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.
TiO2 is also used in oral pharmaceutical formulations, and the Pharmaceutical Excipients handbook considers nano-sized TiO2 a non-irritant and non-toxic excipient. Despite the fact that TiO2 submicron- and nano-sized particles are widely used as food and pharmaceutical additives, information on their toxicity and distribution upon oral exposure is very limited.