At social gatherings, after exchanging the usual “so what do you do” answers, I am often then asked which toothpaste is the best. I usually mutter something about fluoride and the ADA Seal of Approval, and then move the conversation to more important issues, like did the Mets win or not. It’s not that I don’t want to say what I think of some gigantic corporate manufacturer, it’s just that I don’t care all that much about their toothpaste. I do care about healthy teeth and gums, but the big secret is that toothpaste is, in most cases, very overrated.
I know, I know, I too have seen the constant barrage of toothpaste ads. The right toothpaste, we are told, will prevent cavities, arrest cavities, whiten teeth, freshen breath, create instant sex appeal, prevent gingivitis, form a protective shield of some sort, and make the gums 65% stronger (whatever that even means). So I should start by asking, what is toothpaste really supposed to do?
What is toothpaste really supposed to do?
The primary purpose of toothpaste is to assist mechanical brushing in removing bacterial plaque from the tooth surface and at the gum margins. A great analogy I read describing the role of toothpaste is one of peanut butter on a butter knife. One can rinse it, pour soap or detergent on it or apply toothpaste to it, and the peanut butter remains. The only way to get it completely off is to wipe or brush it off, using a little soap to help. The plaque on a tooth adheres just as stubbornly, and the toothpaste is just an aid to help the toothbrush more quickly wipe the plaque off. That is about it, pretty simple.
So why are there about 1,000 different toothpaste formulations out there? Most of the ingredients in toothpaste are for add-on therapies, which may or may not be of any use or effectiveness. By the way, have you noticed that the ingredients are listed on the box but usually not the tube, and the box is usually thrown away before you decide to read the ingredients? Those tricky packagers! That brings me to the ingredients-what are they and why are they in there?
What are the toothpaste ingredients and why are they there?
Fluoride is found in most toothpaste, and it’s function is to remineralize areas of tooth surfaces that have been weakened by acid, and to make the tooth surfaces more resistant to acid attack. Fluoride has been an additive to toothpaste since the mid 1950’s, and has been shown in countless studies to be effective in reducing cavity rates. There are some who question its safety for various reasons, and I may discuss the research pros and cons regarding that in a future article. Suffice it to say for now that my family and I use fluoridated toothpastes.
Toothpaste usually contains various ingredients like glycerin to prevent the paste from drying out, and others like cellulose to act as a binder to prevent separation of the ingredients (otherwise you’d have to stir it before each use).
Toothpaste also contains some sort of abrasive. The most commonly used are hydrated silica, hydrated alumina, calcium carbonate, and dicalcium phosphate. The most common problem with toothpaste is that many are just too abrasive. Unfortunately the degree of abrasiveness is not required (in the US) to be listed on the box (which you threw away anyway), and is difficult to find on their websites. I have added a chart here that gives the relative ratings for abrasiveness of many of the major toothpastes. I recommend that you try to select a toothpaste with a rating below 100, especially if tooth wear or gum recession has been a problem for you.
Detergent foaming agents are often added to act as a surfactant and make it feel like it’s doing something. The most common is sodium lauryl/laureth sulfate (SLS). SLS has a very limited effect on plaque or stain removal, and some people can have an increase in canker sores or develop mouth skin lesions due to this ingredient. There are a few brands that don’t contain it, and I wish more would eliminate it from their products.
There are toothpastes with ingredients added to help reduce tooth sensitivity. The most common ingredient is sodium nitrate, but strontium chloride and prescription-level fluoride are also used. With regular use over a period of several weeks, they may help those who suffer from tooth sensitivity to sweets and cold, but I feel should only be used if recommended by your dentist.
There are additive ingredients that are anti-bacterial, like Triclosan, that have marginal effectiveness. Some toothpastes add tetrasodium pyrophosphate that is claimed to reduce tartar formation but is pretty useless for that and also has problems with side-effects in some users. The synthetic sweetener Xylitol is sometimes added, and some claim it can reduce cavity rates. Recent studies question those claims, however. There are a host of other ingredients that may be added, from seaweed to EDTA to any number of herbs in so-called natural toothpastes. There are flavoring agents, coloring dyes, and purely cosmetic sparkly bits of plastic non-degradable polyethylene microbeads that some toothpaste wizards (thanks Procter & Gamble) have added.
New chemical additives for toothpaste are always on the horizon, and in rare cases a few may actually prove to be useful. The bottom line for me is to remember what toothpaste primarily does: it helps the toothbrush be more efficient at removing plaque. In my opinion, caution should be taken in adding ever more chemicals to our toothpaste and to our diets in general. These chemicals may or may not have any benefit, but in combination over time may have detrimental side effects.
So what toothpaste is best? Mostly, the one that gets on your toothbrush!
PubMed.gov: Factors contributing to adverse soft tissue reactions due to the use of tartar contral toothpastes
PubMed.gov: Role of dentifrice in plaque removal: a clinical trial
Vicky Flint RDH: The Truth About Toothpaste