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Relative to a lot of other things that people should be concerned about, titanium dioxide in my mind, is really low on the list. I would be more worried about some substitutes that people are using for titanium dioxide that don't have decades of research associated with it, said Westerhoff.

Stability and darkening:

No acute effects of nano-sized TiO₂ were observed in Danio rerio (zebrafish) embryos. Exposure of rainbow trout to TiO₂ NPs triggered lipid peroxidation, influence on the respiratory tract, disturbance in the metabolism of Cu and Zn, induction of intestinal erosion  and accumulation in kidney tissue. Linhua et al. exposed juvenile carp to 100 and 200 mg/ml of particles and TiO₂ observed no mortality. However, the fish suffered from oxidative stress and pathological changes in gill and liver. In the infaunal species Arenicola marina, exposure to TiO₂ NPs in sediment caused sub-lethal effects including decrease in casting rate and increase in cellular and DNA damage. Aggregated particles were visible in the lumen of the gut, but no uptake through the gut or the skin was observed.

The trend in the production of NPs is likely to lead to increasing amounts of nano-powders in the air, water and soil, which will consequently affect living organisms. Labielle et al. demonstrated that 25 % of Al(OH)₃-coated TiO₂ particles from sunscreens are dispersed as a stable colloid and become available to microorganisms and filter-feeders, while the remaining 75 % are probably incorporated into geogenic sediments, where they could become available to benthic fauna. Solar UV iradiation may penetrate as far as 20 m in the water column  and therefore photo-activate the dispersed particles, which may have an adverse effect on various aquatic organisms.