Monday, July 28, 2014


I get lots of questions from patients about toothpaste.  The most common questions are about which toothpaste to use and which toothpaste I use.

Unless you have a specific dental condition, such as tooth sensitivity, or a condition for which you need a prescription strength toothpaste, I don't recommend any particular brand or kind.  Personally, I use the cheapest brand on sale that has sodium fluoride in it.  However, to treat my intermittent tooth sensitivity, I use a toothpaste that contains potassium nitrate.  (These toothpastes may be labeled "sensitive" or "sensitivity."  Check the "Drug Facts" label on the box for the active ingredients.)  In the office I use a professional formula to pre-treat patients who have tooth sensitivity.  These products work by blocking pores in the dentin portion of your tooth where sensitivity can occur due to receding gums or worn enamel.*  (Sensitivity may also be due to cavities or build up of tartar (also called hardened plaque or calculus) in which case toothpaste won't help.)

Another question I get is about whitening toothpaste.  Unless a toothpaste contains hydrogen peroxide or carbamide peroxide, ingredients that actually bleach the teeth, any whitening effect is more likely from consistently brushing your teeth.  Only the active ingredient supplies the desired effect of the product.  Some toothpastes contain triclosan or stannous fluoride, for example.  These have anti-bacterial properties that may help with gingivitis.  There are also many "inactive" ingredients in toothpaste that contribute to the abrasiveness, smoothness or taste of the product.  Sodium bicarbonate, also known as baking soda, and silicates are stain removers found in toothpastes.

"Re-enamelizing" or "re-mineralizing" is a question of interest as well.  Once enamel is gone it's gone.  However, fluoride can bind with minerals in the tooth structure to form a protective layer on the surface of the tooth.  This is the basis of the claim that toothpaste prevents "de-mineralization" of the teeth or encourages "re-mineralization," and the reason that fluoride "strengthens" teeth.  Fluoride also has anti-bacterial properties and so may help to reduce germ levels which contribute to the formation of acid.

How about the abrasiveness of toothpaste?  Can toothpaste itself damage the teeth?  I recently found some data regarding the RDA or Radioactive Dentin Abrasion of toothpaste, also referred to as "Relative" Dentin Abrasion.  This is how abrasiveness of toothpaste is rated in a lab setting and must be in a certain range to be approved by the Food and Drug Administration (FDA) and get the seal of the American Dental Association (ADA).  Unfortunately, while there are some online charts that cite these numbers for toothpastes, I can't verify the year or original source of the information.  (If I do, I'll post it.)  Some toothpaste is definitely more abrasive than others.  What I recommend is calling the manufacturer directly and asking them for the RDA, or abrasiveness rating, of the product.  This is sometimes considered to be a "trade secret."  They may just give you a range.

Whatever type of toothpaste you use, what is most important is the mechanical removal of plaque from your teeth.  This means that you should be gently brushing at least two times a day for two minutes using a SOFT toothbrush with a small amount of toothpaste.  The goal is to remove plaque, which is a colony of germs attached to your teeth, before it hardens.  Just like hand washing, toothbrushing must be done thoroughly to ensure the removal of the germs.  Regular brushing of the teeth is more important than the type of toothpaste you use.  Just take care to be gentle.

If the bristles on your toothbrush are smashed after using it two times you are brushing too hard!  If you are an "agressive toothbrusher" an electric toothbrush is probably NOT for you.

If you are are only brushing for 30 seconds you are not brushing long enough.

If you are using so much toothpaste that it only takes you a week to go through the entire tube, you are using too much.

When you brush your teeth, you should also be brushing your gums, another reason to be gentle.

For a great description and illustration of how to properly brush (from the American Dental Hygienists' Association website) go to:

Please use the comment section if you have any questions or comments or if you'd like to share the name of your favorite toothpaste!

*You should discuss gum recession, enamel wear and tooth sensitivity with your dental hygienist or dentist. 

This information is not intended to treat or diagnose any dental or medical condition.  Please contact your medical or dental professional for treatment and information.

