Which Toothpaste is the Right One for You?

Preparing this blog took much longer than we had anticipated! At first we thought we knew all there was to know about different kinds of toothpastes and their use and indications but once we started exploring, we realized how little we knew and how hard it is to get some answers from various toothpaste manufacturers. In choosing a toothpaste most people look for good flavor, thickness (neither too runny nor too hard) and pleasant texture. People also want their mouth to feel clean after brushing, with sweet breath, and for teeth to look not only unstained, but as white as possible. Dentists, on the other hand, say the best toothpaste is the one that protects teeth from cavities, abrasion. Plaque If not removed at least every 24 hours, it hardens into tartar, which builds up and makes teeth and gums even more susceptible to decay - resulting in a negative cycle that can cause first gingivitis, then serious periodontal disease. In turn, quite a few experts believe that periodontal disease may cause systemic problems, including but not limited to heart problems. Lets start off by familiarizing ourselves with commonly found ingredients in toothpastes:

Basic Ingredients

Fluoride: is the main active ingredient found in almost all toothpastes. It

wasn't until about 50 years ago that fluoride was first added to toothpastes. It helps with calcium uptake thereby strengthening the enamel and making it less susceptible to decay. Fluoride only makes up about 0.1%- 0.2% of most toothpaste, although prescription-strength fluoride toothpastes contain more than 1% of fluoride.

Abrasives: are added to aid in removal of plaque and daily deposits from the
tooth. Toothpaste is rated on a scale of RDA 1-200, according to its abrasiveness. The American Dental Association (ADA) recommends using a toothpaste with an abrasive index of less than100. If toothpaste with higher index of abrasiveness is used on a regular basis, irreversible damage may result which includes enamel and root surface wear which may cause tooth sensitivity. Tooth enamel re-mineralizes daily from the supply of ionic calcium and phosphorus in the saliva. Scratching the surface of the tooth with an abrasive such as hydrated silica harms the enamel and prevents remineralization, much like using sand to clean glass. Severe wear could eventually occur. Some examples of abrasives in toothpastes are calcium carbonate, mica, calcium pyrophosphate, dicalcium phosphate, sodium bicarbonate, and hydrated silica. To find out the abrasive index of some commonly used toothpaste please refer to table 1 at the end of this blog.

Detergents: are added to prevent the toothpaste from dripping. They create foam and bubbles. The main detergent in toothpaste is known as sodium lauryl sulfate (SLS) which is shown to cause oral canker sores in some people. If you are one of these people who get frequent canker sores you may want to change your toothpaste to one that does not contain SLS. These toothpastes

are usually found in health food stores or on line. One example of non SLS toothpaste is: Dr. Collins natural toothpaste.

Flavors: are added to give the toothpaste a pleasant and inviting taste and smell. They range from mint to cinnamon and fruits etc. Interestingly enough, they even come in "pickle flavor"!

Moisturizers: are added to keep the toothpaste moist and prevent it from drying out. Examples of some commonly used moisturizers are glycerin, sorbitol, and water

Preservatives: are added to prevent microbes from growing in the toothpaste and spoiling it. It is for the presence of this ingredient that we dont have to refrigerate our toothpastes! Methylparaben is used as a preservative in some toothpaste. Parabens have received some negative attention in recent years for iatrogenic activity - meaning they can add to the risk of some cancers, including breast cancer.

Colors: are added to give the toothpaste an attractive appearance. Some toothpastes have glitters added for special effect or have two colors in a stripe.

Sweeteners: are added to make the experience of brushing a sweet one! Saccharin, aspartame, or xylitol are some of the common sweeteners used in toothpastes.

Thickeners: are added to prevent the toothpaste from being too runny. Carageenan and xanthan gum are common thickeners added to toothpastes.

Other Ingredients

Antibacterial Agents: Certain toothpastes contain Triclosan, which is an antibacterial and anti-fungal agent. It is commonly found in antibacterial soaps. Toothpastes which contain Triclosan are known to prevent plaque from forming around the teeth for up to 12 hours and claim to have a positive effect on the health of the gum by reducing inflammation.

