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ORAL HYGIENE: ANALYSIS OF DENTAL CARE PRODUCTS FROM ISLAMIC PERSPECTIVE.

v Submitted To: Sir Abdul Qayyum.

v Submitted by: Amna Hanif. Nasira Mehmood.

v Submission Date: 25-05-2014.

Riphah International University, Islamabad.

Oral Hygiene: Analysis of Dental Care Products from Islamic Perspective.

Introduction:

The word oral, both in its Latin root and in common usage refers to the mouth.[1] Oral hygiene is the practice of keeping the mouth clean and healthy by brushing and flossing to prevent tooth decay and gum disease.[2]

Oral health is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores and other diseases and disorders that affect the oral cavity. Risk factors for oral diseases include unhealthy diet, tobacco use, harmful alcohol use, and poor oral hygiene.[3]

Oral health is essential to general health and quality of life. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.[4]

Good oral hygiene helps to prevent cavities and stained or yellowed teeth, as well as bad breath. Poor oral health has been linked to a variety of general health problems, such as heart disease and strokes. Medical researchers discover more links between oral and general health each year.

It is important not only to brush at least twice daily and to floss each day, this is also imperative to dentists regularly for a routine examination and professional cleaning. Brushing and flossing correctly and with the right toothpaste, toothbrush, and dental floss is also essential for preventing the onset of dental diseases.[5]

Good oral hygiene helps to prevent dental problems - mainly plaque and calculus which are the main causes of gum disease and caries (tooth decay). Good oral hygiene may also help to prevent or delay dental erosion.

• Dental plaque is a soft whitish deposit that forms on the surface of teeth. It forms when bacteria (germs) combine with food and saliva. Plaque contains many types of bacteria.
• Calculus: sometimes called tartar, is hardened calcified plaque. It sticks firmly to teeth. Generally, it can only be removed with special instruments by a dentist or dental hygienist.[6]

Key facts about Dental Health:

• Worldwide, 60–90% of school children and nearly 100% of adults have dental cavities.
• Dental cavities can be prevented by maintaining a constant low level of fluoride in the oral cavity.
• Severe periodontal (gum) disease, which may result in tooth loss, is found in 15–20% of middle-aged (35-44 years) adults.
• Globally, about 30% of people aged 65–74 have no natural teeth.
• Oral disease in children and adults is higher among poor and disadvantaged population groups.
• Risk factors for oral diseases include an unhealthy diet, tobacco use, harmful alcohol use and poor oral hygiene, and social determinants.[7]

Dental Care Products:

1.      Toothpastes:

Toothpaste was used as long ago as 500 BC in both China and India; however, modern toothpastes were developed in the 1800s. In 1824, a dentist named Peabody was the first person to add soap to toothpaste. John Harris first added chalk as an ingredient to toothpaste in the 1850s. In 1873, Colgate mass-produced the first toothpaste in a jar. In 1892, Dr. Washington Sheffield of Connecticut manufactured toothpaste into a collapsible tube. Sheffield's toothpaste was called Dr. Sheffield's Creme Dentifrice. In 1896, Colgate Dental Cream was packaged in collapsible tubes imitating Sheffield.[8]

Most of us use toothpaste two times a day when we brush our teeth.[9] The study by Sainio and Kanerva summarizes information on toothpaste composition as supplied by the manufacturers. It was concluded that the toothpastes are not entirely safe to use, because almost 50% of the products studied contained a total of some 30 compounds widely recognized as allergens. According to the literature, the most common allergens in toothpastes are flavors (e.g., cinnamic aldehyde, cinnamon oil and peppermint) and preservatives. Symptoms include stomatitis, cheilitis. glossitis, gingivitis, perioral dermatitis and immediate hypersensitivity.[10]

The results of the survey revealed that toothpastes were generally more heavily contaminated than mouthwashes with respect to both bacterial and fungal count. In addition, the incidence of hazardous bacteria is higher in toothpastes than in mouthwash.[11]

As part of good oral hygiene measures, toothpastes play an important part in disease prevention. In addition to flavoring, toothpastes basically contain detergents and polishing agents. Additionally, toothpastes may contain additives for particular benefits, such as anticaries or antimicrobial effect or inhibition of the formation of tartar. Active agents commonly incorporated in dentifrices include Chlorhexidine, Triclosan (Antimicrobial); Potassium Nitrate and Stannous Fluoride (Desensitizers); Sodium Fluoride, Sodium Monofluorophosphate, Acidulated phosphate Fluoride (Anti-cariogenic). Some toothpaste brands claim to 'cure' all diseases of teeth and gums without listing the active therapeutic ingredients on the label. Since toothpaste is not included in the list of items under compulsory monitoring by the Pakistan Standard and Quality Control Authority, manufacturers are not legally bound to follow Pakistan Standards Institution's specifications for toothpastes.[12]

The substances included in the toothpaste are selected for providing healthy teeth. Eight to twenty four ingredients were found in different toothpastes. Toothpaste needs about three functional ingredients: flour for preventing caries, a polishing ingredient and a detergent for cleaning the teeth. Other ingredients provide taste, colour, durability, texture and other effects related to mouth care. These ingredients have hazardous effects on environment.[13]

2.      Toothbrushes:

The toothbrush is a simple concept that dates back to the "chew stick" (a thin twig with a frayed end) used by ancient civilizations more than 5000 years ago. Today, the toothbrush has radically transformed and is a staple of personal hygiene for modern civilizations. It helps us look better, smell better and makes our mouth healthier.[14] 

Natural bristle brushes were invented by the ancient Chinese who made toothbrushes with bristles from the necks of cold climate pigs.

