Toothpaste is toothpaste, right?

Why are there so many different toothpastes?

Taking a look along the aisles at the supermarket and you’d be forgiven for thinking that there’s a special toothpaste for just about everybody.  This is all a little odd considering that toothpaste really isn’t much more effective than simply using a toothbrush alone – the mechanical brushing is what’s most important (1).  However, toothpaste provides a great degree of comfort, a minty fresh feeling, and a small amount of fluoride that will help strengthen slightly weaker areas of the teeth (2).  

The wealth of toothpastes can be divided into several categories of toothpaste including ‘natural’, whitening, sensitive, high fluoride, tartar control and children’s toothpaste.  Let’s take a quick look at each:

Natural Toothpaste

The term ‘natural’ is not legally defined, and usually doesn’t mean organic.  Generally, natural toothpastes do not contain artificial sweeteners, dyes or flavors, but some products do contain sodium lauryl sulfate, a foaming agent that can – in some people – cause mouth sores. Some natural products contain added fluoride.  Some natural toothpastes contain glycerin, which can coat your teeth and prevent them from absorbing minerals.  

Whitening Toothpastes

Whitening toothpastes typically contain either a bleaching agent or an abrasive, such as silica or both. The bleaching agents commonly used are peroxide or sodium tripolyphosphate, the same reagents used to whiten teeth however, with only a few minutes exposure, there is insufficient time – and concentration – to whiten teeth.  These toothpastes have widespread appeal, but are for most people unnecessarily abrasive.  Whitening treatments whiten teeth from the outside in, whitening toothpastes simply aggressively scrub the outer surface of teeth.  

Sensitivity Control Toothpastes

Many patients complain of mild, brief sensitivity to hot or cold foods and liquids.  This common problem has been helped considerably by the creation of toothpastes that contain either potassium nitrate or strontium acetate/chloride to mitigate that sharp pain.  They take about 2 weeks to work, but are a first line of defense against sensitivity.  In-office desensitizers work by the same mechanism, but have greater efficacy vs. over the counter sensitivity toothpastes (3).

High Fluoride Toothpastes

Almost all toothpastes in the US contain fluoride.  Fluoride has been shown conclusively to reduce decay rates when used in concentrations found in modern toothpastes (2).  Many adults benefit from high-fluoride toothpaste, especially if they are taking medications that cause their mouth to be dry, or when they have health conditions that make them more vulnerable to tooth decay.  These products are prescription only and can give a boost of fluoride to help strengthen weaker areas before they cavitate (i.e. form a cavity).  If you suffer from dry mouth, or have a high-decay rate, we’ll be happy to discuss high-fluoride options.  

Tartar Control Toothpastes

Some products claim to help prevent tartar (also known as calculus, or hard build-up)(4). These products are sometimes simply more abrasive, but one product – Colgate Total – contains Triclosan, an effective antimicrobial, that effectively reduces plaque and tartar.  It has been banned from use in soaps (5), but due to it’s efficacy in plaque removal (6) it’s been allowed by the FDA to remain in toothpastes. Typically, we recommend toothpastes that are minimally abrasive, such as those that are based on the very mild reagent sodium bicarbonate (baking soda), which also have the added bonus of neutralizing some of the acid from bacteria that live on our teeth.

Childrens Toothpastes 

The American Academy of Pediatric Dentists now recommends everyone of every age to use a fluoride toothpaste (7)(recall a grain of rice sized portion for youngsters), these products are simply for personal preference.  A wide variety of colors, tastes and packages emblazoned with their favorite characters helps encourage regular brushing.

In conclusion, the frequency and technique of brushing is what matters most.  Use an ADA Approved product (8), a soft toothbrush for 2-3 minutes, 2-3 times a day for the best results.  

Be gentle.  Be thorough.  Be consistent.  

Share if you care!  Please feel free to share this or any Dental Health Matters article and if you have any questions, please feel free to email me at Doodes@ParkBlvdDentistry.com  Who knows, maybe your question will be the subject of another edition!

References:

1. Valkenburg C. et al., J Clin Periodontol. 2016.Does dentifrice use help to remove plaque? A systematic review.
2. Walsh T. et al., Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.Cochrane Database Syst Rev. 2010 Jan 20;(1)Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007868
3. Charig et al., Mechanism of action of a desensitizing fluoride toothpaste delivering calcium and phosphate ingredients in the treatment of dental hypersensitivity. Part II: comparison with a professional treatment for tooth hypersensitivity. Compend Contin Educ Dent. 2009 Nov-Dec;30(9):622-4, 626, 
4. Spivakovsky S. et al., The effect of anti-plaque agents on gingivitis.  Evid Based Dent. 2016 Jun;17(2):48-9. 
5. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm 2016
6. Trombelli L et al., Efficacy of triclosan-based toothpastes in the prevention and treatment of plaque-induced periodontal and peri-implant diseases. Minerva Stomatol. 2013 Mar;62(3):71-88.
7. http://www.aapd.org/resources/frequently_asked_questions/#320

© Paul Doodes DDS PhD.  All rights reserved.