SLS Containing Toothpaste; Cause of Tissue Peeling in Mouth – Tooth Be Told

As a dental hygienist, I discuss different phenomena that occur in the mouth, including tissue peeling. Also called oral epitheliolysis, it can be described as tissue peeling in your mouth, generally on the inside of the cheeks. It can happen unexpectedly and make us start to worry about why it’s happening! 

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Tissues normally shed, but certain ingredients that are found in dental products can speed up this process. This can cause a whitish layer to come off. It can be caused by chemical trauma to the oral tissues by sodium lauryl sulphate and sodium polyphosphates as well as medical conditions, food/drink or physical trauma.

In this post, I go over what SLS is, whether it is safe to use, other causes other than SLS that can cause peeling tissue, and what I recommend to my patients.

What is SLS (Sodium Lauryl Sulphate), and why it’s in toothpaste?

Sodium lauryl sulphate is a surfactant that is put in some kinds of toothpaste and mouthwashes to make them foam. This foaming action gives us the false sense that it is “cleaning more”. Source

You can probably think of many commercials advertising their products, “deep action foam” or “foaming power” to clean better.

However, this doesn’t actually work and doesn’t have any effect on how well the toothpaste performs. 

There is no evidence that SLS improves oral health. In this study, SLS and SLS-free toothpaste performed the EXACT same for reducing plaque, gingivitis, and gingival abrasion. 

In my opinion… why would you use a product when you know it doesn’t improve your oral health but has been known to have adverse effects?

Personally, I do not use SLS-containing products, but the choice is up to you if you want to use them. The below information can help you make that decision.

Crest Gum Detoxify Ingredients

Is SLS safe to use in toothpaste?

SLS is safe to use at lower concentrations. 

To go further under the microscope, (literally) the cells start to change when they have repeated exposure to sodium lauryl sulphate. 

This study went under the microscope and exposed tissue to a low concentration of SLS (less than 0.15%), and at this concentration, the results were;

• The cells started to thicken 
• The cells started to proliferate more (the number increased more rapidly) and can cause the tissue to slough.
• Also, the heightened expression of E-cadherin was observed.

This is the body’s protective response but has no correlation to tissue destruction or illness. 

The same study exposed the tissue to a concentration above 0.15%, and the results were; 

• The thickness of cells decreased
• Cells did not proliferate as quickly 
• And E-cadherin was decreased.  

E-Cadherin is on the outside of a cell which allows it to bridge another cell, keeping them together. 

These characteristics are more destructive and have been linked to oral cancer formation and metastasis. 

Another thing to note is that even though it has been deemed safe to use at low concentrations, there is evidence that it can cause dry mouth, ulcerations and mouth tenderness.

A dry mouth can lead to a more acidic mouth, which increases the effects of the bacteria on the mouth.

Every cause has an effect, and sometimes we forget to look at the bigger picture rather than just through the microscope.

The dose is the poison; how much is too much SLS

The dose makes all the difference with anything we consume.

A dentist I had as a professor once said: “the dose is the poison,” and that stuck with me.

Take water, for example, it’s essential to life, but too much can harm our bodies.

This extends to the ingredients in our toothpaste, with people being more sensitive than others.

Too much SLS will be dependent on the consumer, but reducing the amount used as much as possible should be a priority. If you are using toothpaste that contains SLS, consider switching if the tissue in your mouth begins to peel.

Everyone reacts differently to amounts of SLS

Everyone is different, and your biological makeup can make you more prone to adverse reactions to such ingredients as SLS. 

This study conducted by the British Dental Journal, outlines a case where a lady was using a toothpaste with SLS, which was causing her cheek tissue to peel off. And this peeling was discontinued after switching to an SLS-free toothpaste. 

Some people will have no effects from using SLS-containing toothpaste, whereas others will. 

Use your judgment and discuss it with your dental professional. 

Other causes of tissue peeling in the mouth

Medications, medical conditions and even radiation therapy could also cause tissue sloughing.  

Over 500 medications cause dry mouth, which can contribute to tissue peeling in the mouth. 

When you have diminished saliva, it can really have a negative impact on your oral health. 