French dentists were the first Europeans to promote the use of toothbrushes in the seventeenth and early eighteenth centuries. [15]

Tooth brushing plays an important everyday role for personal oral hygiene and effective plaque removal. Appropriate toothbrush care and maintenance are also important considerations for sound oral hygiene.[16] 

The lowly toothbrush, primarily an instrument of health promotion, has now been found to be an instrument of potentially life-threatening injury in children.[17]

To date, the Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use, although people with bleeding disorders and those severely immuno-depressed may suffer trauma from tooth brushing and may need to seek alternate means of oral hygiene. The mouth is home to millions of microorganisms (germs). In removing plaque and other soft debris from the teeth, toothbrushes become contaminated with bacteria, blood, saliva, oral debris, and toothpaste. Because of this contamination, a common recommendation is to rinse one's toothbrush thoroughly with tap water following brushing. Limited research has suggested that even after being rinsed visibly clean, toothbrushes can remain contaminated with potentially pathogenic organisms.[18]

Researchers at England's University of Manchester found that one uncovered toothbrush can provide refuge for more than 100 million bacteria, including E. coli, which can cause diarrhea and staphylococci ("Staph") bacteria that cause skin infections.[19]

If the toothbrush is made of bristles (pig's hair) then its use is not permissible.[20]

3.      Miswaak:

The miswak (miswaak, siwak, sewak, السواك) is a teeth cleaning twig made from the Salvadora persica tree (known as arak in Arabic). A traditional alternative to the modern toothbrush, it has a long, well-documented history and is reputed for its medicinal benefits. It also features prominently in Islamic hygienical jurisprudence.[21]

The miswak, a traditional chewing stick for cleaning teeth.For religious and cultural reasons, miswak use is firmly established and widespread in Saudi Arabia and most other Muslim countries.[22]

The use of Miswak is well spread in the Muslim population of the world, and is a common entity in Muslim countries. The reason for common use of Miswak by Muslims can be attributed to religious beliefs. The last messenger of Islam used it frequently and also instructed his followers to do the same and hence the practice continues widely in Muslim countries. Note that it is used in place of the ordinary toothbrush and toothpaste. There are 70 benefits of Miswak as suggested by Islamic Literature and many of these have been scientifically proven and the rest haven’t been studied yet.

"The Miswak is a (means of) purification of the mouth (and a means of) pleasure of the Lord "(Al-Bukhari). "Had it not been for the sake of over burdening my Ummah I would have ordered them (to use) Miswak with every ablution"(in another report by Al-Bukhari).

Islam introduced basic oral hygiene by incorporating it as a religious practice. Islam teaches the importance of cleanliness of the body as well as of the mind. Several quotations are found in the compendium of the Prophet Muhammad (PBUH), as to the benefits of Miswak in oral hygiene.[23]

Benefits of Miswaak: Advantages of the Miswaak are:

a)      Miswaak strengthens the gums and prevents tooth decay.

b)      Miswaak assists in eliminating toothaches and prevents further increase of decay which has already set in.

c)      Miswaak creates a fragrance in the mouth and eliminates bad odors and improves the sense of taste..

d)     Miswaak causes the teeth to glow.

e)      Miswaak assists in digestion.

f)       The greatest benefit of using miswaak is gaining the pleasure of Allah.

g)      The reward of Salaah (Prayers) is multiplied 70 times if Miswaak was used before it.[24]

Al Otaibi in his research concluded that, the miswak is more effective than tooth brushing for reducing plaque and gingivitis, when preceded by professional instruction in its correct application. The miswak appeared to be more effective than tooth brushing for removing plaque from the embrasures, thus enhancing interproximal health.[25]

Ingredients and components of Toothpastes and Tooth brushes:

1.     Toothpastes:

Toothpastes are multi-component-mixtures of different inorganic and organic compounds. Besides the mostly inorganic polishing agents they contain detergents as foaming agents, moisturizing components and solvents, water, sweetening agents, flavors, preservatives, thickening agents, dyes and special ingredients, the latter often in very low concentrations.[26] A typical toothpaste contains an abrasive, humectant, binder, detergent, flavour, preservative and therapeutic agent.[27]

Toothpaste is one item that nearly everyone uses today. Some believe that the ingredients contained in a standard package of toothpaste are essential while others believe that water may be just as effective. In the end, there’s a good reason why most toothpaste packages warn: “Do Not Ingest!”

a)      Formaldehyde:

That same ingredient that coroners can’t live without can be found inside of your toothpastes tube. Formaldehyde kills all of those small bacteria that climb onto your teeth after eating or sleeping. If a large amount of formaldehyde is accidentally ingested, the result could be fatal. Severe formaldehyde ingestion results in jaundice, kidney damage, liver damage, and death.

b)     Detergent:

Foam, suds, activation! What would toothpaste be without that satisfying soapy feeling? Manufacturers use regular detergent in order to appease the masses that prefer bubbly toothpaste. While bubbles may be fun, be careful if you accidentally ingest a large amount of this stuff – swallowing detergent can cause digestive tract burning.

c)      Seaweed:

Stretchy and slimy, seaweed holds that paste together. Without this green stuff, toothpaste would simply fall apart! The good news is that seaweed isn’t toxic. In fact, seaweed has a number of nutritional benefits

d)     Peppermint Oil:

