Toothpastes
We are often asked about various dental products and our recommendations for use of these products. In the following paragraphs, I will cover the basics of what is found in various toothpaste products.
There are two categories of inactive ingredients found in toothpaste; structural and sensory. The structural ingredients include humectants, buffering agents, preservatives, thickening agents, and surfactants. Humectants keep the toothpaste moist and prevent it from drying out. Examples are sorbitol and xylitol that also add a sweetening effect. Buffering agents help keep the pH neutral so the product is not too acidic. Preservatives such as sodium benzoate help prevent microbial growth. Thickening agents help bind the ingredients together and surfactants cause the foaming effect. One surfactant used in toothpaste is sodium lauryl sulfate (SLS) and if you suffer from aphthous ulcers, you may consider avoiding this product in your toothpaste as some studies have shown a decreased incidence of recurrent aphthous ulcers in patients using products that are SLS free. The surfactants do play an important role in helping to loosen plaque from the tooth surface.
The other category of inactive ingredients is sensory. Sweeteners and flavoring agents make the taste pleasant to encourage the use of toothpaste. Noncariogenic (something that does not cause cavities) sweeteners mix with cavity-causing bacteria in the mouth so the sweetening effect works without causing cavity-causing acid attacks. Sensitivity to some flavorings and colorings is always possible and the label is carefully evaluated if you have known sensitivities. If you seem to be having a reaction to your toothpaste, or having a reaction of unknown origin, try changing products.
ADA Seal Of Acceptance Marks Safe Toothpaste Products.
In an article about why consumers should avoid fluoride-free toothpaste, Healthline (8/16) quoted American Dental Association spokesman Matthew Messina, DDS, as saying, “I tell all my patients to look for a toothpaste that has earned the ADA Seal of Acceptance. If a product has the ADA seal, it means that it has been tested and proven to be safe and effective.” Healthline added, in the US, “toothpastes that have been proven to be safe and effective at preventing cavities and maintaining optimal oral health all have an ADA Seal of Acceptance. According to the ADA, only toothpaste containing fluoride will have such a label, and only after providing scientific evidence demonstrating the safety and efficacy of the product. As well as containing fluoride, ADA-accepted toothpaste must also not contain flavorings that would cause tooth decay such as sugar, and they must contain active ingredients that assist in teeth whitening, lessen tooth sensitivity, prevent enamel erosion, and reduce gingivitis and buildup of tartar.”
The ADA provides a complete list of toothpastes with the ADA Seal of Acceptance, including some with stain removal attributes. In addition, Crest 3D White Whitestrips Glamorous White have earned the ADA Seal of Acceptance.
Abrasives are present to help remove plaque and stain for tooth surfaces. Without these abrasives, the teeth would not have that clean feeling, and compliance would be low for wanting to brush. One study actually indicated that when some participants were given toothpaste without abrasives, they dropped out of the study.
Abrasives also have a negative quality that can contribute to tooth abrasion. There is a standard for measuring abrasives and the higher the RDA (Radioactive Dentin Abrasivity), the more abrasive the component. Most toothpaste has silica-based products for the abrasive but recent studies have shown that baking soda products have shown significant removal of plaque and are rapidly cleared from the gum sulcus. Regardless of the product chosen, how the product is used (brushing technique), frequency of use and quantity used will play a major role in tooth abrasion and erosion.
Fluoride use in toothpaste has been well established to provide a replenishing of the fluoride-rich outer layer of the tooth and has proven to fight cavities. The effect on the tooth is to prevent demineralization and to help remineralize the enamel to prevent bacteria and their byproducts from destroying the outer layer of the tooth and penetrating to the weaker internal layer of the tooth. Most toothpaste contains 1,000 – 1100 parts per million (ppm) and is effective in fighting cavities.
The American Academy of Pediatric Dentistry recommends that fluoride toothpaste is not needed in children younger than two and that are at low risk for decay. Children at high risk for decay should use a smear of toothpaste on the brush. Children, aged 2 to 5 should use a pea-sized amount of toothpaste. These recommendations are based on preventing overuse of fluoride from ingestion that can cause a problem in the developing tooth enamel called fluorosis. Adults benefit from fluoride as well and the use of toothpaste on the brush in moderation is sufficient for daily use. The large triple rope you see on commercials is not needed.
Popular ingredients found in some of today’s toothpaste are anti-plaque and anti-tartar agents. Triclosan/copolymer in .3% quantity has been shown in some studies to significantly reduce plaque levels by up to 48% compared to a control toothpaste. Colgate Total is one of these toothpaste. Stannous fluoride is another agent that can alter bacterial growth and bacterial adhesion. Zinc citrate in 2% quantity has also shown anti-plaque effects and Tom’s of Maine is one product that has this agent.
Anti-tartar (anti-calculus) agents in toothpaste can help to inhibit the formation of tartar above the gum line. Pyrophosphates interfere with crystal growth during tartar formation. It has been our experience that there are a number of patients sensitive to pyrophosphates and can cause ulcers and irritations.
The number of people that suffer from dry mouth has risen over the years and this is related to both an aging population and side effects from medications. It is important that the toothpaste chosen for dry mouth has fluoride and often we will often recommend a fluoride supplement as decay rates increase with xerostomia.
Patients with dry mouth also may suffer from sores and sensitivity. Choosing a low abrasive toothpaste as well as one that fights sensitivity may be beneficial. Some of the low-foaming toothpaste is helpful and can help stimulate some level of natural lubrication. Sensodyne has some products that fit this description.
In conclusion, reading labels, trial and error with different products, and consultation with us can lead to finding the right product fit for you.
