor: 1,535
  • SCImago Journal Rank (SJR):0,38
  • Source Normalized Impact per Paper (SNIP):0,591

© Thomson Reuters, Journal Citation Reports, 2016

Allergol Immunopathol (Madr) 2008;36:368-70 - DOI: 10.1016/S0301-0546(08)75871-3
The allergy of toothpaste: a case report
M. Ersoya, J. Tanalpb, E. Ozelc,, , R. Cengizlierd, M. Soymane
a. Yeditepe University. Faculty of Dentistry. Department of Operative Dentistry. Istanbul. Turkey
b. Yeditepe University. Faculty of Dentistry. Department of Endodontics. Istanbul. Turkey
c. Private Practice. Ankara. Department of Pediatric Allergy. Istanbul. Turkey
d. Yeditepe University. Faculty of Medicine. Department of Pediatric Allergy. Istanbul. Turkey
e. Department of Operative Dentistry. Faculty of Dentistry. Yeditepe University. Istanbul. Turkey
Abstract

Toothpastes are definitely one of the indispensable elements of oral health care. They are produced to serve multiple purposes and possess complex chemical structures. Slight abrasion, froth, sweetening, bleaching, prevention of plaque, calculus and decay are properties expected from an ideal toothpaste. In recent years, allergic reactions have started to appear more frequently in dental practice. The present case describes the progression of an allergic response to toothpastes, one of the basic agents of oral hygiene.

Key words
Toothpaste, Allergy, Sodium lauryl sulphate
INTRODUCTION

It has been concluded in many studies that the presence of dental plaque is one of the most significant etiological factors of dental caries and periodontal diseases1–5. Although different methods have been suggested for the removal of dental plaque, there is a general consensus among researchers that mechanical treatment is the most efficient method to serve this purpose1,3,6. Toothpastes are additional elements used in the removal of dental plaque along with toothbrushes. Research so far has indicated that toothpastes having abrasives prevent the accumulation of dental plaque7,8.

The effectiveness of toothpastes significantly increases by the addition of surface-active agents. These surface-active materials not only provide the effervescent action of dental toothpastes and enhance the removal of food particles but they also help in the distribution of the toothpaste in the oral cavity1. In the past, toothpastes were supplied with soap to serve this purpose. Nowadays, synthetic detergents are used instead. Sodium lauryl sulphate (SLS) and sodium lauryl sarcosinate are the two most common surface-active agents9. Industrially, SLS is used in hard surface cleansing products, grease cleaners, car washing and detergents, personal hygiene products such as shampoos and shower gels, bath foams, face cleansing soaps, and toothpastes as detergents and foaming agents. The frequent use of this material leads to multiple allergic and toxic reactions10–14. Systemic ingestion of SLS compounds may also exert a carcinogenic effect.

CASE REPORT

A 25-year-old male patient presented to our clinic with complaints of dentinal hypersensitivity and gingival bleeding. Intraoral examination revealed a dense accumulation of calculus and dental plaque corresponding to the maxillary left second premolar and molar regions. A periapical radiograph taken from these regions indicated the presence of deep dentinal caries lesions. Prior to restorative treatment, a periodontal scaling was carried out. The patient was instructed about brushing methods and the utilisation of dental floss and mouth rinse. He indicated that he had been well informed about these methods previously, but he was unable to practice any due to abdominal gases, bloating, cramps, and diarrhoea, which occurred after brushing using toothpaste.

The medical history showed that the first symptoms had started seven years before, which led the patient to consult a physician. He was informed that his complaints may be due to appendicitis and he underwent an appendectomy. The symptoms did not subside following surgery and, after an examination by a gastroenterologist, it was concluded that there may be psychological implications. Although the patient used different brands of toothpastes in the market, symptoms such as nausea, abdominal gases, bloating, and diarrhoea persisted. The patient added that he experienced no problems while using mouth rinses.

Clinical Evaluation

The patient's complaints raised suspicion about the ingredients of toothpastes. A thorough review of the literature also indicated that contact allergy of toothpastes containing SLS may cause repetitive aphthous ulcerations, and oral lesions12–14.

Three samples of toothpaste were prepared in the laboratory; only one of which did not contain SLS. The patient was blind to the toothpastes. Each of them was used on consecutive days. The symptoms occurred with two of them but not with the one which did not contain SLS. To evaluate SLS's allergenicity, skin prick testing was performed. The sterile SLS stock solution containing 1mg/ml SLS was obtained with the help of the Pharmacy Faculty. The stock solution was diluted to 10-4, 10-3, 10-2, 10-1 dilutions with buffered distilled water, as based on a protocol previously described for drug allergy testing15. Prick test was applied to the patient's forearm beginning with the 10-4 dilution. The wheal and flare reaction were compared to the histamine 10mg/ml prick test reaction as a positive control. At least the half size of histamine reaction or 3mm or more wheal diameter was accepted as positive16. The patient was reacted at 10-3 dilution test with 6mm wheal and 30mm flare; and the procedure was stopped. The prick test confirmed that the patient was allergic to SLS (Fig. 1 and 2). The patient has been using SLS free toothpaste for nearly one year without any adverse reactions.

Figure 1.
(0.07MB).

During the prick test, 10mg/ml histamine solution (positive control) and dilution solution that contained no allergens (physiological saline, negative control) were administered intradermally.

Figure 2.
(0.08MB).

Following the Skin Prick test, 10-3 dilution of the 1mg/ ml solution of sodium lauryl sulphate caused the formation of an oedema with 6mm in diameter and erythema with 30mm in diameter.

DISCUSSION

Sodium lauryl sulphate, one of the chemical additives in the composition of toothpastes, is one of the leading products that cause local and systemic reactions17.