Fresh breath can only be kept fresh with the help of peppermint oil! While refreshing when brushing your teeth, peppermint oil can cause a slow pulse, heartburn, and muscle tremors if it is consumed.

e)      Paraffin:

It is derived from Petroleum. It creates a smooth paste and if happens to swallowed, it may end up with abdominal pain, nausea, vomiting and constipation.

f)       Glycerin Glycol:

It is added to toothpaste to prevent it from drying.

g)      Chalk:

Chalk dust may cause problems if inhaled and swallowing it can cause bleeding. It is also an ingredient of the toothpaste.

h)     Titanium Dioxide:

It is an ingredient of toothpastes as well s white paints and keeps the tooth nice and white at least for some time.

i)        Saccharin:

It is also the part of toothpastes to sweeten it but it hs been a hot topic of debate that is it safe or not.

j)       Menthol:

Without menthol, toothpaste might taste like, well, chalk, glycerin, paraffin, detergent, titanium dioxide, and seaweed.[28]

Harmful ingredients in toothpastes: 

a)      Fluoride:

The use of fluoride toothpaste, particularly during early childhood, presents health risks. Risks from ingesting fluoride toothpaste include permanent tooth discoloration (dental fluorosis), stomach ailments, acute toxicity, skin rashes (perioral dermatitis), and impairment in glucose metabolism. All of these risks have been unnecessarily increased by the marketing practices of toothpaste manufacturers, who use cartoon packaging and candy-flavors to target *adult-strength* fluoride toothpaste to young children. The dental community’s failure to educate the public about the dangers of swallowing too much fluoride toothpaste has further exacerbated the problem. Toxic dosage of toothpaste with fluoride can cause death.[29]

        i.            Fluorosis: One side effect from swallowing too much fluoride is dental fluorosis. Dental fluorosis is a defect in tooth enamel caused by excessive fluoride intake during the tooth-forming years (age 0 to 8). In its mild forms, dental fluorosis presents as cloudy splotches and streaks on the teeth, while in its moderate and severe forms, fluorosis can cause extensive brown and black staining along with pitting and crumbling of the enamel. In fact, a single tube of bubble-gum flavored Colgate-for-Kids toothpaste contains enough fluoride (143 mg) to kill a child weighing less than 30 kg. (Whitford 1987a).

      ii.            Skin Rashes : Among some individuals, the use of fluoride toothpaste may cause or aggravate perioral dermatitis (a rosacea-like skin rash around the mouth). (McCaffery 2003; Mellette 1983, 1976). The condition usually appears in women between the ages of 20 and 50.[30]

b)     Triclosan:[31]

This antibiotic/antimicrobial agent is used in many products including dishwashing soap, hand soap, deodorants, toothpaste and mouthwash. In August 2009 the Canadian Medical Association requested Canada Health to ban triclosan use in personal care products due to development of bacterial resistance. In 2006 and 2009, studies demonstrated triclosan exposure significantly impacts thyroid hormone concentrations.

c)      Sodium Lauryl Sulfate (SLS):

Using toothpaste without sodium lauryl sulfate (SLS) may reduce the frequency of canker sores (aphthous ulcers). Researchers speculate that SLS dries out the protective mucous lining in the mouth...making it vulnerable to irritants that lead to canker sores. SLS is a detergent that is in almost all toothpastes, dishwashing soaps and body washes.

In the cleaning industry, SLS is used in products such as garage floor cleaners, engine degreasers and car wash soaps. Elsewhere, SLS is used for clinical testing as a primary skin irritant. Laboratories use it to irritate skin on test animals and humans so that they may then test healing agents to see how effective they are on the irritated skin.[32]

d)     Abrasives:

Tooth sensitivity is caused by many factors. A term used for certain types of tooth sensitivity is known as `abfractions` and may be caused by abrasive toothpaste. Some toothpaste including teeth whitening pastes and tartar control brands may contain stronger abrasives.

e)      Artificial sweeteners:

The FDA has vacillated over the years about the safety of artificial sweeteners such as saccharin. Canada Health has still not approved saccharin as safe.[33]

f)       Artificial dyes/colorings:

There are artificial dyes/colorings often found in familiar toothpaste brands and a wide variety of other products. Recent studies indicate that FD & C Blue Dyes 1 & 2 can trigger a wide number of behavioral, learning, and health problems. FD&C color dyes may also cause potentially severe allergic reactions, asthma attacks, headaches, nausea, fatigue, nervousness, lack of concentration, and cancer.

g)      Hydrated Silica: A whitener that damages tooth enamel

Hydrated silica, which is primarily used as an abrasive in toothpaste, is made from a crystallized compound found in quartz, sand, and flint. Tooth enamel re-mineralizes daily from the supply of ionic calcium and phosphorus in the saliva. Scratching the surface of the tooth with an abrasive such as hydrated silica harms the enamel and prevents re-mineralization, much like using sand to clean glass. Severe wear could eventually occur.[34]

h)     Glycerin: A by-product of soap manufacture used in cosmetics, toothpastes, soaps, ointments, and medicines.[35] Glycerin made from pork fat is also an ingredient in many types of toothpaste.[36]

