Toothpaste – How to choose the right toothpaste

By Jackie Willis, Chief of Staff, The Center for Special Dentistry® in New York City.

Toothpaste, also called dentifrice, is essential to proper oral hygiene and is used for many reasons: to protect and build the enamel against acidic and sugary foods; to clean out all leftover food debris; and to prevent tooth decay and cavities. Part of the apparent growth toward improved personal hygiene can be attributed to biotechnological advances that expand on the function and benefits of traditional toothpaste. Patients can now purchase toothpaste customized to their particular needs or preferences, such as enamel protection, whitening, relieving dry mouth and treatment of sensitivity. This multi-functionality of toothpaste now offers us more targeted control of our oral care regimes at home. This article will educate and guide you in how to choose the right toothpaste for your specific needs. Read our article What is in your Toothpaste for more information.

The purpose of traditional toothpaste is to clean the enamel, remove food particles, stain, and bacteria. Effective toothpaste with the right ingredients should be used to prevent the demineralization process or strengthen and restore the enamel’s mineral with the process of remineralization. While the precise chemical makeup of different toothpastes may vary, most are composed of the same basic elements:  fluoride to protect teeth from cavities; abrasives that remove particles and stain and also polish the teeth; humectants that provide the paste-like consistency and retain moisture; detergents that generate foaming action during brushing; thickeners that contribute to the integrity of the paste; preservatives that help prevent the growth of unwanted microorganisms during storage; flavoring agents, sweeteners, and coloring agents. For more information on toothpaste ingredients, see our article, What’s In Your Toothpaste? – (to be published soon).

Furthermore, a product like toothpaste can be considered both a cosmetic and a drug according to the FDA. Different laws and regulations apply to drugs and cosmetics. When a product has two intended uses like fluoride toothpaste which also whitens teeth, such products must comply with the requirements for both cosmetics and drugs. Firms sometimes violate the law by marketing a cosmetic with a drug claim or by marketing a drug as if it were a cosmetic, without adhering to requirements for drugs.

The American Dental Association (ADA) conducts extensive and thorough laboratory tests on toothpastes to ensure safety and effectiveness. The ADA determines the product’s fluoride content, how it is released and its effectiveness on tooth enamel. Some toothpaste will have an ADA seal, which means the selected toothpaste has been tested on and has met the ADA criteria for safety and effectiveness.

Many research studies confirm and continue to reinforce that fluoride toothpaste is more effective compared to non-fluoride toothpaste.  Fluoride protects the teeth by strengthening the enamel and can remineralize caries like enamel lesions (Arnold, 2006). Common fluoride compounds in toothpastes include sodium fluoride and sodium monofluorophosphate. Studies have shown that toothpaste should have a fluoride concentration of at least 1000 ppm (parts per million) or above to be considered effective in reducing caries and preventing tooth decay (Twetman et al, 2003). Fluorosis is an abnormal condition characterized in children and is caused by excessive intake of fluoride. In children under 6 years, the decision of what fluoride levels of toothpaste to use should be discussed with your dentist (Walsh et al, 2010).

Colgate Total carries the seal of approval from the ADA as it incorporates fluoride to prevent cavities and strengthen enamel. In addition, Colgate Total has another anti-biotic ingredient triclosan, which helps to kill the bacteria that cause plaque and gum disease. This toothpaste incorporates a copolymer to keep the fluoride and triclosan actively protecting teeth and gums for up to 12 hours between brushings. Colgate Total has been certified by independent dental associations in 29 other countries (“Colgate total,” 2012).

2) For Sensitive Teeth

Tooth sensitivity occurs with when there is open exposure of the ‘dentin’, or the softer part of your tooth that is layered under the enamel. Dentin has fluid-filled tubules of nerve endings. When fluid moves, the nerve endings react in response, which causes the distinctive sharp pain. Blowing air, eating or drinking hot, cold or sweet things can cause this fluid to move (Brännström, 1966). Common causes of wearing the enamel away and gradually exposing the dentin include brushing your teeth too vigorously or frequently, gum disease, teeth grinding or clenching, receding gums, and eating or drinking highly acidic foods or drinks which erode the enamel (Addy, 2002).

