Toothpaste Review: The “Dirty” on Getting Clean

January 30, 2012

Patients are always asking what toothpaste they should be using. With so many products available over the counter, and now a huge organic and natural health industry boasting miraculous benefits and convincing testimonials it is hard to know what’s best for you. And indeed, what’s best for YOU is the key.  I have no one recommendation for everyone, because each of you may have a different set of needs to address.  I’ll go over all of that, but first lets talk about getting clean…

Bacterial plaque is forming on our teeth every minute of every hour of every day. The good news is that if you catch the plaque early on before it hardens into tartar, it can be easily be removed by mechanical means alone. That means just the act of brushing, rubbing, and wiping with your brush and floss, toothpicks, or other dental hygiene aids you may have on hand is all that is needed to remove plaque and disrupt bacterial colonies.  The act of disrupting the bacterial colonies and interfering with their adherence to your teeth and gums is what getting clean is all about. So you see, you don’t actually need any toothpaste to clean your teeth.

What you do need toothpaste for are for the ingredients contained therein which may have some therapeutic value. There are only two key ingredients that I really concern myself with when it comes to recommending a toothpaste to my patients.  They are fluoride for cavity prevention, and potassium nitrate for treatment of dentinal hypersensitivity.

Fluoride is the single most effective agent in preventing tooth decay. It replaces hydroxyapatite crystals in the enamel that have been damaged by acids and forms a newer, stronger fluorapatite crystal. Enamel that is made up substantially of these fluorapatite crystals is the strongest naturally occurring tooth structure and is the most resistant to decay.

Potassium Nitrate is the active ingredient found in toothpaste preparations that are indicated for sensitive teeth.  Just underneath the enamel, we all have a layer of tooth structure called dentin which can be highly sensitive . It is made up of a series of tubules where at its innermost core lies a nerve.  Fluid moves back and forth in these tubules in response to stimuli and cause the nerve to depolarize, thereby sending your brain a message of pain.  Sometimes there are areas of our teeth that are devoid of sufficient enamel or cementum to cover and insulate this dentin layer and we are left with sensitive areas of our teeth.  This type of sensitivity most often presents as cold,sweet,or tactile sensitivity with no lingering pain after the stimulus is gone. The potassium nitrate builds up in these tubules over time with repeated use and sedates the nerve by inhibiting nerve depolarization . You should confirm with your dentist that there are no other reasons for your sensitivity that may require treatment.

All other ingredients you may find in toothpaste have only marginal benefits, and sometimes can cause adverse effects. Whitening toothpastes can be effective in cleaning surface stains but they will not whiten the overall shade of your teeth. The added abrasivity in whitening toothpaste may exacerbate sensitive teeth. Tartar control toothpastes demonstrate only sub clinical benefits and may cause soft tissue irritation. Ingredients like baking soda and salt may help to raise the pH in you mouth and buffer acids but their effects are very brief. Hydrogen peroxide and triclosan are antibacterial ingredients but they have little residual action after rinsing. Many natural and organic preparations contain herbal extracts and essential oils which may be soothing, helpful in reducing bacteria, and pleasant tasting but have not been tested or approved by the FDA. I read through a disclaimer recently on a website for a line of natural dental products that I feel is worth quoting one sentence in particular. It reads “We have no competent or reliable scientific evidence to suggest that the testimonialist’s experience is due to the use of our products.” That’s a pretty powerful statement in my opinion; I can see why its only stated in very fine print.

So, here is my final answer.  Use what you like.  Simple as that.  My only request is that you use a toothpaste that contains fluoride to help with cavity prevention.  If your teeth are sensitive, please try a sensitivity toothpaste with potassium nitrate in it because it usually works. When you find something that you like, whether it is because you like the texture and flavor of it, or because you feel assured knowing that it is organic and all-natural, or if for any other reason you just believe in the health benefits of a particular product, you will probably spend more time brushing and will do it more consistently. Discuss any concerns you may have with your dentist or hygienist and they will help you find a product that best suits your needs. Otherwise, enjoy trying different products, and know that the best product is the one that is used every single day.


3 Responses to “Toothpaste Review: The “Dirty” on Getting Clean”

  1. hawbaker said

    Good writeup! I agree with this, use what works for you. This makes me want to do a brushing haiku (ok I may break the rule slightly):

    Luxuriating toothpaste / soap,
    Lathering mouth with fun,
    Brushing ameliorated

  2. Joshua said

    Little known fact that Sodium lauryl sulfate in most toothpastes can cause reoccurring canker sores and extreme patient suffering. Some expensive hard to find brands do not have this in them. 99% of the top brands with the most shelf space do. Some of your ‘sensitive’ patients may be asking you to make sure the stuff used in office cleanings are free from Sodium lauryl sulfate otherwise they will suffer 14+ days from quarter sized canker sores in extreme cases.

    • Many toothpastes contain sodium lauryl sulfate, also known as SLS, to mix ingredients together and create the ‘foaming action’ when you brush your teeth. SLS can cause irritation or canker sores in some patients. There are several brands that work well for those who are more sensitive to SLS, including Sensodyne Pronamel, Sensodyne Iso-active, Closys, and Biotene. These brands are easily found at most drugstores and (with the exception of Closys) are reasonably priced.

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