2.     Tooth brushes:

Before the invention of synthetic fibers, toothbrushes were made from the hair on the back of a boar, although they contained lots of bacteria. The Wild Boar (Sus scrofa) is the ancestor of the domestic pig.[37] Animal bristles at that point had been used for centuries and for a long time were considered to be the superior material to manufacture toothbrushes from. But animal hair actually retains bacteria, meaning that every time people brushed with an animal hair toothbrush they put the old bacteria from their last brush back into their mouths. Today toothbrushes are manufactured worldwide with plastic handles and still made with synthetic nylon fibers for the bristles. The toothbrush is an essential part of everyday hygiene and nearly all households carry toothbrushes.[38] These have two types of bristles:

a)      Natural Bristles:

Toothbrushes were originally made of bamboo and bone handles, and incorporated bristles made of either Siberian boar's hair or horse hair. Though relatively effective for cleaning purposes, they had their disadvantages. Animal hair brushes fell short not only on a hygienic level, as they can retain bacteria, but they also tended to dry more slowly than more contemporary materials. Also, due to a less refined manufacturing process, the bristles would often fall out of the brush.

b)     Nylon Bristles:

Modern toothbrushes are typically outfitted in either nylon or nylon-polyester blend bristles. The first nylon bristled brush was introduced in 1938 and was produced with nylon yarn. Today, nylon bristled brushes come in a variety of shapes, sizes, textures and densities.[39]

Aquafresh, Colgate, Crest, Mentadent, Oral-B and Reach tooth brushes are free from any pig hairs or any animal derived ingredients. Bristles from above brands of tooth brushes are made with nylon according to manufacturer of above brands.[40]

Shariah verdicts regarding Haram ingredients:

Halal ·         Acetic ·         Ammonium chloride ·         Ammonium Sulphate Ascorbic Acid ·         Aspartame ·         Benzoate/Benzoic Acid ·         Calcium Carbonate ·         Calcium Sulphate Carrageenan ·         Cocoa Butter ·         Corn Meal/Corn Starch ·         Corn Syrup ·         Dextrin/Dextrose ·         Dicalcium phosphate ·         Diglyceride (Plant) ·         Enzyme (Plant) ·         Ergosterol ·         Fatty Acid (Plant) ·         Ferrous Sulphate ·         Fructose ·         Fungal Protease Enzyme Glucose ·         Glyceride (Plant)  ·         Glycerol /Glycerine (Plant) ·         Gum Acacia[41]

Haram ·         Acid Human body part ( ex. hair) ·         Alcohol ·         Animal Fat ·         Bacon (Pork) ·         Collegen (pork) ·         Diglyceride (Animal) ·         Dough Conditioners ·         Emulsifier ·         Enzyme (Animal) ·         Ergocalciferol ·         Fatty Acid (Animal) ·         Gelatin ·         Glyceride (Animal) ·         Glycerol/Glycerine (Animal) ·         Lard ·         Harmones (Animal) ·         Hydrolyzed Animal protein ·         Monoglycerides (Animal) ·         Pepsin (Animal) ·         Phospholipid (Animal) ·         Pork & All by Products

TOOTHPASTE
Manufacturer /Vendor	Brand	Coagulant/Ingredients	Use
Colgate Palmolive Co.	Ultra Brite Colgate Paste Colgate Powder	Lard	HARAM
Procter and Gamble	Gleen	Lard	HARAM
NOTE: Contains alcohol; still in doubt about its use.[42]

·         Ruling on using materials to which “animal glycerin” has been added

The materials which are used to manufacture creams, shampoos, toothpaste and soap are either: 

1.     Animal fats

2.     or other substances, of vegetable origin or artificial. 

If the substance comes from animal fats, then it is of two types:  

(a)   Either it comes from animals that are permissible to eat, and it has been slaughtered according to sharee’ah, or it comes from sea creatures that do not need to be slaughtered. The ruling in this case is that it is permissible, with no doubt.

(b)  Or it comes from animals whose meat and fat are forbidden to eat, such as pigs, or it comes from a permissible animal but it has not been slaughtered in the proper shar’i manner, so it is “dead meat”. The ruling in both cases is that it is haraam, with no doubt

The scholars of the Standing Committee said:  

If a Muslim is certain or thinks it most likely that meat, fat or ground bones of a pig have got into any food, medicine or toothpaste etc, then it is not permissible for him to eat it, drink it or use it. In the case of doubt, then he should not use it, because the Prophet (peace and blessings of Allaah be upon him) said: “Leave that which makes you doubt for that which does not make you doubt.” 

If the Muslim is certain or thinks it most like that any pork, lard (pig fat), or ground up pig bones has gotten into his food, medicine, toothpaste and so on, then it is not permissible for him to eat it or drink it, or apply it to his skin.

Shaykh ‘Abd al-‘Azeez ibn Baaz, Shaykh ‘Abd al-Razzaaq ‘Afeefi, Shaykh ‘Abd-Allaah ibn Ghadyaan, Shaykh ‘Abd-Allaah ibn Qa’ood. 

