HISTORY OF TOOTHPASTE

Ever wonder where toothpaste and mouthwash came from? Have you ever thought about what people used for toothpaste
before the invention of Crest, Colgate or Aquafresh? (North American brand name toothpastes). Below are some
interesting, point form facts and recipes that may help satisfy your curiosity - or spur it on!! 

Back in the Days of Buddha.... 

The activity of keeping the mouth clean dates all the way back to the religious figure Buddha. It has been recorded that
he would use a "tooth stick" from the God Sakka as part of his personal hygiene regimen. 

In 23 - 79 AD the practice of oral hygiene included:

Drinking goats milk for sweet breath

Ashes from burnt mice heads, rabbits heads, wolves heads, ox heels and goats feet were thought to benefit the gums. (This probably wouldn't go
over very well today)
Picking the bones out of wolves excrement and wearing them (maybe in the form of a necklace?) was considered to be a form of protection
against toothaches.
Washing your teeth with the blood from a tortoise three times a year was a sure bet against toothaches as well.
Mouthwashes were known to consist of pure white wine, or (get ready for this one) old urine kept especially for this purpose.

The 18th Century 

The earliest record of an actual toothpaste was in 1780 and included scrubbing the teeth with a formula containing burnt
bread. (A common North American breakfast) 

Other toothpastes around this time called for:

1 1/2 oz. dragons blood (So that's where they all went!!)
1 1/2 oz. cinnamon
1 oz. burnt alum

Beat the above ingredients together and use every second day. 

The 19th Century

In the 19th century, charcoal became very popular for teeth cleaning purposes.
Most toothpastes at this time were in the form of a powder.
The purpose of the tooth powder was not only to clean the teeth, but to give fresh breath. (Hmmm....that idea isn't so outdated!!)
The succulent strawberry (still available today) was considered to be a "natural" solution for preventing tartar and giving fresh breath.
In 1855, the Farmers Almanac included this recipe for an appropriate toothpaste: 
1 oz. myrrh (fine powder) 
2 spoonfuls of your best honey (This does not refer to your significant other!!) 
A pinch of green sage

Mix together and use every night on wet teeth.

Another toothpaste included: 

2 oz. cuttlefish bone 
1 oz. cream of tartar 
2 drachms drop lake 
15 drops clover oil

Powder, mix, sift.

The 20th Century

Liquid cleansers (mouth rinses) and pastes became more popular, often containing chlorophyll to give a fresh green color.
Bleeding gums became a concern as well as aching teeth.
In 1915 leaves from certain trees in South East Asia (Eucalyptus) were beginning to be used in mouthwash formulas.

So....what's in the toothpaste of the 90s?

sodium monofluorophosphate (not to be confused with MSG)

color
flavoring
fluoride
foaming agents
detergents
humectants (prevent the paste from hardening)
Herbal toothpastes have gained popularity for people looking for a "natural" toothpaste or for those who don't want fluoride in their dental
cleansers. Some herbal toothpastes contain: 
peppermint oil 
myrrh 
plant extract (strawberry extract) 
special oils and cleansing agents 

Hey, didn't we see these ingredients in the toothpastes of the early 19th century? 

And the 21st Century.... 

Your guess is as good as ours!! If the trends of the 20th century continue we should see more toothpastes that whiten and
brighten the teeth, are canker sore friendly, and give you the ultimate brushing or rinsing experience. 

The more things change, the more they stay the same!
The ancient Egyptian recipe for toothpaste
The world's oldest-known formula for toothpaste, used more than 1,500 years before Colgate began marketing the first commercial brand in 1873, has been
discovered on a piece of dusty papyrus in the basement of a Viennese museum.
In faded black ink made of soot and gum arabic mixed with water, an ancient Egyptian scribe has carefully described what he calls a "powder for white and
perfect teeth".
When mixed with saliva in the mouth, it forms a "clean tooth paste".
According to the document, written in the fourth century AD, the ingredients needed for the perfect smile are one drachma of rock salt - a measure equal to
one hundredth of an ounce - two drachmas of mint, one drachma of dried iris flower and 20 grains of pepper, all of them crushed and mixed together.
The result is a pungent paste which one Austrian dentist who tried it said made his gums bleed but was a "big improvement" on some toothpaste formulae
used as recently as a century ago.
 