Peroxide: are added to those toothpastes that have whitening effect. Peroxide is a whitening agent and is the main ingredient used in most tooth bleaching products. Peroxide can irritate sensitive gums, causing extreme tenderness.

Desensitizing Compounds: are added to desensitizing toothpastes to reduce tooth sensitivity. Two commonly used desensitizing compounds are: Potassium Nitrate and Strontium Chloride. Both compounds interfere with pain transmission but in different ways. The root of the tooth contains many dentinal tubules. These tubules are the pathways from the outside of the tooth to the nerve in the center of the tooth. The nerve can only transmit the sensation pain to the brain. When there is no gum recession these tubules are covered up and protected by the gum. But when the root is exposed due to recession, outside factors such as cold, heat, and air stimulate the tubules. In turn they stimulate the nerve which sends a pain signal to the brain.

Potassium nitrate works by traveling down the dentinal tubule, thereby interrupting pain signals to the brain. Strontium chloride works by physically blocking the dentinal tubules that have become exposed when the gums recede. It is important to keep in mind that not every pain signal is harmless and should be blocked by desensitizing toothpaste. Pain signals should be taken seriously as they could indicate more important problems that if masked temporarily would only get worse over time. So if you have any pain or sensitivity that was not there before, please consult with your oral health care provider prior to using any desensitizing toothpastes.

Baking Soda: is added to help with stain removal. Contrary to common belief baking soda itself is not an abrasive agent. It has been used as a tooth cleanser for more than 150 years. It not only removes stain but it also helps to whiten teeth. To use it as a stain removing agent simply purchase a yellow box of baking soda from any supermarket. Pour some into a small dish and keep beside your sink or medicine cabinet. Dip your wet toothbrush into the baking soda until it is well caked and then proceed to brush for 2 minutes. If you do not like the salty taste simply add a small amount of toothpaste to your brush as well as the baking soda. This will help to mask the salty taste. Some of our patients who have tried this on a regular basis have managed to keep their teeth virtually stain free.

Enzymes: Glucose oxidase, lactoperoxidase and lysozyme are enzymes that are added to reduce the frequency of dry mouth conditions and increase saliva production. These enzymes are used exclusively in Biotin products which are commonly used by people who suffer from a dry mouth condition.

Now that we have talked about various ingredients in toothpastes I think you all agree with us that choosing the right toothpaste can be quite challenging! This is how I would approach it:

1. Some individuals with specific needs or conditions may be advised to use a specific type of toothpaste for a short or longer duration of time until desired objectives are achieved, here are some examples:
o

Individuals who are at high risk of developing cavities due to systemic or genetic predisposition and individuals who are going through orthodontic treatment, may be advised to use a prescription strength, Fluoridated toothpaste for a specific or indefinite length of time Individuals who have some mild, generalized tooth or gum sensitivity may be advised to use toothpaste which contains some "desensitizing agent" for a specific length of time until the sensitivity subsides. Please note that all other adverse factors that could potentially contributing to sensitivity must be ruled out first Individuals with periodontal conditions who have already gone through the active phase of treatment and are following a diligent home care dental hygiene routine, with bleeding gum, may benefit from using toothpaste which contains "antibacterial agents". Short term use of these toothpastes may eliminate the residual periodontal inflammation, ultimately resolving the issue of "bleeding gum

2. If you have healthy and well maintained dentition, you may pick from a variety of toothpastes, based on your personal preferences. We do however; only recommend that you choose from those toothpastes which have the abrasive level of under 100. Please refer to table 1 for a list of such toothpastes 3. Some individuals may opt for using toothpastes without Fluoride due to the controversy surrounding Fluoride toxicity. There are not very many toothpastes in the market which are made without Fluoride but manufacturers are responding more to general public concern and more brands are being added to the market 4. If you get recurring canker sores, you may want to try toothpaste without SLS....your painful recurring episodes may just be over 5. If you drink wine or tea frequently and get stain on your teeth, you may want to use either plain baking soda or any toothpaste containing baking soda. Baking soda is the most gentle, least abrasive yet most effective way of removing stain from your teeth in between your dental cleaning visits. Some individuals attempt to deal with the stain issue through the use of very abrasive toothpaste....while this could lead to irreversible damage to enamel and teeth, it barely proves effective in dealing with the stains. We recommend the use of baking soda and baking soda