Fataawa al-Lajnah al-Daa’imah (22/281).[43]

The scholars of the Standing Committee for Issuing Fatwas are of the view that the prohibition is not lifted, and the ruling does not change at all even if the element is changed into some other thing. Others – such as the Islamic Organization for Medical Sciences – disagreed and said that najis, haraam substances become permissible if they are turned into something else, and the quality of impurity and the name no longer apply to them. This is in accordance with what Ibn al-Qayyim (may Allaah have mercy on him).[44]

Dental Care products in Pakistan:

Toothpaste Market in Pakistan to 2014 (Oral Hygiene) is a comprehensive resource for market and segment level data including value and volume from 2004 to 2014, and market/company shares for 2008-09. The toothpaste market in Pakistan increased at a compound annual growth rate of 3.1% between 2004 and 2009. The standard category led the toothpaste market in Pakistan in 2009, with a share of 40.5%.^[45] The oral healthcare in Pakistan is still growing rapidly with awareness amongst masses improving by the day and more and more people are becoming conscious of their dental needs. According to a new Euro monitor report, the cosmetics and personal care markets had average annual growth rates of 14 per cent in Pakistan. Pakistan is the 9th largest market with an estimate 180 million consumers. In 2002-2007 market for Oral hygiene in Pakistan increased and growing at an average annual rate of 3.4%. But now Oral hygiene had 8% value growth in 2008 to reach value sales of PKR9.6 billion. Toothpaste use is increasing with dynamic rate. The toothpaste market is around 7 billion rupees while the tooth brush and mouth wash markets are 300 million and 85 million rupees respectively. The leading company in the market is Colgate-Palmolive Company. ^[46]

1.      Colgate-Palmolive products:

Colgate-Palmolive (Pakistan) Limited (CP). The Company owns a number of global brands including Colgate toothpaste, Tooth Brushes. The Company was incorporated in Pakistan on December 5, 1977 as a public limited company and its shares are quoted on the stock exchanges in Pakistan. The Company is mainly engaged in manufacture and sale of detergents, personal and other products. Lakson group of Companies is manufacturer and seller of Colgate tooth paste in Pakistan. Lakson group of companies is a national base group of companies.^[47] They state that:

                     “We make the products that make your smile brighter and healthier”

Colgate toothpaste: It has sodium laural sulphate which causes cancer. It contains Sodium, Monofluoro Phosphate, Calcium Carbonate, Silica, Triclosan, mint extract for flavour and base. Water, hydrated silica, glycerin, sorbitol, PVM/MA copolymer, sodium lauryl sulfate (SLS), cellouse gum, and flavor, and some other trace chemicals and Sodium Fluoride and Triclosan for whitening.^[48]

2.      Unilever Company products:

Unilever is one the world’s top packaged consumer goods a company, Unilever has leveraged its brand-name food, cleaning and personal care products into market dominance worldwide. Unilever is one of the industry leader in deodorants (Ax e, Degree), hair care products (Suave, ThermaSilk), prestige fragrances (Calvin Klein, Lagerfeld) and soap (Dove, Lux ). Its other familiar goods include Q-Tips, Vaseline, Pepsodent, Close up and Mentadent tooth pastes and laundry and cleaning products such as all Wisk and Surf.^[50]

a)      Close up: Close-up contains sodium mono-fluorophosphate, a form of fluoride that prevents cavities and fights tooth decay. Inactive ingredients: sorbitol, water, hydrated silica, PEG-32, sodium lauryl, sulfate, SD alcohol 38-B, flavor, cellulose gum, sodium saccharin, red 33, red 40. sorbitol, water, hydrated silica, peg 32,sodium lauryl sulfate, sd alcohol 38 b, flavor ,cellulose gum, sodium saccharin, red 33,red 40,mica.^[51]

Close up is offering the following six types of toothpaste in market:

• Close up      (Crystal with soft blue granules)
• Close up      (Lemmon mint)
• Close up      (Menthol chill)
• Close up      (Red hot)
• Close up      (White teeth fresh breath)
• Close up      (Milk Calcium nutrient)^[52]

b)     Pepsodent: It is the dentist recommended toothpaste. International Dental Health Foundation also approves it.^[53] Fluoride (active ingredient), sorbitol, hydrated silica, peg32, sodium lauryl sulfatem SD alcohol 38B, flavor, cellulose gum, zinc citrate trihydrate, sodium saccharine, titanium dioxide^[54]

Pepsodent is offering the following five types of toothpaste in market:

• Pepsodent Germ check
• Pepsodent Herbal
• Pepsodent SENSITIVE
• Pepsodent Complete 8^[55]

3.      Proctor & Gamble Company products:

a)      Crest toothpaste: Ingredients are sodium fluoride, sorbitol, water, hydrated silica, sodium lauryl sulfate, trisodium phosphate, flavor, sodium phosphate, cellulose gum, carbomer 956, sodium saccharin, titanium dioxide, blue 1. ^[56]

Proctor & Gamble Company is offering the following five types of toothpaste in market:

• Crest Cavity Protection - Regular Paste
• Crest Vivid White - Invigorating Mint
• Crest Vivid White - Revitalizing Mint
• Crest Whitening with Scope
• Crest Pro Health
• Oral-B Tooth brushes^[57]

Interview of the Manager of Werrick Health Care:

Product: Toothbrushes (Dentist and Ezigrip).

The interview of the manager of Werrick Health Care, Mr Atif Hussain was taken. 10 questions were asked to him and taken detailed answers regarding their products, pricing, placing of product and promotional activities.

1.      Company name and introduction:

The company’s name is Werrick Helath care which is producing toothbrushes and other health care products. The main business is the production of medicines and under the name of W-Wilson Pharmaceuticals.  It is located in I10-3, Islamabad.

2.      Tooth brushes: how they made?

The two toothbrushes are made, Ezigrip and Dentist toothbrushes. It is made of Plastic, Nylon is used. First of all the handle is made, then bristles are attached to it and finishing of the brush is done.

3.      Ingredients and components of tooth brushes.

The following components are utilized:

a)      Plastic molding compound (Poly propylene).

HDFP and Kibisan San is also used.

b)     Filaments of different color.

c)      Nickel wire.

d)      Master Batch of different colors.

