It may be the most common question that a San Diego family dentist – or indeed, any dentist anywhere – is asked: What is the best kind of toothpaste? You may be surprised by the answer. It probably doesn’t matter what kind of toothpaste you use, and your family dentist probably doesn’t care. There’s simply no single toothpaste that reliably improves the dental health of all patients. The reason why? Toothpaste is essentially a cosmetic. There’s very little in a tube of toothpaste that can legitimately be called medicine.
In the end, the main reason we brush our teeth is to eliminate bad taste and odor in our mouths – not to improve the health of our teeth. Toothpaste is designed to taste like a Peppermint Patty or a Strawberry Twizzler – or whatever flavor “floats your boat.” The reason we buy a toothpaste is because we like the taste. Whatever is in your toothpaste along with the flavor is there to give the toothpaste additional marketing value. After all, who wants plain old toothpaste when you can get the brand with Super-Whitening Formula XL-7? Let’s take a look at the actual ingredients in a tube of toothpaste.
According to San Diego family dentist Jonathan Fung, “Toothpastes in general are composed of three main ingredients – fluoride, silica, and a foaming agent (like lauryl sulfate). Toothpastes differentiate themselves with additives such as antimicrobial products but overall these three main ingredients comprise the bulk of everyone’s toothpaste. The main characteristics of a toothpaste that I look for as a dentist are: fluoride content to strengthen enamel, low abrasiveness to protect tooth structure, and antimicrobial properties to kill decay causing bacteria.”
Can toothpaste actually be harmful? Probably not, if it’s used as intended and directed. Dr. Jennifer Dean, DMD, advises: “For adults, and in amounts typically used for brushing your teeth, standard commercially available toothpastes that have been approved by the ADA are extremely safe. I would always advise to avoid directly swallowing toothpaste, and if excessive amounts of toothpaste are consumed, it has the potential to be harmful. For standard use, there’s little cause for concern as rigorous testing and evaluation has been performed on these products for decades.”
WHAT IS FLUORIDE AND WHAT DOES IT DO?
The addition of fluoride to toothpaste brings toothpaste under the jurisdiction of the U.S. Food and Drug Administration. Fluoride does not clean the teeth, but over time, it can help to maintain the strength and health of your teeth – provided that your other dental care habits are healthy too. The U.S. Centers for Disease Control and Prevention calls the fluoridation of water “one of ten great public health achievements of the 20th century.” Fluoride and fluoridated water have plenty of vocal critics, but most dentists would probably tell you the benefits of a toothpaste with fluoride, used daily, outweigh any potential risk.
However, San Diego family dentist Jonathan Fung cautions, “Fluoride toothpastes should be avoided in infants less than 6 months of age to prevent over ingestion of fluoride since infants aren’t very good at controlling what they swallow. After 6 months a smear of toothpaste should be introduced to infants as their teeth are emerging to promote enamel health and as children get older, more toothpaste can be introduced. Ingestion of fluoride in large quantities is never good for anyone so eating toothpaste in large quantities should be avoided.”
“Fluoride,” says Dr. Fung, “is fantastic in reducing incidences of tooth decay though it must be used judiciously. Studies have shown that putting trace amounts of fluoride in drinking water has decreased incidences of decay in some communities by nearly 70% compared to non-fluoridated communities. As such, having topical fluoride interacting with patient’s teeth make a definite difference in decreasing decay over a person’s lifetime.”
WHAT ABOUT “WHITENING” TOOTHPASTES?
“As dentists,” says Dr. Fung, “one of our primary concerns is the preservation of tooth structure in a patient’s mouth. That being said, many whitening toothpastes achieve their ‘whitening’ by adding more silica particles, thereby increasing the abrasiveness of the toothpaste to ‘scrub’ off stains but at the potential expense of small amounts of tooth structure. There are studies on either side of the debate of whether abrasive toothpastes cause a significant enough amount of tooth structure loss but personally I would err on the side of caution and go with a non-mechanically whitening toothpaste.”
