The additive goes into a lot of personal care products to whiten and brighten colors and to make them opaque, like toothpaste and makeup.
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.
Certificate of Analysis (Lithopone B301, Lithopone B311 powder TDS)
There's also evidence that inhaling titanium dioxide particles can be dangerous. That's mainly a concern for industrial workers. In places where it's produced, or where it's used to make other products, workers can breathe it in as a dust. The Occupational Health and Safety Administration has exposure standards manufacturers must meet.