4.      The cost of per toothbrush approximately.

The cost of per toothbrush is 40 Rupees for Ezigrip and 60 Rupees for Dentist.

5.      The margin of profit on each toothbrush approximately.

The market price of Ezigrip is 80 Rupees and Dentist is 100 Rupees. The profit margin is almost 40%.

6.      How you promote the toothbrush product.

a)      Though print media.

b)      Sign boards.

c)      Electronic media

d)     Free Sample giving.

7.      Do you made other dental care products? If yes plz mention and what are their ingredients.

No, no other dental care products are manufactured.

8.      Please mention the areas where your dental care products are supplied?

Products are supplied to all over Pakistan through our distributors.

9.      Have you done market segmentation for your product and on which basis you target your market?

Designs of the products are made according to the class of people. As dentist is for rich people so its costly while Ezigrip targets all the middle and lower income groups.

10.  What is your cost of advertisement?

10 million per year is allocated for the advertisement and promotion and cost is added to the price of the product.

Marketing Analysis of Dental Care Products under Four Ps’ with respect to Islam:

Marketing Mix

1.     Product: 

a)      Brand name: Colgate Toothpaste, this product has many flavors which targeted children and youth with the introduction of this toothpaste, as this helps in refresh breath.  

b)     Quality: Colgate Company has specially developed this toothpaste for many problems of people, related to the health of their teeth and gums. The most special aspect of this toothpaste is that it produces quite a lot of freshness in the mouth of users and eliminates any kind of dab scent from the mouth.^[59] 

c)      Design and style: "The Colgate max fresh Red gel toothpaste is an excellent and ingenious solution to your oral care needs, brought to you by Colgate. Presented in an attractive and youthful packaging with a vibrant bright red color gel, this toothpaste is designed to give you all the long lasting freshness and the social confidence you need to get closer to others. Developed after tireless research by the R&D at Colgate, it combines the freshness and minty flavor of fresh mint along with promise of protection from gum diseases. Get ready for an explosion of freshness in your mouth and say goodbye to sleepy mornings. The Colgate max fresh gel toothpaste is designed to work all day, fighting germs that cause plaque and gum diseases, keeping you feeling fresh and smiling all day.^[60]

d)     Features and packaging: the packaging and labels can be used by marketers to encourage potential buyers to purchase the products. Colgate uses attractive packaging which visible it from competitor’s brand. The packaging is from 20gm to 300gm. They have used following colours: red, white and blue. ^[61]

Hide the faults or defects in the products according to Islam:

Honesty is an essential fundamental in all dealings, but especially in selling. One of the essential means of being honest is to avoid over-praising a product or service or exaggerating about it, for this could go beyond the bounds of being open and honest. The Prophet (PBUH) said: “Try not to praise products to one another” (Al-Tirmidhi, no. 1268), i.e., the seller should not praise it in order to encourage the one who hears him to buy it, so that the only reason he buys it is what the vendor says. Some of the scholars counted praise of a product for what it is as a kind of insane or senseless speech from which people should refrain. The guideline here is that the vendor should refrain from saying anything which could later result in regret on the part of the purchaser. The seller should avoid any kind of cheating and deception in his advertising; i.e., he should not make the product appear more attractive than it is, or conceal its faults, or praise it in terms of characteristics and features that it does not have. All of this is haraam, as stated above.[62] The one who sells an item in which there is a fault must point out its faults, whether he is selling it to a Muslim or a kaafir, otherwise he will be deceiving and sinning.  Al-Bukhaari (2079) and Muslim (1532) narrated that Hakeem ibn Hizaam said: The Messenger of Allah (PBUH) said:

“The two parties to a transaction have the option (of cancelling it) until they part. If they are honest and disclose any defects, their transaction will be blessed, but if they lie and conceal defects the blessing will be erased.”

Ibn Qudaamah said in al-Mughni (4/108): If a person knows that there is a defect in his goods, it is not permissible for him to sell them unless he discloses it to the purchaser. If he does not disclose it then he is sinning.  This was stated by Ahmad, because of the report of Hakeem ibn Hizaam that the Prophet (PBUH) said: “The two parties to a transaction have the option (of cancelling it) until they part.” He said that the meaning of concealing faults is concealing them from the purchaser knowingly, or hiding them from him in such a way that the purchaser thinks there are no defects; both are deception which is haraam.[63]

2.      Place

a)      Location: Colgate’s product distribution is immense. Colgate toothpaste is physically located in the oral health isle of stores. Colgate toothpaste can sometimes be found in more prominent locations when on sale or launching new products into the market. Colgate is sold over almost all the retail outlets like, Kirana stores, supermarkets, medical shops, co-operative stores, etc. It is well-distributed through the supply chain of company distributors to whole sealers to retailers to final consumers. All the products are available in all market, including semi-urban and rural markets which are their primary focus areas. But the various varieties of Colgate are not so easily available other than in the oral care outlets or super markets. The small tubes of Colgate are also available in small road-side shops and from the vendors.^[64]

b)     Channels: the local area cable network because it is the most effective way to get the attention of the kids, after that it will switch towards the advertisement on famous television channels including Geo, Aag and PTV.^[65]

3.     Price:

Colgate Company applies Bundle pricing which means that when consumers buy toothpaste, they will receive a toothbrush or mouthwash in this toothpaste. That will encourage customers to buy products. Also, the benefits are not only given to consumers but also the producers because they can sell three things like toothpaste, toothbrush and mouthwash in one time. Colgate changes its prices to meet the competition but only at that time when the prices of competitors decrease because of national change in prices. Every customer has to pay the same amount to buy the products of Colgate Palmolive in Pakistan. It means the company is following uniform delivered pricing strategy for all its products.

