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As a food additive, titanium dioxide and its nanoparticles in particular have been associated with DNA damage and cell mutations, which in turn, have potential to cause cancer. When used as a food coloring, it is known as E171.

Nano, or ultrafine, TiO₂ comprises primary particles sized less than 100nm. In this grade, titanium dioxide is transparent (colourless) and boasts improved UV scattering and absorbing properties compared with larger particle-size pigmentary TiO₂.

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Other scientists, however, have called into question the experimental designs of such studies, citing inconsistent results specifically in studies used to test DNA damage.

TiO₂ comes in many different forms. However, only a few of these forms are considered food-grade (acceptable to be added to food). Many studies that raised concern about the safety of TiO₂, including the concern for genotoxicity, used forms of TiO₂ that are not considered acceptable for use in food and have different properties than food-grade TiO₂. Other studies did use food-grade TiO₂, but took steps to break the material down into smaller particles than what would normally be found in food.

The author thanks Marco Leona, Scientist-in-Charge of the Department of Scientific Research at the Metropolitan Museum of Art for conducting fluorescence spectrometry on Wheel of Fortune and a valuable discussion of the research, as well as Silvia Centeno, Research Scientist at the Metropolitan Museum of Art, who performed Raman analysis on the watercolors and also contributed her insight. The phenomenon of the phosphorescing lithopone was originally discovered during the author's fellowship in the Sherman Fairchild Center for the Conservation of Works on Paper, funded by the Andrew W. Mellon Foundation. The author thanks all her colleagues for their ideas and support during the research of this paper, and special thanks to Rachel Mustalish for her assistance in editing this work.

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We've measured many different immunological markers, both in the mucosa of the intestine and the lymphoid organs part of the intestine and we didn't see any inflammation there or changes in white blood cell number, Kaminski said. They also looked at the spleen where titanium dioxide was taken up into the bloodstream. You would expect [titanium dioxide] would be filtered out in the spleen and maybe induce inflammation there, but we did not see that, Kaminski added.

Titanium dioxide as used in sunscreens is commonly modified with other ingredients to ensure efficacy and stability. Examples of what are known as surface modifier ingredients used for titanium dioxide include stearic acid, isostearic acid, polyhydroxystearic acid, and dimethicone/methicone copolymer.

For years scientists have raised concerns about the potential toxicity of titanium dioxide.