Dr. Fung’s conclusion is this: “I would opt for a chemical whitening toothpaste such as a toothpaste with peroxide (such as Arm and Hammer Baking Soda Toothpaste with Peroxide) over something that is purely more abrasive. In-office whitening or over-the-counter white strips can also work for people who are inclined to try chemical whitening.”
WHAT MAKES TOOTHPASTE FOAMY?
What makes toothpaste foamy is soap – specifically sodium lauryl ether sulfate, a detergent with a rich, thick, fresh quality that we associate with cleanliness. The problem, however, is that there’s not really enough soap in a toothpaste to break down – thoroughly and reliably – the microscopic bacteria, tartar, and anything else that might be forming on your teeth. Scrubbing your teeth – like washing your car – is a good idea, but it’s still primarily cosmetic.
Dr. Harold Katz, founder of the California Breath Clinics, warns that “Nearly every toothpaste contains sodium lauryl sulfate (a harsh detergent) which has been proven to dry out your mouth and is now scientifically linked to canker sores. It is placed into toothpaste to create the foaming action that you believe is helping to clean your mouth. It’s not helping to clean your mouth – it’s drying it out.”
WHAT ABOUT THE TOOTHPASTES FOR “SENSITIVE” TEETH?
Adults with overly-sensitive teeth – teeth that easily experience pain from touching anything hot, cold, or even sugary – should certainly consider a toothpaste that includes desensitizers: potassium nitrate or stannous fluoride. A toothpaste like Sensodyne makes sense if your teeth are genuinely sensitive, but make certain that your teeth aren’t hurting because of a cavity or some other problem that you should take to your dentist.
WHAT IS IT IN SOME TOOTHPASTES THAT FEELS LIKE SAND?
The sandy or gritty, abrasive particles that you feel in some toothpastes are hydrated silica. It’s added to “polish” your teeth, and it’s the “whitening” ingredient in the toothpastes that advertise whiter teeth with regular use. The truth, however, is that no toothpaste can get your teeth whiter than a professional dental cleansing. A thirty-minute professional cleaning is both quick and efficient.
CAN A TOOTHPASTE CONTROL TARTAR?
Does the toothpaste you use “bite” or burn? It may include tetrasodium pyrophosphate. That’s the toothpaste additive that purportedly stops tartar from forming on the inside surfaces of your teeth. However, for the tetrasodium pyrophosphate to work effectively, it has to be dissolved in a strong detergent – hence the biting or burning sensation. If you have a professional dental cleansing twice a year, tartar really should not be an issue.
WHAT IS TRICLOSAN?
Triclosan is an antibacterial and antifungal agent added to some toothpastes ostensibly to reduce infections between the teeth and gums. However, if you’re doing everything else you should be doing for your teeth, triclosan is probably a redundant ingredient for you. Like fluoride, triclosan has some vocal critics, but the evidence shows that, although sometimes doing little, triclosan in the long run does more good than harm.
Dr. Fung adds, “There are additional ingredients in many toothpastes like Triclosan that are antibacterial and help to decrease the bacterial population in the mouth. That is always an added bonus and it is a nice thing to have in your toothpaste. Since the general environment in the oral cavity tends towards the acidic, I find that toothpastes like baking soda toothpastes help to neutralize the acidity in the oral cavity, raising the pH level of the mouth into a zone that harmful bacteria do not thrive in.”
SO, CAN TOOTHPASTE BE BAD FOR YOU?
“Overall,” says Dr. Fung, “I would say that it is hard to hurt yourself with toothpaste, but bad brushing habits (aka forward and back sawing motion) coupled with a hard/medium bristled toothbrush and abrasive toothpastes can cause unnecessary wear and tear on a person’s teeth. Always be careful with small children and toothpaste – fluoride is a wonderful at fighting the decay process when used topically but too much systemic exposure is dangerous for very young children.”
He recommends that you “Pick a toothpaste that does the maximum amount of good for you with the least risks involved. I usually recommend two different toothpastes for my patients who want ‘everything’: Arm and Hammer Sensitive Whitening and Sensodyne True White. I’ve used them at home and I don’t see many downsides to them as opposed to some of the more abrasive toothpastes out there.”