INTERESTING FACTS:

Facts

 Toothpaste is an abrasive paste (an abrasive is something that will scratch or grind something)
 In the case of toothpaste it grinds away the leftover food and plaque on your teeth, with the help of your toothbrush.
 The abrasive in toothpaste is called Dicalcium phosphate dihydrate and it makes up about a 5th of a tube of toothpaste
 The other main part of toothpaste is the paste which is made up of water and things to help it spread through your mouth easily like a
 type of detergent which makes it foam and something to make your teeth shiny.

 
Did You Know?

 The flavours of toothpaste are usually from plants like Spearmint and Peppermint most toothpastes are sweetened with artificial
sweetener.
 Before toothpaste was invented people used all kinds of dry, rough things as an abrasive to clean their teeth – things like crushed
eggshell, pumice the burnt hooves of animals!!!
 Before toothbrushes were invented people used twigs or their fingers to brush their teeth.
 A couple of hundred years ago when people didn’t know about brushing their teeth most people had black rotten teeth especially if they
ate lots of sugar like Queen Elizabeth the first.

 
The ancient Egyptian recipe for toothpaste
The world's oldest-known formula for toothpaste, used more than 1,500 years before Colgate began marketing the first commercial brand in
1873, has been discovered on a piece of dusty papyrus in the basement of a Viennese museum.
In faded black ink made of soot and gum arabic mixed with water, an ancient Egyptian scribe has carefully described what he calls a "powder for
white and perfect teeth".
When mixed with saliva in the mouth, it forms a "clean tooth paste".
According to the document, written in the fourth century AD, the ingredients needed for the perfect smile are one drachma of rock salt - a
measure equal to one hundredth of an ounce - two drachmas of mint, one drachma of dried iris flower and 20 grains of pepper, all of them
crushed and mixed together.
The result is a pungent paste which one Austrian dentist who tried it said made his gums bleed but was a "big improvement" on some toothpaste
formulae used as recently as a century ago.

COLLECTION HIGHLIGHTS:

Toothpaste Party Store - alcohol drinks flavored toothpastes. 

Bourbon Whiskey Flavored Toothpaste

Scotch Whiskey Flavored Toothpaste

Manufactured by Poynter Products, Inc., Cincinnati, OH. in 1954

SIX PROOF toothpastes. Contain real alcohol - no more than 3% alcohol by wt., 2.6 oz
This toothpaste was invented by Don Poynter and was his first big novelty product. He needed $10,000 to start manufacturing this tooth
fellow alum Bob Boeh gave him a bank loan, although Bob's father, who also worked at the bank, nearly killed him. It turned into the co
biggest novelty seller at the time. Life magazine ran photos, and Don Poynter was featured on "What's My Line?"
 
 
Thanks to inventor Don Poynter the world also got to enjoy the first basketball backboard for a wastebasket, "The Thing" coin box featu
Addams Family (14 million sold), Uncle Fester's mystery light bulb (also featured on the show), and crossword-puzzle toilet tissue. Poyn
created the world’s smallest working record player, sold with 39 tiny records that Poynter recorded with real orchestras, and a Steer-N-G
landscape for Matchbox cars, which grossed $75 million in its first year.
 
Jigger Bourbon Whiskey Flavored Toothpaste
The refreshing morning-after pick up.
Distributed by Bandwagon Mfg. Inc., Boston, MA
SIX PROOF toothpaste. Contains real alcohol - no more than 3% alcohol by wt., 2oz
 

 
Wellington's Whisky Flavoured Toothpaste
The refreshing morning-after pick up. Extra special.
Made in England by WELLINGTONS LTD, Stamford Lincs, UK
No indication of real alcohol present, 50 ml
 

 
Bourbon Flavored Toothpaste
Scotch Flavored Toothpaste
Manufactured by Neiman-Marcus, Distr., Dallas, TX 75201
No indication of real alcohol present, 3 oz
 
 
Champagne Flavoured Toothpaste
Genuine Booze Flavoured Toothpaste.
Produced in Great Britain for Boxer, BD3 9QY, UK
No indication of real alcohol present, active ingredient Sodium Monofluorophosphate 08.%, 50 ml
 

