By Jonathan Levine DMD
I, along with many of my colleagues, gave a sigh of fatigue and frustration when we read on Tuesday that the FDA banned a chemical called Triclosan from just about everything from floor cleaners to furniture polish, but failed yet again to remove it from toothpaste. I have been calling for a ban on Triclosan in toothpaste for years - its presence in toothpaste represents the regulatory entropy that occurs when the general public isn’t outraged enough. There is only one toothpaste left on the market containing Triclosan, and it’s Colgate Total. Colgate Total happens to be a market leader and one of the most popular brands in the country.
Everyone I know in the dental profession shares my concern for the risks of this ingredient. The FDA is worried enough to make sure it doesn’t seep into groundwater. The European Union has made sure to ban it, not just in toothpaste but in soaps, floor cleaners and detergents as well, as part of their effort to protect their citizens. And perhaps the greatest irony of all – Colgate-Palmolive is concerned enough about Triclosan that they quickly removed it from their cleaners and soaps when the European Union banned it in 2015. Somehow, they reasoned to keep it in Colgate Total toothpaste, a product that flows over consumers’ sensitive gum tissue, perhaps even being swallowed in saliva. The health risk that lead to action in Europe a year ago and in America last week is that Triclosan causes cancer, is a possible cause of antibiotic resistance, and can be an “endocrine disruptor” (a class of toxins that cause hormone production to go haywire and may be connected to everything from early puberty to diabetes to obesity).
This loophole in public safety is an easy fix, and the lack of action should upset everyone. Let’s look at the facts:
Triclosan was historically a chemical in surgical sanitation that “weaponized” soaps and therefore theoretically reduced infection. It did not appear in toothpaste until Colgate added it to “Colgate Total” in 1997. To be fair, the Colgate-Palmolive company submitted extensive safety studies as part of the FDA approval process and the FDA felt that the science showed the benefits outweighed the risks. Due diligence was performed by both parties - no argument there. Secondary research showed that over a three-year period of use, Colgate Total was more effective in battling plaque and gingivitis - I have no argument with its efficacy.
That research also showed that in the three-year period there were no adverse health effects observed. It’s important to note that much of the scientific literature that showed the efficacy of Colgate Total was research that was funded by Colgate-Palmolive. This is routine in the FDA review process, that the research evaluated by regulatory agencies is often funded by the manufacturing pharmaceutical or consumer products company. What’s routine isn’t necessarily best however, and while we should expect the corporations who want to bring a product to market to bear the cost of the safety research, we must always remember that it allows motives to get muddy. Without independent oversight, no amount of “research” should be taken at face value when funded by the manufacturer. Colgate-Palmolive here is a case in point: perhaps there were no adverse health effects observed in the three-year window, but with the class of toxins called endocrine disruptors, long-term effects are more peripheral, difficult to pinpoint, and would likely not be seen until many years later.
It’s a philosophical and ethical argument that speaks to the very essence of how we regulate public health: Do we need to prove something is safe before we allow people to use it every day inside their mouths, or do we let the public use a questionable product until someone can prove it’s harmful? And, are we letting a huge multi-national cooperation be the schoolyard bully and keep market share at the expense of public safety?
Putting a possible carcinogen in your mouth every morning isn’t an existential or abstract concept; it’s a simple choice that for now rests with each person until our oversight agencies start putting consumers’ health first. There are two aggravating factors which are inescapable: 1) The “benefit” that the FDA points to is presumably Triclosan’s efficacy in reducing periodontal disease. But 50 percent of the population still has periodontal disease and gingivitis so something clearly isn’t working and the “benefit” argument breaks down - but more importantly 2) There is substantial global concern and regulation about Triclosan as a carcinogen in other products, so much so that the FDA felt the risk was too great to even wash your hands with the chemical!
Surely the scientific rationale that applies to hand washing must also apply to whatever you put inside your mouth, no? And don’t we have a moral imperative to err on the side of safety rather than wait years for people’s deteriorating health to prove that Colgate-Palmolive was just throwing their weight around?
The FDA has been concerned about Triclosan for years. Triclosan is found in about 40 percent of liquid soaps, usually ones that are labeled as “anti-bacterial”. After washing your hands and face the rinsing puts the soaps into the water table after it goes down your sink drain, into the sewer and then to whatever body of water is fortunate enough to receive the sewage run off. Ralph Haden, a scientist at the Biodesign Institute at Arizona State University who has been tracking the Triclosan risk for years was quoted in the New York Times saying, “It has boggled my mind why we were clinging to these compounds, and now that they are gone I feel liberated. They had absolutely no benefit but we kept them buzzing around us everywhere. They are in breast milk, in urine, in blood, in babies just born, in dust, in water.”
There is some good news in that there is a large selection of toothpastes on the shelf without Triclosan, even several made by our very same Colgate-Palmolive! A simple conversation with patients by dentists can raise awareness and stimulate healthy choices. Conventional media attention can also educate consumers and drive better toothpaste selections. The most powerful vote of all is with the pocketbook - the huge companies who manufacture and sell toothpaste will respond to consumer demand. It’s just as easy for mega-manufacturers to change their dental hygiene lines as well—both Johnson & Johnson and Procter & Gamble immediately responded by proposing re-formulations of their soaps covered in the FDA action. They had a head start when the European Union acted last summer and even Colgate Palmolive removed it from its soaps. (Yes you read that correctly!)
Why wait for the day when regulatory lethargy and big corporate cronyism subsides before you reduce your risk? Be an informed person as you brush your teeth every morning and make the decision that oversight agencies won’t by selecting smart, non-toxic toothpaste. There are far better ways to control plaque in the mouth than putting your health at risk by using a questionable chemical linked to hormonal and carcinogenic risks.