Currently, titanium dioxide as a food additive is classified as GRAS, or “generally recognized as safe.” 

Since then, there has been a few animal studies suggesting titanium dioxide is connected to cancer. A 2017 study in Scientific Reports, for instance, found that rats with titanium dioxide in their diet had impaired immune systems, which could contribute to autoimmune diseases and colorectal cancer.

The skin of an adult person is, in most places, covered with a relatively thick (∼10 μm) barrier of keratinised dead cells. One of the main questions is still whether TiO₂ NPs are able to penetrate into the deeper layers of the skin. The majority of studies suggest that TiO₂ NPs, neither uncoated nor coated (SiO₂, Al₂O₃ and SiO₂/Al₂O₃) of different crystalline structures, penetrate normal animal or human skin. However, in most of these studies the exposures were short term (up to 48 h); only few long-term or repeated exposure studies have been published. Wu et al.83 have shown that dermal application of nano-TiO₂ of different crystal structures and sizes (4–90 nm) to pig ears for 30 days did not result in penetration of NPs beyond deep epidermis. On the other hand, in the same study the authors reported dermal penetration of TiO₂ NPs with subsequent appearance of lesions in multiple organs in hairless mice, that were dermal exposed to nano-TiO₂ for 60 days. However, the relevance of this study for human exposure is not conclusive because hairless mice skin has abnormal hair follicles, and mice stratum corneum has higher lipid content than human stratum corneum, which may contribute to different penetration. Recently Sadrieh et al. performed a 4 week dermal exposure to three different TiO₂ particles (uncoated submicron-sized, uncoated nano-sized and coated nano-sized) in 5 % sunscreen formulation with minipigs. They found elevated titanium levels in epidermis, dermis and in inguinal lymph nodes, but not in precapsular and submandibular lymph nodes and in liver. With the energy dispersive X-ray spectrometry and transmission electron microscopy (TEM) analysis the authors confirmed presence of few TiO₂ particles in dermis and calculated that uncoated nano-sized TiO₂ particles observed in dermis represented only 0.00008 % of the total applied amount of TiO₂ particles. Based on the same assumptions used by the authors in their calculations it can be calculated that the total number of particles applied was 1.8 × 10¹³ /cm² and of these 1.4 x10⁷/cm² penetrated. The surface area of skin in humans is around 1.8 m²  and for sun protection the cream is applied over whole body, which would mean that 4 week usage of such cream with 5 % TiO₂ would result in penetration of totally 2.6 × 10¹⁰ particles. Although Sadrieh et al.concluded that there was no significant penetration of TiO₂ NPs through intact normal epidermis, the results are not completely confirmative.

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.

A dense, white, opaque pigment composed of a mixture of Zinc sulfide (30%) and Barium sulfate (70%) with trace amounts of Zinc oxide. Lithopone, first produced in 1874, was called Orr's white. The mixture of the two components is so intimate that it is hard to distinguish microscopically. Lithopone is an inert, transparent pigment which is often used as a filler or as a base for lake pigments. Lithopone was widely used in house paints in the first half of the 20th century. It was also used for some artist grounds, inks and as a filler in Paper, Leather, and Linoleum. Now lithopone has mostly been replaced by Titanium dioxide.

With 30% of the world's lithopone factories located in China, the country has become a major player in the global lithopone market. Chinese manufacturers are able to produce lithopone at a competitive price, making it an attractive option for companies looking to reduce their production costs. In addition, China's large production capacity ensures a steady and reliable supply of lithopone to markets around the world.