 
California Wine  Toothpaste Kit
Chablis Flavored Toothpaste
Burgundy Flavored Toothpaste
Extra-Dry Champaign Flavored Toothpaste
Manufactured by Neiman-Marcus, Distr., Dallas, TX 75201
No indication of real alcohol present, 2.7 oz
 
 
After Dinner  Toothpaste Kit
Creme de Menthe Flavored Toothpaste
Amaretto Flavored Toothpaste
Anisette Flavored Toothpaste
Manufactured by Neiman-Marcus, Distr., Dallas, TX 75201
No indication of real alcohol present, 2.7 oz

 
 
Cordially Yours Toothpaste Kit
Creme de Cafe Flavored Toothpaste
Irish Cream Flavored Toothpaste
Peppermint Schnapps Flavored Toothpaste
Manufactured by Neiman-Marcus, Distr., Dallas, TX 75201
No indication of real alcohol present, 2.7 oz
 
Introduction
Globalization has provoked changes in many facets of human life,
particularly in diet. Trends in the development of dental caries in
population have traditionally followed developmental patterns where,
as economies grow and populations have access to a wider variety of
food products as a result of more income and trade, the rate of tooth
decay begins to increase. As countries become wealthier, there is a
trend to greater preference for a more "western" diet, high in
carbohydrates and refined sugars. Rapid globalization of many
economies has accelerated this process [1]. These dietary changes
have a substantial impact on diseases such as diabetes and dental
caries[2,3]. The cariogenic potential of diet emerges in areas where
fluoride supplementation is inadequate [4]. Dental caries is a global
health problem [5] and has a significant negative impact on quality
of life, economic productivity, adult and children's general health and
development. Untreated dental caries in pre-school children is
associated with poorer quality of life, discomfort, and difficulties in
ingesting food that can result in failure to gain weight and impaired
cognitive development [6]. Since low-income countries cannot afford
dental restorative treatment [7] and in general the poor are most
vulnerable to the impacts of illness, they should be afforded a greater
degree of protection.
By WHO estimates one third of the world's population have
inadequate access to needed medicines primarily because they cannot
afford them [8]. Despite the inclusion of sodium fluoride in the World
Health Organization's Essential Medicines Model List [9], the global
availability and accessibility of fluoride for the prevention of dental
caries remains a global problem. The optimal use of fluoride is an
essential and basic public health strategy in the prevention and
control of dental caries, the most common non-communicable disease
on the planet. Although a whole range of fluoride vehicles are
available for fluoride use (drinking water, salt, milk, varnish, etc.),
the most widely used method for maintaining a constant low level of
fluoride in the oral environment is fluoride toothpaste. As one of the
key components of the WHO endorsed Basic Package of Oral
Care [10], the promotion of affordable and effective fluoride
toothpaste is important for improving equity in oral health.
The promotion of brushing twice a day with fluoride toothpaste is
based on strong scientific evidence [11,12]. The widespread use of
fluoride toothpaste has been recognised as the single most important
reason for the decline of dental caries in developed countries during
the 1970s and 1980s [13]. An example is the United Kingdom where
the only organized preventive program has been that of water
fluoridation but that only about 9% of the UK population benefit from
optimally fluoridated water [14]. The introduction of fluoride
toothpaste is the major most likely contributing factor to the decline
in caries witnessed in the United Kingdom although other
confounding factors inevitably play a role. More recently, the decline
in dental caries amongst school children in Nepal, a low-income
country, has been attributed to improved access to affordable fluoride
toothpaste in Nepal [15]. For many low-income nations, fluoride
toothpaste is probably the only realistic population strategy for the
control and prevention of dental caries since cheaper alternatives
such as water or salt fluoridation are not feasible due to poor
infrastructure and limited financial and technological resources. The
use of topical fluoride e.g. in the form of varnish or gels for dental
caries prevention is similarly impractical since it relies on repeated
applications of fluoride by trained personnel on an individual basis
and therefore in terms of cost cannot be considered as part of a
population based preventive strategy.
Based on global estimates, about 500 million people utilize fluoride
toothpaste, 210 million have access to fluoridated water, 40 million
have access to fluoridated salt, and 60 million benefit from fluoride
mouth rinses, tablets and clinically applied fluoride [5]. Taking into
account the global population for 2007 is estimated to be 6.6 billion it
can be assumed that only about 12.5% of the world's population
benefit from the caries preventive possibilities of fluoride toothpaste.
The use of an efficacious fluoride toothpaste is largely dependent
upon its socio-cultural integration in personal oral hygiene habits,
availability and the ability of individuals to purchase and use it on a
regular basis. The price of fluoride toothpaste is believed to be too
high in some developing countries [16] and this might impede
equitable access. In a survey conducted at a hospital dental clinic in
Lagos, Nigeria 32.5% of the respondents reported that the cost of
toothpaste influenced their choice of brands and 54% also reported
that the availability of dentifrices influenced their choice [17]. WHO
endorses the development and use of affordable fluoride toothpaste
and defines affordable toothpaste as "one that is available at a price
that allows people on low income to purchase it [18]." To date there
have not been any attempts to quantify affordability or to suggest a
reasonable retail price which consumers might pay for fluoride
toothpaste; nor has there been any research to evaluate the effects of
affordability, purchasing, and utilisation. The aim of this paper is to
compare the cost and relative affordability of fluoride toothpaste in
high-, middle- and low-income countries. The hypothesis is that
fluoride toothpaste is not equally affordable in high-, middle- and
low-income countries.