containing toothpaste for mild stain in between professional cleaning visits and use of OTC or custom made trays and bleach material for handling the moderate to severe stains 6. While this blog addresses only adult toothpastes, I would like to take this opportunity and remind all parents to supervise brushing of your youngsters and to remind them not to swallow the toothpaste as frequent ingestion may result in poisoning due the Fluoride toxicity if used in dosages higher than recommended. Please always use children's toothpaste for children and always read the label as well I hope you find this blog informative and interesting. As always, Dr. Rahbar and her team would be more than happy to discuss any issues or concerns you may have and to answer all your questions and help you with choosing the toothpaste that is right for you! Please refer to the following table (table 1) for a list of commonly used ingredients in some common brands of toothpaste.

Brands

FluorideDetergents Sweeteners

Antibacterial

Whiteners

Desensitizer

ADA Stain Removal RDA Seal

Aloesense Toothpaste Aquafresh All Tartar Control Aquafresh Fluoride Aquafresh Multi Action Whitening Aquafresh Sensitive Aquafresh Striped Gel Whitening Aquafresh Triple Protection Aquafresh Whitening With Fluoride

Yes Yes

SLS SLS

Sacchari ne Sacchari n Sacchari n Sacchari ne Sacchari ne Sacchari ne Sacchari ne Sacchari ne

No No

No No

No No

Yes No

Hydrated Silica

Yes

SLS

No

No

No

Hydrated Silica Baking Soda & Yes Hydrated Silica No Hydrated Silica Hydrated Silica Hydrated Silica

110 91 113 91 119 105 113

Yes

SLS

No

No

No Yes (KNO3) No

Yes

SLS

No

No

No

Yes

SLS

No

No

No

Yes

SLS

No

No

No

Baking Soda & Yes Hydrated Silica No Hydrated Silica

Yes

SLS

No

No

No

Arm & Hammer Dental Care Advance Cleaning w/Baking Soda Arm & Hammer Dental Care Whitening Arm & Hammer Peroxicare Baking Soda Colgate 2-in-1 paste Mouthwash Whitening Colgate Baking Soda & Peroxide w/ Tartar Control Colgate Baking Soda & Peroxide w/ Tartar Control Whitening Colgate Cavity Protection Gel Colgate Cavity Protection Regular Colgate Luminous Fluoride Toothpaste Colgate MaxFresh with Mini Breath Strips Colgate Sensitive Maximum Strength Colgate Simply White Advanced Whitening Colgate Tartar Control Whitening Mint Colgate Toothpaste, Regular Colgate Total 12Hour MultiProtection Plus Whitening Gel Colgate Total Clean Mint

Yes

SLS

Sacchari ne

No

No

No

Yes

Baking Soda

42

Yes

SLS

Sacchari ne Sacchari ne

No

No

No

No

Baking Soda Baking Soda

168 49

Yes

SLS

No

Peroxide

No

No

Yes

SLS

Sacchari ne

No

No

No

Hydrated Silica Baking Soda & Hydrated Silica Baking Soda & Hydrated Silica Hydrated Silica No

200

Yes

SLS

Sacchari ne

No

Peroxide

No

No

125

Yes

SLS

Sacchari ne Sacchari ne Sacchari ne

No

Peroxide

No

No

145 65 65

Yes Yes

SLS SLS

No No

No No

No No

Yes Yes

Yes

SLS

Sacchari ne

No

No

No

Yes

Hydrated Silica

175

No

No

Sacchari ne

No

No

No

No

Hydrated Silica

175

Yes

SLS

Sacchari ne Sacchari ne Sacchari ne Sacchari ne

No

No

Yes (KNO3)

No

Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica

67 124 170 65

Yes

SLS

No

Peroxide

No

No

Yes

SLS

No

No

No

No

Yes

SLS

No

No

No

No

Yes

SLS

Sacchari ne

Yes (Triclosan)

No

No

Yes

Hydrated Silica

213

Yes

SLS

Sacchari ne

Yes (Triclosan)