Remember, toothpaste is essentially a cosmetic. Most people use more toothpaste than they need, don’t brush long enough to have any effect at all, and don’t pay attention or brush in any methodical, effective manner. Just a dash of toothpaste on the brush – say the size of a pea – is enough. There’s no need to squeeze out that full line of toothpaste – with the swirls on each end – that you see in the toothpaste ads.
Take at least two minutes to brush your teeth. That’s really the minimum amount of time you need to brush thoroughly. Have a plan. Move from left to right and from top to bottom methodically, or whatever works best for you – just make certain that you’ve done the job thoroughly. It’s the friction that cleans your teeth – not the toothpaste or any of the additives, so attention to detail is the key to brushing.
Dr. Steven J. Edwards, DDS, says, “It is better not to think of brushing and flossing, or even hygiene, but instead think of oral fitness.” Dr. Edwards says “oral fitness” includes:
- exercises (what everyone considers ‘hygiene’)
- personal training
- professional care
Unless your dentist specifically tells you otherwise, the best recommendation is probably just to use the toothpaste you like best. If it tastes good, feels clean, and it makes you feel good, you’ll use it more and you’ll brush longer. What’s important is brushing often and thoroughly. Brushing can’t be bad for you. In fact, do it thoroughly at least twice a day and three times if you can. Other tips for brushing:
- Use a soft-bristled brush that allows you to reach all areas easily.
- Position the brush at a 45-degree angle to the gums.
- Move the brush back and forth in short strokes.
- Brush the outer and inner surfaces and the chewing surfaces of the teeth.
- Brush your tongue. That kills bacteria and makes your breath fresh.
- For the inside surfaces of the front teeth, position the brush vertically and make short up-and-down strokes.
- Every three to four months, use a new toothbrush – sooner if the bristles are frayed.
- Understand that brushing is only one part of effective dental care.
Dr. Kami Hoss, a DDS and orthodontist, with the Howard Dental Academy, summarizes the important points to remember about toothpaste: “Toothpaste is a cosmetic. Aside from brushing our teeth to clean them, we also do it so our mouth feels refreshed. A fluoride toothpaste may improve the strength of your teeth, but it does not necessarily clean teeth. The foam in toothpaste is not enough to break down things that grow in your mouth. Some toothpastes may also contain silica to whiten and polish teeth. You may remember silica for being the clear bead packets that read do not eat.”
Regarding cleansing and whitening, Dr. Hoss says, “Going to your dentist for a deep cleaning and whitening is more effective and less abrasive. The difference between a good brushing session and a ‘bad’ one depends mostly on the length of time you brush, and how much attention you pay to brushing all your teeth. For more natural and effective alternatives to toothpaste, you can try baking soda or coconut oil.”
Dr. Steven Edwards explains why dental care is so vitally important to everyone: “What most people do not understand is that tooth decay and gum problems are actually contagious, transmissible, microbial infections. You can give your cavities and gum disease to your kids, spouse, etc. People must realize that we are fighting a set nasty contagious microbial infections. Most of the billions of germs that exist in your mouth are embedded and protected in biofilm, especially between teeth and at the gumlines and on the tongue surface.”
Thus, Dr. Edwards insists that professional dental care is imperative: “I can’t believe how many people tell me that their teeth are bad because they didn’t visit the dentist for a couple years. Dentists are so busy chasing decay and gum disease firestorms every day, that they rarely have time for prevention. You are responsible for your prevention and oral health…. Once people begin to understand that tooth decay and gum problems are actually contagious microbial diseases, and not things that ‘just happen,’ possibly we will start being able to prevent dental problems, especially outside of the dental office.”
You should also floss daily to clean between your teeth. Floss gets where toothbrush bristles can’t to remove food particles and plaque. Eat a balanced diet, don’t use tobacco, and if you snack between meals, snack on fruits and vegetables and avoid sugary treats. Have a dentist that you see routinely – in southern California, a San Diego family dentist – and visit your dentist at least twice a year for checkups and cleanings. If you can adhere to all of these recommendations, it doesn’t matter what toothpaste you use. There’s a very good chance that you’ll have healthy teeth and a great smile for years to come.