Methods
Study design
A cross-sectional survey of fluoride toothpaste brands and the retail
cost was conducted between December 2005 and March 2006. Data
was collected on a self-completion questionnaire that was distributed
to dental associations, non-governmental oral health organisations
and individuals around the world in 136 countries. They were asked
to provide in a tabulated format the brand name, the retail price and
the quantity/package size for as many brands that could be identified
on the local retail market. Several international brands were
specified to facilitate comparison. Since the price of toothpaste often
differs according to size sold, the price for a packaging size closest to
100 g/100 ml was asked. In addition, information was sought on the
cheapest available fluoride toothpaste.
Data entry and statistical analysis
The study assumed the therapeutic dose of fluoride toothpaste to be a
pea-sized amount (0.25 g). The annual cost of fluoride toothpaste in
US dollars per person was based on the therapeutic dose used twice
daily for a year, which amounts to 182.5 g of toothpaste [19].
Toothpaste prices were obtained in national currency units. The data
for all brands reported were entered into Microsoft Excel and
converted to the annual cost expressed in US dollars using
international exchange rate data (xe.com). In order to examine
affordability, the prices were first adjusted to the year 2003 because
the economic indicators used for comparisons were available most
completely for that year. The 2006 to 2003 price adjustment was done
using the inflation, GDP deflators for the years 2003, and 2004,
obtained from the World Bank World Development Indicators
2006 [20]. For 2005, the 2004 GDP deflator was used because the
2005 deflator was not yet available.
The adjusted 2003 price and economic indicator data were converted
to a SAS dataset for calculation of the median price for each country
as well as other statistics using PROC MEANS and PROC
UNIVARIATE. Two sets of comparisons were made, one using all
products for which prices were collected, the second using the four
selected international (or multinational brands) and the brand
available at the cheapest price only. The ratios were calculated to
facilitate the analysis of affordability within countries and in order to
make cross-country comparisons. Household final consumption
expenditures is the indicator used to evaluate affordability within the
countries [20]. The per capita 2003 household final consumption
expenditures were calculated for the total population and by income
group, to allow for evaluation of the results by population segments,
e.g. the poorest 30%, 50%, and 70% of the population. The analysis
of affordability expressed the cost of the annually recommended dose
of fluoride toothpaste as a proportion of the available household
expenditures required to purchase enough toothpaste for one person
for one year at the lowest available price. Affordability was also
evaluated by estimating the number of days of work required to buy
the recommended dose for one person for one year using the
country's per capita annual income (basis 250 working days).
The measure chosen for affordability was a ratio of the number of
days needed to pay for one annual therapeutic dosage of toothpaste
at the lowest price for the poorest 30% of the population. According
to Health Action International (HAI) a medication costing more than
the equivalent of one day's wages is considered unaffordable [21].
The data from this affordability comparison was ranked into high and
low prices using the median number of days of household final
consumption income needed to pay for one dosage of toothpaste using
one day as the cut-off point.