Saliva is a natural lubricant that has antimicrobial and remineralization properties that protect every surface of your mouth.

Because of this, when you have a dry mouth, the tissue because more susceptible to being irritated by things you consume or products used in the mouth, for example, toothpaste. 

Again SLS can cause dry mouth, so if you already have a dry mouth…. do not use SLS-containing toothpaste.

Toothpaste/Mouthwash sensitivities

As well, some people don’t like mint toothpaste, so the next popular flavour is cinnamon. 

A lot of people have an allergy to cinnamon, and they may not even know it. This allergy can cause tissue sloughing as well. 

If you have recently started using a new toothpaste and the sloughing occurs, just switch back to your old one and see if it resolves.  

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Cheek and lip biting

This is my worst habit, if I’m nervous, anxious or have a lot on my mind, I tend to take it out on my inner cheeks and lips. And by the time I’ve caught myself, it’s too late. I have really tried to be conscious of this because it is not a good habit to get into. 

After a few days of biting the tissues, the tissue starts to slough off, revealing fresh, healthy unbitten tissue underneath. 

It’s important to try and stop this habit because traumatizing the tissue over and over again can cause damage, pain and discomfort.

I go through periods of time where I am really good at stopping. I am aware of what makes me do it, so I try to do other things to distract myself, like chewing xylitol gum or mentally taking note of what I’m doing and stopping.

It’s like a nail-biting habit; very hard to break!

Clenching and grinding 

Clenching and grinding can cause linea alba, which looks like a white raised line that stretches across the inside of the cheeks.

Linea Alba on the inside of the cheek.

The line is adjacent to where your teeth bite together (the bite plane) and can start at the back of the mouth and stretch to the corner of the mouth.

If you clench or grind your teeth, you should be wearing a nightguard when you sleep at night. The nightguard will protect your teeth and cheeks.

The best nightguards are custom-made by your dentist, but if you don’t want to do that, then the next best one on the market is this one. You can read why this nightguard is the best non-custom-made one at the end of this post.

Acidic foods/drinks

It could even be a mild allergy, but tissue sloughing can occur after eating a lot of pineapples, kiwi or other highly acidic foods.

These foods/drinks can irritate the tissue, causing your body to go into protective mode and increase the proliferation of the cells – which in turn causes sloughing. 

How to remove the peeling tissue from the mouth

Take a warm moist washcloth and wrap it around your pointer finger. Gently rub up and down along the inside of your cheek or wherever the peeling is occurring. You may want to take out the cloth and rinse it under warm water to remove the tissue from the cloth. 

Try not to scratch it off with your fingernails or bite it because it could cause more damage.

Switch to an SLS-free product to reduce tissue peeling

My favourite toothpaste is Sensodyne, and most of them do not have sodium lauryl sulphate in them. I personally use ProNamel. However, you may benefit from one of the other versions. 

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One thing to be very aware of is what brand you are purchasing from. I find that some smaller/less scientific-based companies will jump on the bandwagon of the “what product is bad for you now”.

This can be harmful to your health because they will take out the “bad” ingredient but replace it with one that hasn’t been scientifically researched or approved to be safe for use.  

What to use instead of mouthwash to prevent tissue peeling

The tried and trusted way of cleansing your mouth is using a saltwater rinse.

Adding salt water rinses to your oral health routine (brushing and flossing) has been proven to reduce many different pathogenic (bad) bacteria in the mouth, resulting in preventing oral diseases. 

You can read more about it in this study. 

Saltwater rinses are only effective if the concentration of salt is at least a MIC (minimum inhibitory concentration) of 0.7 M.

Recipe for salt water rinse; safe and effective mouth rinse

At least ½ teaspoon to every 1 cup of water. This will give you a 0.9 M concentration which is more than enough to inhibit the bad bacteria in your mouth. 

1. Warm 1 cup of water in the microwave. You do not want it hot! 
2. Stir in and dissolve at least ½ a teaspoon of table salt. 
3. Once dissolved completely, you can then start rinsing.  
4. Take a mouthful of the salt water, gently swish it around your mouth for at least 5-10 seconds, and spit it out. 
5. Repeat until the whole cup of saltwater is used. 