Before setting price Colgate considers the following:

·         Pricing objectives 

·         Importance of pricing for target customers

·         Identifies the demand

·         Estimated costs

·         Competitors prices^[66]

Selling Haram things according to Islam:

It is not permissible to sell them because when Allaah forbids a thing He also forbids its price. Ibn ‘Abbaas (may Allaah be pleased with them both) said: “The Messenger of Allaah (peace and blessings of Allaah be upon him) said: ‘Allaah has cursed the Jews because fat was forbidden to them, but they sold it and took its price. When Allaah forbids something he also forbids its price.’” (Reported by Imaam Ahmad, 2546).

With regard to doubtful things, it is better not to sell them, so as to be free of any blame, as the Prophet (peace and blessings of Allaah be upon him) said. Al-Nu’maan ibn Basheer said: “I heard him saying, ‘I heard the Messenger of Allaah (peace and blessings of Allaah be upon him) say: “What is permitted is clear and what is prohibited is clear, and between them are doubtful things which many people do not know about. Whoever avoids doubtful things will be on the safe side with regard to his religion and his honour, but whoever falls into doubtful things will fall into haraam things.”’” (Reported by Muslim, 2996). And Allaah is the Source of Strength[67]

4.      Promotion: 

The management at Colgate Palmolive realizes the importance of promotion and huge efforts are made to ensure effective promotional planning and the success of all promotional campaign. The promotional mix of Colgate consists of the following activities:

a)      Advertising:

                                i.            Bill Boards: the company advertises their product through billboard because the kids who watch our ads on television when they will watch our value added product on billboards they will definitely enforce their parents to buy it for them.

                              ii.            Television: the company advertises our product on local area cable network because it is the most effective way to get the attention of the kids, after that it will switch towards the advertisement on famous television channels including Geo, Aag and PTV. Our commercial ads especially during the intervals of cartoons and children concerning serials or in times when children can almost certainly watch TV.^[68]

In 2012 the famous duo Shahid Kapoor and Genelia D’souze, were the Max Fresh celebrities who drove Pakistani Max Fresh fans to switch on their power of freshness. They were the highlight of the integrated 360 degree advertising campaign launching in May 2012, which was created to further emphasize the benefits of the Max Fresh cooling crystals. The fresh and energetic campaign has worked well for the brand and enables Colgate Max Fresh to strengthen its equity among the freshness seekers in Pakistan.

Year 2013 brought about new news on Max Fresh with a new pack design and communication change to take the lead against the competition. The new creative platform ‘Mind blowing’ highlighted Max Fresh having cooling crystals, which give people intense freshening that blows your mind and unleashes their energy.^[69]

Women in ads for the promotion of the products:

With regard to the posters on which there are pictures of women, it is forbidden to hang them, also the pictures of women scantily dressed are forbidden as they propagate for the spread of fornication and adultery, so one must avoid them as they spread corruption and evil [fornication and adultery] and incite one's desires. Allah Says (what means):

{Indeed, those who like that the crime of illegal sexual intercourse should be spread [or publicized] among those who have believed will have a painful punishment in this world and the Hereafter.}[Quran 24:20].

 It is an obligation to prevent evil which leads to something forbidden; this includes selling them by advertising them on shelves and the like. As regards concealing these pictures of scantily dressed women, if you men covering them with something which one could take off, then this do not change their ruling as what is forbidden still remains. But if these pictures are totally removed, then it is permissible to sell and hang them as the pictures do no longer exist.[70]

                            iii.            Newspapers & magazines: The companies also advertise our product in newspapers and magazines using interesting and appealing pictures of their favorite cartoon characters so that more kids can be made aware of our product. The most preferable magazines would be Aurora, Blaze and Review through which we are supposed to publish our advertisements. Newspapers which are selected for this purpose are Dawn and Din newspapers.^[71] 

b)     Sale promotion

                                                        i.            Free sampling: free small sized samples of toothpaste are given to doctors, dentists and general consumers.

                                                      ii.            Distribution of souvenirs: free souvenirs and movement likes pens, key chains, T-shirta etc are distributed to consumers, especially students.

                                                    iii.            Contests: sales contests are organized amongst retailers and prizes and distributed amongst the winners.

                                                    iv.            Conferences: annual conference are held, doctors, dentists and the Colgate’s sales team attend these conference. These conferences not only enhance sale but also help in image building.

c)      Personal Selling: Regular presentation is arranged for dentists and medical students. Workshops are also frequently organized in medical collages. The aim is to convince future dentists that Colgate is the best toothpaste as for as quality is concerned.  

d)     Public relations, Publicity: The public relations activates are undertaken as regard as Colgate toothpaste is concerned focus on creating a healthy image of the brand. Sponsorship of community events, distribution of customer newsletter among the dental community are important example. Publicity for the Colgate toothpaste usually takes place through mention in newspaper, medical journal and other magazines.^[72]

Contests for promotion of products according to Islam:

It is not permissible, rather is it an evil action and a kind of gambling which Allah has forbidden because it involves risks and deceit, and consuming people’s wealth unlawfully.