Results
A total of 136 countries were contacted and 45 countries responded.
Prices were obtained for 360 toothpaste products priced in 45
countries: 15 low-income, 17 middle-income, and 13 high-income
countries. Economic data were available for 40 countries only,
eliminating 3 low-income and 2 middle-income countries from the
analysis (317 products). Where only the chosen international brands
and the most inexpensive toothpastes available were analysed, data
from 39 countries were used for a total of 137 products.
Comparison of the ratio of the lowest and median toothpaste prices to
household final consumption expenditures, by country, showed that as
the per capita income decreases the proportion of annual per capita
income required for the annual therapeutic dose of toothpaste
increases (Figure 1). For the poorest 30% of the population, the ratio
for all toothpaste products surveyed ranges from 0.015% (U.K) to
4.3% (Zambia) (median = 0.29; SD = 0.8, whereas the median for
the total population is 0.07% (range 0.004%–0.8%; SD = 0.18%). A
similar range and standard deviation were observed for prices for the
selected international and the cheapest available brands only as
proportion of annual household final consumption expenditures per
capita for the poorest 30% of the population.

Figure 1. Toothpaste (annual dosage) at lowest price as a

proportion of annual household expenditures per capita. Cost of one
annual dosage of toothpaste at the lowest price as a proportion of
annual household expenditures per capita by population group for
selected countries.
Affordability is illustrated in Figure 2 with ratios of the lowest price
of toothpaste as a proportion of one workday of per capita income for
all brands for the four income distribution levels. Countries are
ranked by household final consumption expenditures from highest on
the left to lowest on the right. The resulting estimates for the number
of workdays needed to pay for one annual dose of toothpaste per
person at the lowest price for the poorest 30% of the population,
range from 0.03 days in the United Kingdom to 9.34 days in Kenya
(SD = 1.88), while for the same countries over the total population
the range was 0.01–2. The range and standard deviation for the
poorest 30% of the population is comparable for both the selected
international brands and the lowest price brands.

Figure 2. Days of household expenditures to pay for

toothpaste (one person, one year) at the lowest price. Number of days
of household expenditures required to pay for one annual dosage of
toothpaste at the lowest price by country and population group. This
figure includes countries for which the proportion was greater than
10% of a day of household expenditures.
When viewed by country category for all product brands surveyed in
40 countries, the prices for the poorest 30% of the population in each
of 9 of the 12 (75%) of the lowest income countries were categorized
as high, while prices in 6 of 15 (40%) of the middle-income countries
were high. None of the high-income countries fell into the high
category. As wealthier income groups were aggregated into the ratio
the price category changed to the point where, for the total
population toothpaste seemed expensive in only 4 (33%) of the low
income countries and none of the middle income countries.
Nonetheless for the lowest income countries the price remained in the
high category in 7 of 12 countries for 70% of the population. In
general, global brands seem to be more expensive than the generic
brands.
Limitations of the study
This investigation is not a comprehensive study on fluoride toothpaste
affordability as only 24% of all World Bank member countries (184)
participated in the survey. In addition, the data were predominantly
collected from urban retail shops, chosen by convenience. Variations
in retail cost of toothpaste and even of the same brands may occur
within countries, between urban and rural markets and between
countries due to natural factors (e.g. size of packaging,
transportation costs) structural factors (e.g. local taxation and
business regulations) and market conditions [22]. Larger retailers or
wholesalers can charge lower prices, than small shops; whereas
bargaining in street markets may result in lower prices.
The World Health Organization (WHO) and Health Action
International (HAI) are field-testing a methodology for detailed
country studies of affordability and costs of medicines within and
between countries [21]. While this study was not designed using the
WHO/HAI Medicine Prices protocol, in as much as possible the study
adapted methodologies recommended in the protocol. The cross-
sectional, multi-country nature of the study and prices obtained from
retail outlets prevented the same comparisons.
Global indicators used to facilitate comparisons
WHO/HAI suggests comparing "the cost of therapy with the daily
wage of the lowest paid government worker [21]." The current study
did not utilise wage information since it was not readily available;
instead, household final consumption expenditures were used as a
proxy for annual income.
The authors of this study recognise that all indicators, whether
household data, income distribution or total health expenditure,
possess limitations which make cross-country comparisons difficult.
Therefore, future assessments of fluoride toothpaste affordability may
benefit from the application of 'research triangulation'[23] as well as
the use of multiple indices to further investigate this issue.
Ratios were calculated for the poorest 30%, 50% and 70% of the
population and the total population. The ratios for the poorest 30%
and the total population are reported to provide a sense of the
difference in impact on the total population, compared to the strata of
the poorest sector of the population with the greatest health needs
and least access to services, including health and dental services.
Access to a preventive measure like fluoride toothpaste has a
potentially huge positive impact on these populations.