You will want to do a saltwater rinse at least 1 x a day for 1 week if your aim is healing, but if you are rinsing with it to replace mouthwash, you don’t want to do it too often, even just 1 x a week will do. 

Remember, it’s the mechanical removal of the plaque on your teeth that will improve your oral health the most.

Mouth rinses are not a replacement for flossing and brushing.  

Discuss peeling tissue with your dental professional

Tissue sloughing is not something you want to ignore.

Please mention it to your dentist/dental professional next time you go, or if it does not go away within 2 weeks of switching up your routine.

If it goes away after you’ve stopped using a product such as mouthwash, it is probably from that.  

However, it could be something else. 

To rule it out, you will need to have an in-person exam with your dental professional. 

Another reason why it is so important for you to discuss this with your dental professional is that the sloughing can come and go and could be indicative of another medical condition. 

If it is from clenching and grinding, then you should be wearing a nightguard to protect the soft tissues of your mouth, not to mention your teeth. 

Have a great day!

Holly 🙂

Why You Shouldn’t Ignore Your Peeling Gums

Are you experiencing peeling gums? This may be a symptom of a larger health issue. Even before we learn how to hold a toothbrush on our own, we begin to understand the importance of keeping our teeth cavity-free. Not to say that’s always enough motivation to want to brush our teeth as often and for as long as we should or to avoid the things that can increase our risk of getting cavities. It just means that we get that our teeth are important to our oral health.

The trouble is, most of us never come to appreciate the tissue surrounding our teeth in the same way. But in many ways, the gums are just as valuable of an indicator of our oral health as the teeth. And not just our oral health; our overall health, too.

Studies are beginning to confirm what periodontists have suspected for a while now: There’s a direct link between gum disease, also known as periodontal disease, and several potentially fatal diseases, including heart disease and diabetes. People with gum disease, which includes half of American adults, are also at greater risk of developing certain types of cancer and Alzheimer’s disease.

Still, too many of us are willing to shrug it off when we notice our gums are bleeding or peeling a little after brushing. As long as I don’t have any cavities, I’m good, we think. But they can be early warning signs of a potentially serious problem. And the longer we go on ignoring them, hoping they’ll disappear on their own, the bigger the threat becomes to our overall health.

What are peeling gums?

Peeling gums is a pretty accurate name for what’s going on. You’ll notice small bits of loose dead tissue sloughing off your gums and the inside of your cheeks. It’s not enough to gag you. In fact, you’re likely to chew on them or simply swallow them without giving much thought to what it is.

Peeling gums may also be accompanied by:

• Bleeding gums
• Discoloration on your gums and the inside of your cheeks
• Changes in the texture of your gums
• Sores or blisters on your gums

Gum disease is a common cause of peeling gums. (More on that in a moment.) But there are also a number of oral hygiene products that can have the same effect, including over-the-counter whitening products. Aside from failing to do what they’re supposed to and eating away at your teeth, home whitening kits can also trigger a slew of issues with your gums, like peeling.

If you’ve noticed any peeling or another adverse effect, such as increased gum or teeth sensitivity, after using a whitening kit, toothpaste, or mouthwash, stop using the product and schedule an appointment with your dentist, just to be on the safe side.

It’s not just whitening mouthwashes or toothpaste, either. Most mouthwashes contain some type of alcohol, which can dry out the mouth and irritate the gums. Similarly, a 2016 study found that low-pH toothpastes were likely to cause peeling gums, among other symptoms.

You don’t need to start experiencing symptoms to change your mouthwash or toothpaste. Look for a mouthwash that says “alcohol-free,” or something to that effect, on the label. Toothpastes are a little trickier because there are so many varieties. Look for one that’s marketed as “sensitive,” or try a brand made with natural ingredients, like Tom’s of Maine.

Where does gum disease fit into this?

You could be brushing with a Tom’s toothpaste and swishing with an alcohol-free mouthwash and still be experiencing peeling. In that scenario, you may have gingivitis, the earliest form of gum disease, without realizing it.