Using a sensitivity toothpaste like Sensodyne Pronamel toothpaste treats and protects against sensitivity. “The potassium ions in Sensodyne toothpaste builds a protective barrier that blocks the pain caused by pain stimuli,” (“Minimizing the risk,” 2012). This toothpaste will relieve the sensitivity and help protect against the effects of acid erosion. Sensodyne Pronamel is formulated to re-harden acid-softened tooth enamel while also preventing cavities. Two active ingredients are potassium nitrate, which aids against teeth sensitivity, and sodium fluoride, which aids against cavity formation.

Desensitizing toothpastes normally take some time to reduce sensitivity. However, a recently new oral product called Colgate Sensitive Pro-Relief Desensitizing Paste has Pro-Argin technology which claims to provide instant sensitivity relief after one application. The Pro-Argin Technology effectively plugs and seals open dentin tubules when polished into teeth with a rotary cup. This desensitizing paste can only be administered by professionals trained in performing dental prophylaxis (“Colgate sensitive pro-relief,” 2012). Since our technological world is rapidly advancing, it is only a matter of time until this new technology can occur in toothpaste.

3) To Whiten Teeth

Patients continue to increase their demand for products that whiten teeth. As time passes, teeth may become discolored and stained from various causes such as drinking alcohol or coffee, eating certain foods, and smoking tobacco. Specific peroxide-based bleaching pastes and gels are used to improve intrinsic tooth color or remove and prevent extrinsic tooth stain. Whitening toothpaste may commonly include special abrasives that gently polish the teeth and sodium tripolyphosphate to help break down or dissolve stains. However, some whitening toothpastes may be highly potent with abrasive agents, which can harm the enamel if used too often. When choosing whitening toothpaste, you want to consider active ingredients, effectiveness and safety.

Whitening toothpaste does not change the natural color of teeth or reverse discoloration. It merely whitens the teeth slightly by removing surface stains. It is highly recommended to seek whitening treatment in a dental office rather than use toothpaste products. Nevertheless, ADA sealed toothpastes such as Crest’s Pro-Health Whitening Toothpaste is safe and effective in helping to whiten teeth by removing surface stains, when used as directed (“ADA seal product report,” 2013). In addition, it is effective in helping to prevent and reduce tooth decay, gingivitis, and plaque above the gumline, bad breath, and relieves sensitivity.

New research shows the chemical blue covarine can make teeth appear whiter immediately after treatment. Blue covarine adheres to the surface of the teeth to create an optical illusion making teeth appear less yellow. In addition, “silica based whitening toothpaste containing blue covarine did not have an undue degree of abrasivity to enamel or dentine compared to other relevant commercially available products and is an efficacious source of fluoride” (Joiner, 2009). Technological breakthroughs have advanced toothpaste so that the optical properties of the tooth color are modified rather than having the enamel at risk of being abraded.

4) To Relieve Dry Mouth

Xerostomia is the medical term for having a dry mouth due to lack of saliva. Having a dry mouth is an uncomfortable and unhealthy condition that should be treated and improved. Xerostomia increases the risk for tooth decay, gum disease, and bad breath since the lack of saliva leaves the mouth unprotected. It is very common among adults and is generally caused by, but not limited to: side effects of medications, allergies, sleep apnea, snoring, radiation therapy and chemotherapy. Dry mouth persists by dehydrating the body with smoking, ingesting caffeine or alcohol. Age and menopause also decrease how much saliva we produce. Treatment of xerostomia relies on the diagnosis so it is best to seek the advice of your dentist and a multidisciplinary team of doctors.