“O you who believe Eat not up your property among yourselves unjustly” [al-Nisa’ 4:29]

And it was narrated in a Saheeh Hadith that the Prophet (PBUH) forbade deceitful and ambiguous sales. Fatwa no, 18324 Fataawa al-Lajnah, 15/195.

Shaytaan (Satan) wants only to excite enmity and hatred between you with intoxicants (alcoholic drinks) and gambling, and hinder you from the remembrance of Allah and from As‑Salaah (the prayer). So, will you not then abstain?” [al-Maa'idah 5:90-95]

This competition is regarded as a form of gambling, which Allah has forbidden. The authorities and scholars in Fujayrah and elsewhere should denounce these competitions and warn against them, because that goes against the Book of Allah and is also consuming the people’s wealth unlawfully. Majallat al-Da’wah, issue no. 1145

Shaykh Ibn ‘Uthaymeen discussed in detail the ruling on taking part in the prize competitions. Companies nowadays offer prizes to those who buy from them. He said that it is permissible so long as two conditions are met. He said:

·         The price – of the goods purchased – should be their true price, i.e., the price should not be raised because of the prize. If the price is raised because of the prize then this is gambling and is not permissible.

·         The second condition is that the customer should not buy the product in order to win the prize. If he buys it only because he wants to win the prize, and he has no need of the product, then this is a waste of money. This is not permissible, because it is a waste of money, and the Prophet (peace and blessings of Allah be upon him) forbade wasting money.

As’ilat al-Baab il-Maftooh (no. 1162).[73]

Comparative study of toothpaste/Brushes and Miswaak:

Encouragement to use the siwaak as part of the Sunnah is mentioned in many hadith, and the effect of using the siwaak is described as purifying the mouth, cleansing it of dirt, making it smell good and preventing disease. It is a general word which affirms that siwaak possesses all powers of purification and protection. 

Dr. ‘Abd-Allaah ‘Abd al-Razzaaq al-Sa’eed says: 

“It is indeed a miracle of the trustworthy and unlettered Messenger (blessings and peace of Allah be upon him), who said: it was narrated from ‘Aa’ishah (may Allah be pleased with her) that the Prophet (blessings and peace of Allah be upon him) said: “Siwaak is purifying for the mouth and pleasing to the Lord.”

All the means that may be followed to keep the mouth and teeth clean are very valuable in preventive medicine. One of these means is the stick from the araa k tree, which is mentioned in many hadeeths from the Prophet (blessings and peace of Allah be upon him). This stick is called siwaak. 

Prof. Dr. Muhammad Sa’eed al-Jareedli – head of the Mouth Disease department at Cairo University – said: 

“The siwaak is many times better than the toothbrush and toothpaste in chemical and mechanical terms”.

After carrying out research he found that the substance which is in the siwaak kills germs and heals our mouths from disease. By itself it can take the place of the toothbrush and toothpaste because of the numerous substances it contains which are superior to those contained in toothpaste. Similarly, strong, gentle natural fibres work better than the fibres of the toothbrush and do not damage the gums. They also effectively remove what is left in our mouths and clings to our teeth of leftover food, which can cause disease and damage to the mouth and teeth. Up until today, in our civilized world, there is no toothpaste that contains the substances contained in the siwaak. Similarly, it says in the weekly magazine American Dentist that most of the toothpastes used in the United States of America are not good or healthy. 

For example, we see that most of the toothpastes on the market are commercial and cheap, aimed at nothing other than making a profit, and the mouth and gums do not benefit from them at all. But in the case of siwaak, it was found -- after scientific research -- that it contains a lot of effective substances carried in its fibres, including cleansers such as sinigrin, astringents which strengthen the gums, such as gallic acid, volatile oils which give the mouth a good smell, sodium chloride, sodium bicarbonate, potassium chloride, calcium oxalate and a number of substances which clean the teeth. Some substances in the siwaak also kill germs, so it has an effect similar to that of penicillin. 

So the siwaak is indeed the purifier for the mouth and teeth.

In the research of Dr. James Turner, of the Faculty of Medicine in the American University of Tennessee, which is published in the journal Oral Medicine and Dentistry, it says:

“The miswaak of the araak tree contains substances which purify and kill microbes, the most important of which are sulphur and sitosterol B (or β-sitosterol), as well as sodium.

Research and experiments indicate that the siwaak contains a substance which stops bleeding, purifies the gums and sterilises wounds in the gums. It also contains in its fibres large amounts of mineral salts and ions such as calcium, iron, phosphates and sodium.

Siwaak contains vitamin C, and it is well known to scientists that the interaction between this vitamin and antibiotics is regarded as one of the most effective of remedies. It also contains tannin which helps to strengthen the gums”. [74]

Findings and Conclusion:

The research carves out the facts about toothpastes and its ingredients, its benefits and health hazards in detail. It also highlighted the components of toothbrushes and their quality and their characteristics. The thorough research is done regarding hazardous components of toothpastes which are not only dangerous for the consumers but also for the environment. On the other hand, the detailed introduction of Miswaak and its advantages and comparison with the toothpastes/toothbrushes are done to strengthen the facts. The interview of the manager of Verick Helath Care is also taken to understand that how they Produce Easy Grip and Dentist toothbrushes and how they tackle with four Ps. The research is done to evaluate four Ps in the perspective of Islam regarding the toothpaste and toothbrushes industry. It is concluded that Miswaak is better than toothpastes/toothbrushes and has no bad affects on health. It is the Sunnah so it also has reward and pleasing to Allah Almighty.

=======================

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