The truth about toothpaste

As a dental hygienist, I get LOTS of questions about toothpaste. Companies make a lot of claims about what their toothpastes do, from whitening to enamel protection. Basically, so long as a toothpaste has some kind of fluoride in it, that's what should be used. Fluoride is necessary to remineralize and protect teeth. 

Some toothpastes have ingredients such as stannous fluoride and potassium nitrate that can help with sensitivity. Potassium nitrate has worked for me personally. Since sensitivity can be caused by various dental issues including receding gums, cavities, and dry mouth, sensitivity should be discussed with your dentist or dental hygienist. 

I work at two dental offices and the toothpaste samples given to patients vary. I rely on my colleagues and my professional network to learn about any problems or issues with toothpastes rather than claims from the companies that make them. For example, there was a toothpaste on the market that had blue beads in it. When hygienists began finding these beads embedded in people's gums, the alarm was sounded and the manufacturer corrected the problem. Stannous fluoride has had issues as well. It was found to stain the teeth and manufacturers have since added ingredients to counteract this. 

In addition to stannous fluoride, sodium fluoride and sodium monofluorophosphate can be found in toothpastes. They are all effective and essentially do the same thing: provide some fluoride directly to the teeth and into the saliva. A dentist may prescribe a toothpaste with a higher amount of fluoride if a patient needs it due to their dental condition.

Finally, teeth must be brushed regularly regardless of the type of fluoride in the toothpaste. It seems simple, but people rarely brush for long enough, or brush only once a day. Brushing and flossing physically removes plaque germs from the teeth and gums. While toothpaste is important, this is the most important aspect of caring for the teeth. Brushing the teeth 2 to 3 times a day for 2 minutes (set a timer) will clean teeth and create a healthy mouth.

These blog posts are not intended to treat, diagnose, cure, or advise about any dental or medical condition. Please see your dentist or doctor for any treatment you need. 

Toothpaste

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:
http://www.adha.org/resources-docs/7221_Proper_Brushing.pdf

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.