Gingivitis can cause the gums to become red, swollen, and bleed easily. It can slip under the radar because there’s usually little, if any, discomfort.  And it can develop for a number of reasons unrelated to our brushing-and-flossing regimens, including: smoking, stress, hormonal fluctuations, the use of certain medications, certain systematic diseases, aging, and a genetic predisposition. Though, the most common cause is inconsistent brushing and flossing and not keeping up with twice-a-year dental checkups.

The good news: Gingivitis is reversible as long as it’s treated early. If, however, it’s left unchecked, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque will irritate the gums and stimulate a chronic inflammatory response in which the body basically turns on itself, and the gums and bone that support the teeth gradually breakdown.

For what sounds like a very dramatic process, the symptoms can be pretty mild. In other words, one day you’re shrugging off peeling gums. The next, you’re staring into the mirror at deep pockets that have formed around your teeth. This much more serious form of gum disease, which is known as periodontitis, as you may already have realized, is a lot more difficult (and costly) to remedy.

Now what?

If you’re reading this to be extra cautious, keep doing what you’re doing: brushing and flossing twice a day and seeing your dentist every six months. If, however, you’ve noticed some occasional peeling, don’t ignore it. You may barely notice it, and it may not be painful, but it’s most likely a sign that something’s not right in your mouth.

In such a case, it’s always better to be safe than sorry. See your dentist or schedule an appointment with me. Either way, we’ll determine the source of your peeling and then tailor a treatment plan that will have you smiling again in no time.

Inflammation after professional oral hygiene

The modern technique of professional teeth cleaning is safe and comfortable for the patient. The procedure can be performed even during pregnancy.

Complete cleaning is practically painless, in very rare cases anesthesia is required. Removal of hard dental deposits and soft plaque is carried out in several stages:

• Tartar removal. First, all hard dental deposits are removed. The procedure is carried out using ultrasound.
• Purification with Air Flow. Under the action of water pressure, containing abrasive particles, tooth enamel is not only cleaned of soft plaque, but also whitened to its natural shade.
• Polishing. After cleaning, the surface of the teeth becomes slightly rough, which will contribute to the rapid accumulation of plaque. To avoid this, the tooth surface is treated with special discs and bristles. After the procedure, the enamel becomes smooth and protected from the effects of pathogenic microflora.
• Treatment with antiseptics. To prevent the spread of infection and to prevent inflammation of the gums, the oral cavity is treated with an antiseptic solution.
• Fluorination. After brushing, the teeth are covered with fluorine varnish to strengthen and reduce the sensitivity of the enamel.
• Application of medical dressings. With severe inflammation of the gums and periodontal bleeding, special therapeutic dressings are applied. The composition of the dressings may include antiseptics, antiviral drugs, antibiotics.

Inflammation after cleaning

The main cause of inflammation is increased sensitivity of the teeth and gums. Hypersensitivity may be an individual feature of the patient’s body, or it may be a consequence of such gum pathologies as: gingivitis, periodontitis or periodontal disease. Sometimes the cause of discomfort can be a deep tartar, the removal of which caused inflammation. If all the recommendations of the hygienist are followed, the discomfort will disappear within a few hours after the procedure.

Also, the causes of inflammation after brushing can be an incorrectly selected toothbrush and paste, as well as injury to soft tissues due to inaccurate brushing of teeth. That is why it is very important to follow all the recommendations of a specialist. After brushing the teeth, the hygienist shows the patient how to properly brush their teeth. In addition, the doctor selects the appropriate brush, paste, dental floss and additional oral care products for the patient.

Rehabilitation after the procedure

In order to prevent inflammation of the gums after the procedure, and the result is fixed for a long time, the patient is required to properly care for the oral cavity.

What is required from the patient:

• Do not consume coloring food and drinks on the first day after the procedure. These products include: coloring fruits, vegetables and berries, coffee, red wine and natural juices.
• Do not drink too hot or cold drinks immediately after the procedure.
• Immediately after cleaning, replace the old toothbrush with a new one.
• Not only use a toothbrush twice a day, but use dental floss and an irrigator at least once a day.
• Be sure to visit a dentist every six months for a scheduled preventive examination.
• Do not neglect professional teeth cleaning, undergo the procedure regularly according to the indications of a specialist. As a rule, doctors recommend a comprehensive cleaning twice a year.

