For people with recurrent canker sores, is it better to use a toothpaste with SLS, CAPB, or no foaming agents at all?
At the time a study was published, sodium lauryl sulfate (SLS) had been used as a foaming agent in toothpastes for more than half a century demonstrate Tissue damage in most patients who had it smeared on their gums – but that was “most” of only ten subjects. The same applies to a study Find A dramatic decrease in the number of canker sores when people switched to an SLS-free toothpaste. (Again only ten people.)
But that was all we had until 1999 when a randomized, double-blind, crossover study was done releasedTesting SLS versus non-SLS toothpaste on not just 10 people, but 47 people with recurrent cancerous ulcers. The study looked at the number of days of pain, total pain, number of ulcers, how long they lasted, and how big they were, and found no significant differences. It didn’t seem to matter whether the toothpaste contained sodium lauryl sulfate or not. But what about this study? demonstrate the 70 percent decrease in canker sores after switching to an SLS-free toothpaste? Well, maybe these cases were worse and the type of toothpaste used only matters if you have really bad canker sores?
Science ended there until 13 years later, as a Korean researcher picked raise the torch. We’ve had studies showing that SLS-free toothpaste helps and other studies that found no benefit, which created “significant controversy.” Therefore, they started the largest study to date with 90 subjects. What did you find? The same number of ulcer and ulcer episodes in the groups, but the ulcer duration and mean pain score were significantly reduced when the subjects used the SLS-free toothpaste. The researchers therefore concluded that switching to an SLS-free toothpaste may not reduce the number of canker sores, but it may heal faster and make them less painful.
So, yes, sodium lauryl sulfate “creates an impression of cleanliness and a sip of foam just feels cleaner,” but the potential downside could be that “SLS lowers the protective barrier of the oral epithelium,” likely our oral mucosa due to the breakage of the bonds that hold our cells together. This can sometimes lead to flaking, ulcers, and sores that dry out the protective layer of mucus that lines our mouth and make us more susceptible to irritants.
Please wait. How did the Korean researchers explain that their study found a problem but the previous study didn’t? They suggested that it could be a racial problem. “Really?” Well, they stated that “Koreans eat more spicy and spicy food,” so maybe that makes a difference?
Regardless of how spicy your food is, if you have cancer ulcers, try an SLS-free toothpaste to see if it makes a difference for you – but possibly not SLS toothpaste to have other detergents, most commonly cocamidopropyl betaine (CAPB). As I discuss in my video Is CAPD Better In SLS-Free Toothpaste? Swiss researchers took Nine toothpastes, including Colgate, Crest, Oral-B, and Sensodyne, dripped onto some human gum cells freshly taken from people whose wisdom teeth were extracted. They then used live dead cell staining: all cells were stained green and then a red dye was added to cover the green dye, but only in dead cells as the living cells are actively pumping out the red dye. So the living cells stay green, but the dead cells turn red. As you can see in mine at 3:25 Video, Colgate contains SLS because the cells are all red and all dead. And coat of arms? The cells are mostly red and mostly dead. With SLS-free Sensodyne, the cells are all green and alive because they contain the SLS-free detergent CAPB instead.
But that was in a petri dish. Do that Translate in actual tissue damage in humans? A double-blind crossover study with toothpastes containing SLS compared to toothpastes containing CAPB resulted in 42 desquamative reactions, i.e. tissue peeling reactions after four days of four minutes per day of the SLS toothpaste on the gums of the test subjects, compared with only three reactions with the alternative Detergent, CAPB. And there were no such reactions at all when using the exact same toothpaste without SLS or CAPB – detergent-free toothpaste.
How does this lead to an incidence of canker sores? A randomized, double-blind, crossover study examined the effects of toothpastes that contain SLS, CAPB or no detergent at all. The researchers found a “significantly higher incidence” of cancerous ulcers when patients were brushed with toothpastes containing SLS instead of non-SLS toothpastes, whether CAPB-containing or detergent-free. Therefore, they suggest recommending an “SLS-free toothpaste” for patients with recurring aphthae “, canker sores. But as you can see in mine at 5:00 am Videothey found more than that.
Yes, SLS was the worst, but the detergent-free, non-foaming toothpaste beat both SLS and CAPB. Indeed, the non-foaming toothpaste caused significantly fewer ulcers than the alternative non-SLS detergent CAPB, which in turn caused significantly fewer ulcers than the SLS toothpaste. The vast majority of patients with recurrent cancerous ulcers would benefit from switching from regular toothpaste to non-foaming toothpaste, but most would benefit from staying away from SLS independently.
But if your toothpaste doesn’t contain sodium lauryl sulfate, it will job also? I’m not just talking about “the impression of cleanliness”, but about the actual effect on plaque and gingivitis? SLS can kill our cells, but it also kills bacteria. So is it possible that an SLS-free toothpaste isn’t working that well? It turns out that SLS-free toothpaste “works just as well in terms of reducing gingivitis and plaque”. Therefore, we can recommend it for patients with recurrent cancerous ulcers. Sodium Lauryl Sulphate can make the situation worse by dissolving the protective mucous layer and eventually penetrating the deeper layers of the oral mucosa, where “the function of living tissues can be impaired”.
However, people missed the frothiness of a toothpaste with SLS. Choosing an SLS-free toothpaste offers an additional advantage: SLS also penetrates our tongue and “disrupts the internal mechanisms of our taste cells”. It is actually responsible for the “orange juice effect”. You know that after brushing your teeth, you get a strange taste of citrus fruits? SLS is obviously what has to do with your taste cells.
Sodium lauryl sulfate? Wasn’t that part of an internet scam? I describe the background to this in my video Is Sodium Lauryl Sulphate Safe?.
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Michael Greger, MD
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