Research does show how the use of toothpaste and mouthwash based on triclosan, fluoride, gingival revitalizers and mineral salts improves the symptoms of patients who suffer from dry mouth (Lopez-Jornet, 2011). Toothpastes such as Biotene Dry Mouth may improve dry mouth, but it certainly does not cure xerostomia completely. This toothpaste contains patented Salivary LP3 enzyme system that supplements the mouth’s salivary defenses. Using a bio-active enzyme system to replace salivary enzymes helps reduce tissue irritation. In addition, Biotene Dry Mouth contains a gentle formula not to irritate the gums, fluoride to fight cavities, and it reduces bacteria associated with bad breath (“Biotene dry mouth,” 2013).

5) To Relieve Bad Breath

Halitosis is when unpleasant odors are released from breathing. Oral malodor may be one of the top three reasons why patients seek dental visits, following after concerns over dental caries and periodontal disease (Loesche & Kazor, 2002). Bad breath can result from poor dental health habits and may also be a sign of other health problems such as yeast infection, dry mouth, diabetes, or pneumonia. If you do not follow oral regimens daily, bacterial will grow between your teeth, on your tongue and around your gums from eating. Persistent bad breath may be a warning sign of gum disease and it is important to make a visit to your local Periodontist, a dentist who specializes in treating gum conditions.

Studies have consistently shown that toothpastes containing zinc ions help to reduce volatile sulfur compounds (VSCs) and oral malodor (Burnett et al, 2011). Stannous-containing toothpastes show statistically significant reduction of bad breath (Feng, 2010). Of course, understanding the cause of your bad breath and making changes to medications or habits will help to relieve halitosis. Crest Pro-Health Toothpaste is formulated toothpaste containing stabilized stannous fluoride, which kills bacteria associated with plaque and gingivitis.

• ADA seal product report: Crest pro-health whitening toothpaste.
  (2013).
• Addy, M. (2002). Dentine hypersensitivity: new perspectives on an old problem. International dental journal, 52(5), 367-375.
• Arnold, W. H. et al. (2006). Effect of fluoride toothpastes on enamel demineralization. BMC Oral Health, 6(8), doi:10.1186/1472-6831-6-8
• Biotene dry mouth toothpaste. (2013).
• Brännström, M. (1966). Sensitivity of dentine. Oral Surgery, Oral Medicine, Oral Pathology, 21(4), 517-526. doi:10.1016/0030-4220(66)90411-7
• Burnett, G. et al. (2011). In vitro effects of novel toothpaste actives on components of oral malodour. International Dental Journal, 3, 67-73. doi:10.1111/j.1875-595X.2011.00052.x.
• Colgate sensitive pro-relief desensitizing paste. (2012).
• Colgate total. (2012).
• Feng, X. et al. (2010). Breath malodor reduction with use of a stannous-containing sodium fluoride dentifrice: a meta-analysis of four randomized and controlled clinical trials. American journal of dentistry.
• Joiner, A. (2009). A silica toothpaste containing blue covarine: a new technological breakthrough in whitening. International Dental Journal, 59(5), 284-8.
• Loesche, W. J. and Kazor, C. (2002), Microbiology and treatment of halitosis. Periodontology 2000, 28: 256-279. doi: 10.1034/j.1600-0757.2002.280111.x
• Lopez-Jornet, M. (2011). Clinical and antimicrobial evaluation of a mouthwash and toothpaste for xerostomia: a randomized, double-blind, crossover study. Journal of dentistry, 39(11), 757-63. doi: 10.1016/j.jdent.2011.08.007
• Minimizing the risk of sensitivity – sensodyne. (n.d.).
• Twetman, S. et al. (2003). Caries-preventive effect of fluoride
  toothpaste: a systematic review. Acta Odontologica Scandinavica, 61(6), 347-355. doi:10.1080/00016350310007590
• U.S. Department of Health & Human Services, (2011). Cosmetics & U.S. law.
• Walsh, T. et al. (2010). Fluoride toothpaste of different concentrations for preventing dental caries in children and adolescents. The Cochrane Library, doi: 10.1002/14651858.CD007868.pub2

Categorised in: Dr. Dorfman Says

This post was written by Dr. Jeffrey Dorfman