Sunday, July 13, 2014

Pick a loser

As a follow up to my last post regarding e-cigarettes I'd like to share another issue about tobacco.  I was catching up on episodes of The Daily Show with Jon Stewart and watched an excellent piece on tobacco farming and child labor laws.  This shocking situation has also been reported on by the BBC, NPR, various local news stations and is being monitored by Human Rights Watch.  Apparently children as young as 12 can legally work on farms.  There is NO minimum age on small farms.  Children are working ridiculously long hours in unsafe conditions and without personal protective equipment.  They are being sickened and poisoned by contact with the tobacco leaves and pesticides.  Yet under pressure from big agriculture in 2012, the Labor Department withdrew a proposal to more strictly regulate the age and conditions of child farm laborers.  The tobacco companies response to child laborers?  Well, they are certainly "concerned."  (Yep, that's pretty much it.)  It is sickening to know that children are working under terrible conditions, using dangerous equipment and being exposed to harmful chemicals.  It is even more disgusting that this occurs in an industry that grows a toxic product that destroys people's health and causes cancer while making billions of dollars in profit in the process. And, of course, the US government gets it share through taxes.  So what if a few kids get harmed?  After all, they get the benefit of helping their families make money and learning the value of hard work.  That's the farmers' perspective.  Well, whatever helps you sleep at night.  But I think that in an industry that makes this much money in a country where we claim we are so concerned about human rights, more can be done to protect these kids.  What do you think?

For a great summary of the HRW report and excellent video, (the boys featured are remarkable,) view the following BBC report:

Monday, July 7, 2014

Up in Vape

Recently, on a beautiful day in Seaside Heights, I sat on a boardwalk bench waiting for my son and his friends and doing some people watching.  As I observed the variety of swimsuits, sundresses, piercings and tattoos adorning the bodies of early summer beach goers, (including a teen wearing a horse head mask,) activity at one particular store caught my eye.  It was a smoke shop selling e-cigs and other smoking paraphernalia.  What struck me was the number of young people, mostly in groups, stopping to purchase and browse.  The attraction of teens and young people to smoking is nothing new, of course, and as I age the range of people I consider to be “young” increases.  It is a fact, however, that there is still so much unknown about the effect of e-cigarettes and vaping on health.  E-cigs even eliminate the fear of “getting caught” because there is no smoke involved.  High school kids will vape in school, even in class.  Opportunities to “smoke” continue to grow, regardless of our lack of understanding of the long term consequences.  For adults who currently smoke and are considering quitting, e-cigs may be a viable “lower risk” alternative.   However, despite claims that e-cigs are safer than regular cigarettes and can help people quit there is little research yet to support this.  And more and more products are being developed all the time that stress lifestyle benefits over health benefits.  RJ Reynolds aims to make e-products that deliver a “satisfying” experience to smokers.  Philip Morris is developing a product that uses tobacco to deliver a tobacco flavor nicotine vapor claiming “reduced” risk.  There was a time when “light” cigarettes were marketed as such until it was found that these claims were untrue or murky at best.  And, if you are old enough to remember, there was a time when doctors were used to advertise the health benefits of cigarettes.  These new products contribute to the illusion that starting this kind of a habit is not at all harmful when this is far from true.  Smoking flavored tobacco using a hookah is also very much in vogue.  In the past year there has been a 21% increase in high school students who do this.  This is another practice where there is a huge misconception that it is safer than traditional cigarettes, just like it was once assumed that chewing tobacco was safer.  Finally, let’s look at the players in this industry.  These products are largely unregulated and there is a lot of money to be made.  E-cigarettes and vapor delivery systems have gained a lot of popularity with the public for a variety of reasons including the legalization of pot for medicinal and non-medicinal use in some states.  But don’t think for one minute that these companies are concerned about anything other than how to relieve you of your money.  They have a long history of just blowing smoke.

This information is not intended to treat or diagnose any dental or medical condition or illness.  Please visit your medical or dental health professional if you need medical or dental treatment.