How can toothpaste hurt? Expert answers

Simple things

Lizaveta Shaturova

August 31, 2020 15:06

Such a household tool as toothpaste, if you are not lucky, can be not only useless, but also dangerous. Dry lips or the appearance of jams after brushing your teeth are signs of an allergy. Afisha Daily learned from a dentist how to choose a paste and not harm yourself.

PhD, orthodontist, periodontist at the Alliance Française 9 Clinic0003

Tooth enamel is unable to recover from the damaging effects of bacteria that cause caries and mechanical trauma (chips, cracks). Toothpaste is the most affordable carrier of mineral components to strengthen enamel and prevent caries. The use of special remineralizing components in the composition can help prevent tooth decay and eliminate tooth sensitivity. Toothpaste manufacturers strive to create a highly effective product with active ingredients, which sometimes causes an allergic side effect.

Is it possible to find a hypoallergenic toothpaste?

There are methods for assessing the potential allergenicity of toothpastes. The difficulty lies in the fact that the concept of hypoallergenicity is very arbitrary, since any natural or chemical component is alien to our body, which means it can cause an allergic reaction . Therefore, even the most modern tests and developments today do not guarantee the absence of an allergic reaction in a particular person, but they allow predicting the likelihood.

How do I know if I’m allergic to toothpaste?

Allergies can start immediately after contact with toothpaste or have a cumulative effect and manifest themselves after a few days. Therefore, when buying a new product, you need to observe your feelings for several days. If there are manifestations of an allergic reaction (dryness of the lips, oral mucosa, redness, itching, swelling), stop using and contact an allergist. It will help determine the main allergen and choose a hygiene product that does not contain components dangerous to your body.

Which ingredients should be avoided?

The composition of the pastes includes components to improve the degree of purification, antibacterial and antiseptic preparations, foaming elements, remineralizing components, flavors and dyes.

The most likely allergens are foaming agents (SLS – sodium lauryl sulfate). This component can cause a chronic form of aphthous stomatitis or xerostomia (decreased saliva production). Also, foaming agents can cause a sharp narrowing of blood vessels and capillaries, which aggravates the course of inflammatory periodontal diseases. That is why I recommend pastes without this component – don’t be confused by the lack of foam, this does not affect the effectiveness of cleansing.

Thickener – Commonly used is sodium alginate, a salt of alginic acid that causes an allergic reaction in nearly 1% of the population. An alternative worth looking for in the composition is glycerin, pectin, agar-agar.

Despite its positive properties, the most allergic of the remineralizing components is fluorine , which is found in most toothpastes. A good alternative is zinc-substituted hydroxyapatite, calcium glycerophosphate, organic-based calcium and nanohydroxyapatite.

The composition of anti-inflammatory and antiseptic toothpastes, which are prescribed for periodontal diseases, includes urea (urea), an allergy to which occurs with prolonged use, as well as the antiseptic chlorhexidine, zinc nitrates, triclosan, potassium pyrophosphate, which can also cause allergic reaction.

The most common allergens are completely optional components of toothpastes. These are dyes and flavors . For example, the usual menthol is a very strong allergen.

Natural ingredients, essential oils, herbal extracts, may cause allergies in case of individual intolerance. Pay attention to their presence in the composition, especially if you suffer from seasonal allergies.

How to choose a toothpaste?

• Toothpaste should be preventive, medical paste is prescribed by a doctor. You should not self-medicate if inflammation or bleeding of the gums occurs, all pastes for these complaints should be selected individually and, if used improperly, can have the opposite effect.
• Pay attention to the abrasive content (RDA). Unless you are a heavy smoker with a tendency to quickly form pigmented brown plaque, the RDA should be up to 90, with tooth sensitivity – 17-40. Above 90 I do not recommend. A good option is the content in the paste of enzymes that dissolve the plaque matrix, due to which it is easily brushed off with a toothbrush without the effect of additional abrasives on the enamel.
• Fluorine content must not exceed 950 ppm, 1000-1200 ppm possible for sensitive teeth. You cannot use fluoride pastes for fluorosis, but you can find alternatives in the composition proposed above.
• Choose a white toothpaste that is free of dyes and fragrances.