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TOOTHPASTES AVAILABLE IN THE MALAYSIAN MARKET
S Musa, R Saub. Toothpastes available in the Malaysianmarket,
Annals Dent Univ Malaya 1998; 5: 45-48
ABSTRACTThis study was undertaken to investigate the number
andtypes (fluoride or non-fluoride) of toothpaste products
avail-able in the Malaysian market based on the label.
Thirty-fivebrands of toothpaste were identified, of which ten (29%)
werespecifically recommended for children. Two of the chil-dren's
toothpaste recommended that children below sevenyears old use a pea
size amount of toothpaste. One (3%) wasrecommended for both
children and adult. The remaining 24(69%) did not state if they
were recommended for either chil-dren or adults. To improve the
flavour of the toothpastes, avariety of flavours had been added
especially in children'stoothpaste. Almost half of the toothpastes
were for preventionof tooth decay and gum disease. Other
indications were fortooth sensitivity, tooth whitening and stain
removal. Twenty-seven (77%) of the toothpastes were imported, while
eight(23%) were made in Malaysia. Twenty-six (74%) of thetoothpaste
contained fluoride and the most common type offluoride used was
sodium monofluorophosphate (NaMFP).The fluoride concentration was
not labeled in more than half(63%) of the fluoridated toothpaste.
Of those that were flu-oridated, different units of measurement
were used. As thereis no uniformity in the labelling of these
products, it is rec-ommended that the responsible authorities
should take moreaction in enforcing proper labelling of the
fluoride concen-tration in the toothpaste using standardized
units.
Keywords: fluoride toothpaste, children, labelling
INTRODUCTIONThe prevalence of dental caries especially among
school-children has declined worldwide (1). In Malaysia, the
meanDMFf for 12-year-old children has decreased from 3.7 in1971 to
2.4 in 1988 (2). Several factors have been thought tobring about
this reduction and fluoride in drinking water andin toothpaste have
been shown to contribute to this decline(3).
Numerous studies have shown that water fluoridation hasa great
impact on the reduction of dental caries prevalence(1). However, in
areas where the water supply is not fluori-dated, toothpaste has
become a source of fluoride for cariesprevention. The WHO in 1993
(3) reported that in industri-alized countries, the decline in the
prevalence of dental cariesin the past 20 years was attributed
mainly to the widespreaduse of fluoride toothpaste. Fluoridated
toothpaste has beensuggested to be responsible for 20-35 per cent
of cariesreduction in developed countries (4).
Although fluoride has been shown to be an effectiveagent in
caries prevention, overdoses can lead to unwantedeffect such as
developmental defects of enamel and bones.Although fluoridation of
water supplies in Malaysia is wide-spread, toothpastes are also
easily accessible since 1970's(2,5).
Several studies have been conducted to determine the
1 Sabri Musa, 2 Roslan Saub
Lecturer.1 Department of Children's Dentistry and Orthodontics2
Department of Community Dentistry
Faculty of DentistryUniversity of Malaya50603 Kuala Lumpur
prevalence of the enamel defects. Razak and Hussein (6) in1986
examined 11-12-year-old children from a fluoridatedarea in
Selangor. They found that the prevalence of enameldefects was 72.5%
and over 90% of the affected teeth havethe diffuse patchy type,
which has been related to a mild formof fluorosis. In 1986, a study
by the Dental Division,Ministry of Health (7) in lohore, on
12-year-old childrenfound that 81.2% of the children from the areas
with fluori-dated water supply had diffuse opacities, while only
56.0%of the children from areas with unfluoridated water
supplyexhibited diffuse opacities. In addition, the children
whowere involved in those studies grew up at the time when
thefluoride toothpaste was widely used in Malaysia. Most stud-ies
had found that the prevalence of the developmental enam-el defects
was high, however, one study had found that gen-erally its
psychosocial impact on 16-year-old school childrenwas low (16).
In Malaysia recently, the issue of fluoride in the tooth-paste
has received considerable public attention in discussion,claiming
that fluoride is a poison. In fact, all chemical prod-ucts are
poisonous when consumed in large amounts. For allchemical products
there is a recommended therapeutic doseand this also applies to the
use of fluoride in fluoridated tooth-paste.
The influx of toothpastes of all kinds and brands into
theMalaysian market seems to be occuning without any control.With
the increasing concern from the public on the fluorideissue, it
seems necessary that precautionary actions areundertaken to ensure
safe and continued use of fluoridetoothpaste. In developed
countries however, while realizingthat the impact of fluoridated
toothpaste has led to cariesdecline, action has been taken to
prevent fluorosis i.e throughlabelling and messages containing
advice on the box.However different standards have been used in
Malaysia.