Discussion
Inequities in global affordability of fluoride toothpaste
The results of this study clearly demonstrate significant inequities in
the affordability of fluoride toothpaste. There is a general trend
where the poorer the country, the larger the proportion of the
household expenditure that is needed to pay for one annual dosage of
toothpaste for one person. In the 13 high-income nations the cost of
toothpaste represents less than one percent of per capita household
consumption expenditures, ranging from 0.004% to 0.041%.
Toothpaste products surveyed in the middle- and low-income
countries showed the proportion of household expenditure required to
acquire one annual therapeutic dose of toothpaste is considerably
larger and variable.
Two publications connected to the WHO-HAI studies state that a
treatment regimen costing one or five days is considered expensive,
and that these numbers are debatable [24]. While fluoride toothpaste
is considered essential for the prevention of dental decay and its use
should be part of daily hygiene, it should be more accessible and
cheaper than life-saving medicines. On the basis of the survey results
we suggest that a different metric is needed to establish a threshold
for affordability, wherein the ability to pay of the poorest income
groups, as well as a viable sales price are taken into account.
Measures to reduce the costs of fluoride toothpaste
Equity Pricing
Equity pricing is based on the principle that the poor should pay less
for, and have better access to an effective preventive product. The
price of fluoride toothpaste should be fair, equitable and affordable,
even for poor communities. The same brand of toothpaste should be
available at different prices in different countries in accordance with
the peoples' purchasing power.
Removal of taxation and tariffs
Taxes and tariffs on fluoride toothpaste sometimes significantly
contribute to higher prices, lower demand and inequity since they
target the poor. Toothpastes are usually classified as a cosmetic
product and as such often highly taxed by governments. For example,
various taxes such as excise tax, VAT, local taxes as well as taxation
on the ingredients and packaging contribute to 25% of the retail cost
of toothpaste in Nepal and India, and 50% of the retail price in
Burkina Faso. In many developing countries essential preventive
products, such as insecticide-treated mosquito nets, vaccines,
contraceptives and oral rehydration salts, are exempt from import
taxes or benefit from partial tax relief [25]. Olcay and Laing [24]
found that pharmaceutical tariffs could be eliminated without
adversely impacting on government revenue or industrial policy.
There is also a significant negative relationship between the levels of
tariffs and access to essential medicines. Analysis suggests that a 1%
reduction in taxation will increase access to essential medicines by
approximately 1% [26]. These findings may also be valid for fluoride
toothpastes; hence, WHO continues to recommend the removal taxes
and tariffs on fluoride toothpastes[5,27]. Any lost revenue can be
restored by higher taxes on sugar and high sugar containing
foods [28], which are common risk factors for dental caries,
coronary heart disease, diabetes and obesity [29]. Along with tax
relief on quality fluoride toothpaste, taxation of non-fluoride
toothpaste, which has little preventive properties [30,31] would
encourage consumers to make 'healthy choices the easy choices'. Any
savings from tax relief on fluoride toothpastes must however be
passed on to the customer.
Generic competition
Generic competition has been a powerful strategy for reducing drug
prices and may have the same potential for increasing the availability
and affordability of toothpastes. During the first half of the 1980s,
world market prices for drugs on the WHO Model List fell by 40%
through increased demand and competition [32]; while in Brazil the
price of AIDS drugs fell by 82% over 5 years as a result of generic
competition. In Myanmar, generic fluoride toothpaste is
manufactured and distributed by the government – it is 3.5 times less
expensive than the most expensive imported brand [33]. Social
marketing has been successful in the prevention of HIV/AIDS and
malaria[34,35] and has been proposed for increasing the availability
and affordability of fluoride toothpaste [36].
Encouraging local production
The production of toothpaste within a country has the potential to
make fluoride toothpaste more affordable than imported products. In
Nepal, fluoride toothpaste was limited to expensive imported
products. However, due to successful advocacy for locally
manufactured fluoride toothpaste, the least expensive locally
manufactured fluoride toothpaste is now 170 times less costly than
the most expensive import [37]. In the Philippines, local
manufacturers are able to satisfy consumer preferences and compete
against multinationals by discounting the price of toothpaste by as
much as 55% against global brands; and typically receive a 40%
profit margin compared to 70% for multinational producers [38].
Inexpensive ingredients and packaging
Approximately 40% of the cost of production of toothpaste is related
to the packaging, another 40% to the ingredients and 20% to
labour [38]. High quality low cost fluoride toothpaste can be
produced using (cheaper) precipitated calcium carbonate without
interfering with the in vitro anti-caries efficacy [39]. Many countries
use sachet packaging (10 ml) which make fluoride toothpaste more
affordable to the poor who cannot afford a one-time expenditure for a
larger quantity.
In order to achieve these measures, advocacy by international health
organisations such as the WHO and the FDI World Dental
Federation, as well as national advocacy by oral health stakeholders,
is required in order to:
• Transform government policies and regional trade policies to
eliminate taxation of quality fluoride toothpaste;
• Encourage generic and local production of affordable fluoride
toothpaste.
• Encourage multinational toothpaste manufacturers to implement
differential pricing for poorer countries and reduce the cost of
toothpaste through inexpensive packaging and cheaper ingredients;