No

No

Yes

Hydrated Silica

70

Colgate Total Advanced Whitening Gel Colgate Total Advanced Whitening Paste Colgate Total Clean Mint Paste Colgate Total Enamel Strength Colgate Total Gum Defense

Yes

SLS

Sacchari ne Sacchari ne Sacchari ne Sacchari ne Sacchari ne

Yes (Triclosan) Yes (Triclosan) Yes (Triclosan) Yes (Triclosan) Yes (Triclosan)

No

No

Yes

Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica

190 19 0 124 110 175

Yes

SLS

No

No

Yes

Yes Yes Yes

SLS SLS SLS

No No No

No No No

Yes Yes Yes

Colgate Total Whitening Gel Colgate Total Whitening Paste Cool Wave Fresh Mint Gel Fluoride Anticavity Crest Baking Soda & Peroxide Whitening with Tartar Protection Crest Cavity Protection Cool Mint Gel Crest Cavity Protection Paste Crest Extra White Plus Scope Crest Multi Care Crest MultiCare Whitening Fluoride Anticavity Crest Nature's Expression, Mint Plus Green Tea Extract Crest Pro-Health Crest Pro-Health Night Toothpaste Crest Pro-Health Whitening

Yes Yes

SLS SLS

Sacchari ne Sacchari ne No

Yes (Triclosan) Yes (Triclosan) No

No No

No No

Yes Yes

Hydrated Silica Hydrated Silica Hydrated Silica

175 175 200

Yes

SLS

No

No

Yes

Yes

SLS

Sacchari ne

No

Peroxide

No

No

Baking Soda

75

Yes Yes

SLS SLS

No Sacchari ne

No No

No No

No No

Yes Yes

Hydrated Silica Hydrated Silica Hydrated Silica Baking Soda Baking Soda

95 95

Yes

SLS

Yes Sacchari (Cetylpyridinu ne m Chloride+ Alcohol) Sacchari ne No

No

No

No

130 144 144

Yes

SLS

No

No

No

Yes

SLS

Xylitol

No

No

No

No

Yes

SLS

Sacchari ne Sacchari ne Sacchari ne Sacchari ne

No

No

No

No

Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica

144 156 144 166

Yes Yes Yes

SLS SLS SLS

No No No

No No No

No No No

Yes Yes Yes

Crest Sensitivity Protection Extra Whitening Crest Sensitivity Protection Whitening Plus Scope Crest Tartar Control Crest Tartar Protection Fresh Mint Gel Crest Whitening Expressions Anticavity DTI Toothpaste/Gel DTI Paste/Gel Saccharin Free Gator Paste Fluoride Protection Ibis Daant Whitening Toothpaste Mentadent Advanced Care with Baking Soda & Peroxide Mentadent Toothpaste Advanced Cleaning Nature's Gate Herbal Crme De Anise Noles Fluoride Protection Oraline Fluoride Mint Toothpaste Oraline Secure Clear Fluoride Mint Toothpaste Rembrandt Classic Sensitive Rembrandt Extra Gentle Mint Sensodyne Anticavity for Sensitive Teeth with Baking Soda Sensodyne Anticavity for

Yes

SLS

Sucralos e

Yes(Cetylpyri dinum Chloride + Alcohol) Yes(Cetylpyri dinum Chloride + Alcohol) No No

No

Yes (KNO3)

No

Hydrated Silica

168

Yes

SLS

Sucralos e Sacchari ne Sacchari ne Sacchari ne Sacchari ne No Sacchari ne Sacchari ne

No

Yes (KNO3)

No

Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Baking Soda & Hydrated Silica Baking Soda & Hydrated Silica Baking Soda Hydrated Silica Hydrated Silica Hydrated Silica

107

Yes Yes

SLS SLS

No No

No No

Yes Yes

144 144 144

Yes Yes Yes Yes

SLS SLS SLS SLS

No No No No

No No No No

No No No No

No Yes Yes Yes

Yes

SLS

No

No

No

No

Yes

SLS

Sacchari ne

Alcohol

Peroxide

No

No

103

Yes

SLS

Sacchari ne

Alcohol

Peroxide

No

No

103

No Yes Yes

SLS SLS SLS

No Sacchari ne Sacchari ne Sacchari ne Sacchari ne

No No No

No No No

No No No

No Yes Yes

Yes

SLS

No

No

No Yes (KNO3)