Therefore the purpose of this study was to investigate thenumber
and types (fluoride or non-fluoride) of toothpasteproducts
available in the Malaysian market based on the label.
Materials and MethodFive selected supermarkets and four selected
pharmaciesaround Petaling laya, Selangor were visited. The
selection ofthe supermarket and pharmacies was based on the
locationand popularity. The assumption made in this study was
alltypes of toothpastes available in any part of Malaysia will
beavailable in the study area. All types of toothpastes sold
wereidentified. The following information written on thebox/pack
were recorded
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Table 2: Fluoridated toothpastes in the Malaysian market
46 Annals of Dentistry, University of Malaya Vol. 5 1998
Manufacturer
AustraliaJapanIndiaUSAFranceSingaporeMalaysiaMalaysiaMalaysia
Brand name
SensodyneZactDaburUncle DocPyodontylTollyjoyZaitun (adult)Zaitun
(children)Promisce
Table 3: Non fluoridated toothpastes inMalaysian market
123456789
[FI]
Not givenNot givenNot givengivenNot given7.6mg/g4.0mg/g17.0%
0.02%w/wNot givenNot givenNot given0.1%Not given0.76%0.76%Not
givenNot given0.8%0.683%0.022%Not given0.025%Not givenNot givenNot
givenNot given
Type of toothpaste Manufacturer
Imported Local Totaln % n % n %
Fluoridated 21 77.8 5 62.5 26 74.3Nonfluoridated 6 22.2 3 37.5 9
25.7
Total 27 77.1 8 22.9 3S 100.0
Table I: Number and percentage of local and importedtoothpastes
in Malaysian market
mended for children. One was recommended for both chil-dren and
adult while the remaining twenty-four (69%) did notstate whether
they were recommended for either children oradult or both. Two
brand of the children's toothpastes had amessage "children below
seven years old use only a pea sizeamount of toothpaste" written on
the box.
Twenty-six (74.3%) of the toothpastes contained fluoride(Table
I). The most common type of fluoride used was sodi-um
monofluorophosphate (59%). Other fluoride compoundsused in the
toothpaste were sodium fluoride (19%), stannous
fluoride (15%), hydroxyapatite sodiumfluoride (4%), fluoride
mineral (4%) and'2 fluoride system' (4%). However, 16 ofthe 26
fluoridated toothpastes did not indi-cate the fluoride
concentration. For thosewhich indicated the fluoride content,
dif-ferent units of labelling the concentrationwere used such as
mg/g, %w/w and %.The concentration of fluoride in the tooth-pastes
was clearly labelled for 11 out of 26toothpastes which contained
fluoride.These were Sensodyne-F (7.6mg/g), Oral-B (for tooth and
gum care, 4mg/g; forsensitive teeth, 17%), Rembrandt
(0.76%),Clinomyn (0.76%), Mentadent-P (0.8%)and Fluocaril bifluore
(0.683%,0.0221 %).For the children's toothpaste the concen-tration
of fluoride were stated by Oral-B(0.02%w/w), Zwitsal (0.1 %) and
Boots(0.025% ).
MFP and NaFNaF2 Fl systemNotNaMFPNaMFPStannous
FLHydroxyapatiteNaFNaFNot
givenNaMFPNaMFPNaMFPNaMFPNaMFPNaMFPNaMFPNaMFPNaMFPNaMFPNaFNaMFPNaPNaMFPFl
mineralNot givenNaMFP
Manufacturer Type of Fluoride
MalaysiaMalaysiaMalaysiaNaMFPHong KongAustraliaCanadaCanada
Brand name
ColgateColgate TotalFresh end
whiteSparkelIndonesiaDarlieSensodyne-FOral- BOral- B
I2345678
9 Oral-B Canada10 Kodomo Lion Japan11 Zact Japan12 Tooty
Malaysia13 Zwitsal Indonesia14 Uncle Doc USA15 Rembrandt USA16
Clinomyn UK17 Clinomyn Singapore18 Topol Plus USA19 Mentadent P
UK20 Fluocaril Bi-fluore France
21 Zoothpaste Korea22 Boots UK23 Chicco Italy24 Daun Sirih
Indonesia25 Polleney China26 Dent Fresh Malaysia
[FL] denote fluoride concentration
1. the brand name2. place of manufacture3. the type and fluoride
content in units used4. flavours5. recommendations for use6. the
endorsement by the Malaysian Dental Association
RESULTSThirty-five brands of toothpaste were identified
available inthe market. Out of these, twenty-seven (77%) were
import-ed. This included two herbal toothpastes, and only
eight(23%) were made locally (Table I). Among the
importedtoothpastes, four were from USA; three from UK,
Canada,Japan and Indonesia; two from Australia, Singapore
andFrance; one from India, Hong Kong, Korea, Italy and China(Table
2 and 3).