It has been reported in some studies that the utilisation of toothpastes may cause acute toxic reactions such as oral lesions, aphthous ulcerations, and xerostomia12–14,18,19. Although the chronic toxic effects of SLS are observed mainly in lungs, there has not been sufficient research to confirm this finding.

The patient's complaints such as abdominal gas and cramps, bloatedness and diarrhoea support our hypothesis that SLS may be an allergic material. Similarly, the fact that no symptoms occurred following brushing with the SLS free laboratory product and the positive result of the prick test confirms our result16.

Researchers have concluded that the local application of toothpastes containing SLS may cause oral lesions whereas carcinogenic effects may ensue with systemic usage10,12–14,19–21.

The initiation of reactions immediately after the utilisation of the toothpaste containing SLS suggests that they may result from the absorption of the material sublingually or from the oral mucosa.

Nowadays, allergic reactions may occur due to many chemical products. Synthetic materials added in the composition of toothpastes may lead to allergic reactions of varying severity.

CONCLUSION

Toothpastes are one of the indispensable elements of oral healthcare. It is also a fact that they may contain allergenic synthetic products. Dental practitioners as well as health care providers must be aware of the possibility of allergic reactions and should take all necessary precautions. Furthermore, the selection of natural additives instead of artificial products in toothpastes may exert a positive influence on the prevention of allergic reactions.

REFERENCES
1.
F.A. Carranza
Glickman's Clinical Periodotology
9th ed., WB Saunders Co, (2002)
2.
H.J. Gülzow,G. Busse
Klinisch-experimentelle untersuchungen über die Wirksamkeit verschiedener Zahnputzmethoden und Zahnputzmittel
Dtsch Zahnärztl, 25 (1970), pp. 1126-1134
3.
S.S. Socransky
Relationship of bacteria to the etiology of periodontal disease
J Dent Res, 49 (1970), pp. 203-222
4.
R.J. Genco,H.M. Goldman,D.W. Cohen
Contemporary Periodontics
1st ed., St Louis, (1990)
5.
M. Nevins,J.T. Mellonig
Periodontal Therapy
2nd ed., Quintessence Publishing Co, Inc, (1998)
6.
G. Sangnes
Traumatization of teeth and gingiva related to habitual tooth cleaning procedures
J Clin Periodontol, 3 (1976), pp. 94-103
7.
C.A. Saxton
The effect of dentifrices on the appearance of the tooth surface observed with the scanning electron microscope
J Periodontol Res, 11 (1976), pp. 74-85
8.
A.R. Volpe
Dentifrices and mouth Rinses
A Textbook of Preventive Dentistry, 2nd ed., pp. 170-216
9.
B.B. Herlofson,P. Barkvoll
The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers
Acta Odontol Scand, 54 (1996), pp. 150-153
10.
H. Babich,J.P. Babich
Sodium lauryl sulfate and triclosan: in vitro cytotoxicity studies with gingival cell
Toxicol Lett, 91 (1997), pp. 189-196
11.
P.N. Bear
Toothpaste allergies
J Clin Pediatr Dent, 16 (1992), pp. 230-231
12.
H. Benta,P. Barkvoll
Sodium lauryl sulfate and recurrent aphthous ulcers: A preliminary study
Acta Odontol Scand, 52 (1994), pp. 257-259
13.
H. Benta,P. Barkvoll
The effect of two toothpaste detergents on the frequency of recurrent aphthous ulcers
Acta Odontol Scand, 54 (1996), pp. 150-153
14.
A.Y. Lee,S.H. Yoo,J.G. Oh,Y.G. Kim
2 cases of allergic contact cheilitis from sodium lauryl sulfate in toothpaste
Contact Dermatitis, 42 (2000), pp. 111
15.
A. Romano,R.M. Guéant-Rodriguez,M. Viola,F. Amoghly,F. Gaeta,J.P. Nicolas,J.L. Guéant
Diagnosing immediate reactions to cephalosporins
Clin Exp Allergy, 35 (2005), pp. 1234-1242 http://dx.doi.org/10.1111/j.1365-2222.2005.02317.x
16.
E.D. Misirlioglu,M.R. Cengizlier
Skin prick test results of child patients diagnosed as bronchial asthma
Allergol Immunopathol (Madr), 35 (2007), pp. 21-24
17.
W.G. Wade,M. Addy
Antibacterial activity of some triclosancontaining toothpaste and their ingredients
J Periodontol, 63 (1992), pp. 280-282 http://dx.doi.org/10.1902/jop.1992.63.4.280
18.
P. Barkvoll,G. Rolla
Possible effects of sodium lauryl sulfate (SLS) on the oral mucosa
J Dent Res, 68 (1989), pp. 991
19.
A. Skaare,V. Kjaerheim,P. Barkvoll,G. Rolla
Skin reactions and irritation potential of four commercial toothpastes
Acta Odontol Scand, 55 (1997), pp. 133-136
20.
P. Duffin,G.C. Cowan
An allergic reaction to toothpaste
J Ir Dent Assoc, 31 (1985), pp. 11-13
21.
B.M. Hausen
Toothpaste allergy
Dtsch Med Wochenschr, 24 (1984), pp. 300-302
Correspondence: Emre Ozel DDS, MSc, PhD. Turan Gunes Bulvari. Akturk-1 Sitesi C Blok Daire:7. Yildiz-Ankara. Turkey. Phone: 0090 543 844 97 97. Fax: 0090 216 372 18 22. (E. Ozel emreozel77@yahoo.com)
Copyright © 2008. Sociedad Española de Inmunología Clínica y Alergología Pediátrica y Elsevier España, S.L.