Yes

Yes Yes No

No No AluminumHyd roxide

No No Baking Soda & Hydrated Silica Hydrated Silica

53 63 98 96

Xylitol

No

Yes Yes

SLS SLS

Sacchari ne Sacchari ne

No No

No No

Yes (KNO3) Yes (KNO3)

No No

Sensitive Teeth with Fluoride Sensodyne Anticavity Toothpaste for Sensitive Teeth Sensodyne Extra Whitening Sensodyne for Sensitive Teeth, Tartar Control Plus Whitening Sensodyne Fresh Impact Sensodyne Pronamel Sheffield Fluoride Toothpaste Squigle Enamel Saver Squigle Regular Squigle Tooth Builder The U Fluoride Protection Tom's of Maine Baking Soda Cavity Protection Tom's of Maine Clean & Gentle Care Tom's of Maine Fluoride Free Antiplaque + Whitening Tom's of Maine Fluoride Free Clean & Gentle Care Tom's of Maine Fluoride Free for Sensitive Teeth Tom's of Maine Fluoride Free with Propolis & Myrrh Tom's of Maine Max Strength for Sensitive Teeth

Yes

SLS

Sacchari ne

No

No

Yes (KNO3)

No

Hydrated Silica Baking Soda & Hydrated Silica Hydrated Silica

98

Yes

SLS

Sacchari ne

No

Peroxide

Yes (KNO3)

No

110

Yes

SLS

Sacchari ne Sacchari ne Sacchari ne Sacchari ne Xylitol Xylitol Xylitol Sacchari ne

No

No

Yes (KNO3)

No

110 96 34

Yes Yes

SLS No

No No

No No

Yes Hydrated Yes (KNO3) Silica Yes (KNO3) No No Hydrated Silica Hydrated Silica No No No Hydrated Silica Baking Soda Hydrated Silica

Yes

SLS

No Yes (Calcium Propionate) No Yes (Calcium Propionate) No

No

Yes

Yes Yes No

No No No

No No No

Lactoferri No n Lactoferri No n Lactoferri No n No Yes

44 55 55

Yes

SLS

No

Yes

SLS

Xylitol

No

No

No

Yes

41 45

Yes

SLS

Xylitol

No

No

No

Yes

No

SLS

Xylitol

No

No

No

No

Baking Soda

41

No

SLS

Xylitol

No

No

No

No

No

41

No

SLS

Xylitol

No

No

Yes (KNO3)

No

Hydrated Silica

41

No Yes

SLS SLS

Xylitol Xylitol

No No

No No

No Yes (KNO3)

No No

No Hydrated Silica

41 41

w/ Fluoride Tom's of Maine Natural Anticavity Fluoride Tom's of Maine Simply White Fluoride Tom's of Maine Whole Care Fluoride Tom's of Maine Wicked Fresh Topol Whitening Anticavity Ultra Brite Advanced Whitening Ultra Brite Baking Soda Ultra Brite Baking Soda & Peroxide Whitening Ultra Brite Gel Ultra Brite Toothpaste USO Fluoride Mint Toothpaste Viadent Advanced Care Fluoride Xclear Spry XyliWhite
Hydrated Silica

Yes

SLS

Xylitol

No

No

No

Yes

93

Yes

SLS

Xylitol

No

No

No

Yes

No

41 93 93

Yes Yes Yes Yes

SLS SLS SLS SLS

Xylitol Xylitol Sacchari ne Sacchari ne Sacchari ne

No No No No

No No No No

No No No No

No No No No

Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Baking Soda & Hydrated Silica Baking Soda & Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Hydrated Silica Unknown Baking Soda & Hydrated Silica

145 145

Yes

SLS

No

No

No

No

Yes

SLS

Sacchari ne Sacchari ne Sacchari ne Sacchari ne Sacchari ne Xylitol

No

Peroxide

No

No

145 145 145

Yes Yes Yes Yes

SLS SLS SLS SLS

No No No No

No No No No

No No No No

No No Yes No

Yes

No Yes (Tea Tree Oil)

No

No

No

No

No

Xylitol

Papain

No

No