Fourteen (40%) of the toothpastes were recommendedfor prevention
of tooth decay and gum diseases. Other useswere for sensitive teeth
(15%), as teeth whitening agents (5%)and stain removal (9%). Nine
(26%) of the toothpastes didnot state any special usage
indications.
Ten (29%) of the toothpastes were specifically recom-
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Eight out of 9 children's toothpastes contained differentfruit
flavours such as banana, strawberry, melon, grape,orange, apple,
mixed fruit, tropical fruit and chewing gumflavour.
Only three toothpastes had the endorsement from theMalaysian
Dental Association. These were Colgate, ColgateTotal and
Sparkle.
DISCUSSIONIn Malaysia, there are many varieties of toothpastes
sold inthe market. However, most of the brands are imported.
Thefluoride concentration in the imported toothpastes may not
bevery suitable for the Malaysian use. Thus the responsiblebody
should analyse and ensure that the fluoride concentra-tion in the
toothpastes is suitable and safe before they areallowed to be
marketed in this country.
Out of 35 brands available, only three brands were giventhe
endorsement by the Malaysian Dental Association(MDA), two were
locally manufactured (Colgate andColgate Total) and one was
imported (Sparkle). Althoughthey have been endorsed, these products
were not uniform-ly labelled. Furthermore, these brands do not
indicate the usefor either children or adults. Studies have shown
that childrentend to swallow the toothpaste while brushing and it
hasbecome one of the sources of fluoride intake (10-14). Theamount
of fluoride intake during the first 6 years is criticalin children
because it can cause enamel opacities in the per-manent dentition
(8,9,13,14). This is important because thefluoride concentration
which are recommended for use bychildren are different from that of
an adult. From the resultsof several scientific studies and
evidence at present, childrenunder the age of 6 years who were
found to be at low risk ofdeveloping dental caries are recommended
to use a toothpastecontaining no more than 600 parts per million
(ppm) of flu-oride (15). Those with a higher risk of developing
cariesshould use the toothpaste containing 1000 ppm of
fluoride(15).
Most of the toothpastes sold in Malaysia indicated thetype of
fluoride content such as monofluorophosphate, sodi-um fluoride, and
sodium monofluorophosphate. However, theconcentration of the
fluoride was not stated. Several westerncountries have made
labelling of fluoride concentration andcomposition mandatory.
However, this study found that dif-ferent manufacturers used
different units in labelling.Therefore, to avoid confusion to the
customers and even tothe dentists, standardised unit such as in ppm
should beused (14,15).
This study also identified several toothpastes labelled
as"family packs" being sold in the market. These toothpasteswere
meant for use by the whole family including children.Although it is
much cheaper, the toothpaste may not be suit-able for use by
children due to the different concentrations offluoride which is
recommended for children and adults.Therefore, any toothpaste sold
in the market should clearlystate whether it is indicated for use
by children or adults.
Herbal toothpastes were also available in the market.Two brands
were identified, both were imported, one wasfrom India (Dabur) and
the other from Indonesia (Daun
Toothpastes available in the Malaysia Market 47
Sirih). However, no known clinical study has been carried outon
these products. Therefore, the safety and the effectivenessof these
products are questionable. Although the manufacturerclaimed that
their products are effective, there is no scientif-ic evidence to
support their claims. Moreover, concentrationof fluoride in such
products are not known. Hence, it is sug-gested that before these
products are allowed to be market-ed, the manufacturers have to
provide scientific evidence toshow the safety and effectiveness of
the products.
Developmental enamel defects will only develop whenexcessive
amount of fluoride is ingested during the formationof teeth. If
excessive fluoride intake occurs during the first sixyears of life,
all permanent teeth will be at risk, whilst if thisoccurs during
the first three years of life, only permanentincisors will be at
risk (8,9). Therefore, parents are advisedto supervise and train
their children to use only a small pea-sized amount of toothpaste.
A simple message of advice forpa~nts on the label is highly
recommended./
CONCLUSIONThere are many types of toothpastes which are
available inthe Malaysian market. They are sold either for cosmetic
ortherapeutic purposes. To enable a potential consumer tomake
his/her selection easily and safely, proper labelling
isrecommended. Authorities such as the Ministry of Health andthe
Malaysian Dental Association should play their role inmonitoring
and ensuring that these products are safe forpeople to use.
ACKNOWLEDGEMENTSWe would like to thank Associate Prof. Dr Nik
Noriah NikHussein for her comments and advice.
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page1titlesTOOTHPASTES AVAILABLE IN THE MALAYSIAN MARKET
page2titlesRESULTS
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