Conclusion
World experts at a conference on "Oral Health through Fluoride for
China and Southeast Asia" on September 18–19, 2007, in Beijing,
China, have confirmed that: "fluoride toothpaste remains the most
widespread and significant form of prevention of and protection
against tooth decay used worldwide. It is also the most rigorously
evaluated vehicle for fluoride use" [40]. In view of the current
extremely inequitable use of fluoride throughout countries and
regions, all efforts to make fluoride and fluoride toothpaste
affordable and accessible must be intensified. As a first step to
addressing the issue of affordability of fluoride toothpaste in the
poorer countries in-depth country studies should be undertaken to
analyze the price of toothpaste in the context of the country
economies.

Competing interests
The authors declare that they have no competing interests.

Authors' contributions
CJH, RY, and HB conceived and designed the study, and supervised
data collection, AG analyzed the data. All authors participated in
additional research as well as drafting and editing the manuscript.

Acknowledgements
This study was undertaken with the logistical assistance of the FDI
World Dental Federation and the cooperation of national dental
associations, oral health stakeholders and non-governmental
organisations participating in the survey part. Daniel Hawes, MA
contributed graphic and research suggestions and Curtis B. O'Neal,
research support.

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TOOTHPASTE MARKET

Toothpaste brands – How many you need?

These days even selecting toothpaste is not an easy decision to
make. Take the case of Colgate-Palmolive, one of the leading
players in the oral care segment in India.
They’ve toothpaste for complete 12 hour gem protection –
Colgate Total-12, tooth paste to clean and whiten teeth –
Colgate advanced whitening, one with cooling crystals –
Colgate Max Fresh, one with herbal ingredients – Colgate
Herbal, one that contains salt – Colgate Active salt, a
toothpaste for long lasting fresh breadth – Colgate Fresh
Energy gel, one that is 100% vegetarian – Colgate Dental
cream, one with fruity bubble gum flavour for kids – Colgate
Kids toothpaste.

Selecting one from this list is not that easy. But, wait all these
different choices are from just one company. So when you
consider other leading brands like Close-up, Pepsodent,
Dabur, you’ll be spoilt for choice.

Marketing strategy – Launching a new brand:

Well, in this clutter of toothpaste brands is there a possibility
for a new brand to grow and gain significant market share?
Only a disruptive strategy will help.

How about a toothpaste specially made for brushing at night?

If such a product has its benefits and is proven scientifically,
then it will be easy to weave a marketing strategy around this
concept and make every other brand as morning toothpaste
category. This will help the new brand to gain significant
market share in its niche, night dental care segment.

Win-Win:
As still significant percentage of people brush only in the
morning, a separate toothpaste for night will push more
people to brush before going to bed. This will not only improve
the topline growth of toothpaste brands, but also help people
develop the good habit of brushing twice a day.