What is the best toothpaste to use?

Have you ever found yourself in the store’s toothpaste aisle staring at the multitude of choices available? Where do you even start – fluoride, whitening, tartar control, sensitivity, mouthwash added, natural, herbal? The list goes on and on. To make it more difficult, the competition is so intense among manufacturers that they are constantly changing formulas and names to compete with other products that show sales success or to measure up to focus group results. They are always playing on your emotions! So you try and find something that you’ve liked before, and – it is no longer available.

Let’s talk a little about what active ingredients you can find in a toothpaste and what is important. Grab your toothpaste and look at the label (you may need reading glasses…it is the very small print, usually on the box it came in).

Fluoride – Most toothpastes today have a varying amount of fluoride in them. It is different in type and amount than is in fluoridated municipal drinking water (that fluoride is incorporated into the tooth structure as it develops – making the enamel more resistant to decay). The fluoride in toothpaste coats the surface of the enamel and helps to keep the surface resistant (fights de-cay). Fluoride also acts as a desensitizer on dentin by clogging up the microscopic pores in the dentin that lead from the surface down toward the nerve.

Potassium Nitrate – You will find this in most “sensitivity” toothpastes. It acts chemically to de-polarize the nerve endings, resulting in a dampened reaction to whatever is causing the sensitivity.

Hydroxyapatite – This is used for remineralization to replace minerals that are taken off the tooth by drinks (especially acidic drinks), wear, food, etc.

Sodium Laurel Sulfate (SLS) – This is a foaming agent that makes it feel effective. It is also a common cause of allergies.

Xylitol – A natural sweetener that fights bacteria (they can’t metabolize it). You will see xylitol appearing in more and more products.

Lastly, and one of the most overlooked – Hydrated Silica – also known as sand. Grit. It is what cleans surface stain off teeth. The labels do not show how much grit there is in the paste, and it can vary a lot! Many manufacturers make it hard to find out. There is, however, a scale of how much grit is in a product and how abrasive to a tooth it is – the RDA (Relative Dentin Abrasivity) scale. The higher the number, the more grit it contains, and the more tooth structure can be worn away by improper brushing.

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Think of it like sandpaper – if you’ve ever sanded wood, you start with a coarse paper, and move down to medium, fine, and then extra fine. If you grab a tube of “whitening” toothpaste, it is like you are scrubbing your teeth with coarse sandpaper. The name is very misleading because these toothpastes do NOT whiten your teeth – they simply remove surface stains off your teeth, which technically “whitens,” but only to the whiteness your teeth naturally are! It is like scrubbing a coffee stain off your kitchen countertop with soft scrub – the stain is gone, so the counter is “whiter,” but you didn’t change the actual color of the top. Unfortunately, if you have recession or an acidic mouth, you can do much more damage to the teeth. One of the causes of notches at the gum line is toothpaste abrasion. This is more severe in acidic mouths.

So, what do we recommend?

It depends on your need:

Prone to cavities? Use one with a high level (even a prescription level) of fluoride and xylitol (such as CariFree CTX4 gel 5000 – not over the counter)

Sensitivity? Most sensitivity toothpastes have 5% Potassium Nitrate. Some add fluoride, others Hydroxyapatite. Perioscience’s sensitivity toothpaste has all three.

Stain? You’ve got to be careful here. Consider modifying your intake of coffee, tea, red wine, berries, etc. Also consider a professional cleaning more often. And only use a soft brush, or (my favorite) a Sonicare electric.

Tartar build up? – The tartar control toothpastes act by inhibiting the formation of new tartar – not getting rid of old accumulations. That requires a professional cleaning. Be advised, however, that many people have irritated gums because of it. If you’ve started using one and notice sore or irritated gums – quit using it!

Allergies, or burning of the mouth? – Try a natural toothpaste or one without SLS.

How much should you use? IGNORE the pictures and ads that show a huge ribbon of tooth-paste. They want to sell you more toothpaste! Use an amount about the size of an english pea.

Here is a chart that gives the RDA values for many common toothpastes. Sticking to one under 70 puts you in the “fine or extra fine” range of sandpaper.

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