Last Updated on April 13, 2021 by A. Scott, BSDH
“Which is the best toothpaste to use?” – this is one of the most common questions I am asked by patients. It’s a logical question, since there are so many toothpastes on the market that claim to do wonders for your teeth and oral health. But it’s a tough one for that same reason.
The best way to answer the question is to help my patients understand what toothpaste really is. Then, to understand what toothpaste can actually do for our oral health and what its limitations are.
Next we need to know what the patient’s dental goals are and finally, we need to interpret the list of ingredients. Once you know what the ingredients are, you can decide if you want to use them in your body or not. And if not, what are the alternatives?
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What Is Toothpaste Anyway?
Toothpaste is a mildly abrasive agent that helps the toothbrush remove soft deposits from the tooth surface. Some ‘toothpastes’ actually come in powder form, while others are in paste or gel form. Some pastes foam up and some do not. Moreover, they come in a wide range of flavors and colors.
Toothpastes cannot remove hard deposits from the teeth. A toothbrush cannot remove hard deposits either, for that matter. Hard deposits must be removed with metal instruments by a specially trained dental professional, such as a dental hygienist or a periodontist.
Depending upon which active ingredients are present, toothpastes can provide many health benefits to the teeth and gums. For example, fluoride and other substances strengthen the enamel to provide cavity protection.
Essential oils and anti-inflammatory agents may help to reduce the swelling seen with gingivitis. In addition, abrasive ingredients polish the tooth surfaces to make them feel smoother and look whiter. Finally, anti-tartar ingredients prevent the tartar crystals from crystalizing.
Toothpaste In History
Humans have always known about oral health. Research has shown that even ancient cultures used abrasives with flavorings to clean their teeth. Based on such findings, only the wealthy had access to such things.
With time, these dental powders and paste preparations became widely available. Lower prices made them more accessible to the general public. Around this same time, scientists also began to experiment with the ingredients, to improve upon toothpastes. In addition to ingredients to improve the taste, fluoride was added for caries protection.
A clinical trial back in the 1940s and 1950s confirmed that the addition of fluoride to toothpastes does protect against caries. Researchers began to see the health benefits of adding active agents to toothpastes to fight against oral diseases. Adding fluoride to toothpaste became the standard.
The challenge which toothpaste developers now face is how to provide more than just a temporary solution to dental disease. In other words, make the ingredients work for a longer time to produce lasting oral health benefits.
Toothpaste And Gingivitis
Gum disease begins as inflammation of the gums, or gingivitis. This common problem often presents itself as swollen and bleeding gums, the cause of which is dental plaque. Dental plaque is a sticky, bacterial substance that clings to the teeth and gums.
Gingivitis may cause the gums to hurt, but not always. Many people don’t even know that they have gingivitis. But if gingivitis is not treated, it will lead to periodontal disease, which in turn can result in tooth loss.
Some makers of toothpastes create products to treat gingivitis, and these are called “antiplaque” or “anti-gingivitis” toothpastes. Such dental products have ingredients that will temporarily reduce the amount of bad bacteria. However, more is needed.
You must take care to brush with the correct technique in order to remove old food from your teeth. If not, then the bad bacteria will quickly return to the leftover food, use it for energy and continue to infect the gums. Therefore, controlling gum disease takes a varied approach. Additionally, some manufacturers use essential oils and other natural ingredients to treat gingivitis.
Toothpaste And Dental Caries
According to the WHO, untreated dental caries is the most common health condition in the world. Dental caries are caused by bacteria. Early dental caries can be reversed, but sadly, they are not always noticeable in the mouth. Often the teeth can look perfectly healthy but be weakened by dental caries on a hidden surface. If the caries are not treated, the tooth will develop a hole or may even break off.
Small dental caries do not usually cause pain. Large, deep dental caries may cause pain. But this pain is only felt when the caries are so deep that the tooth nerve begins to die.
We can stop dental caries in many ways. The best way to prevent dental caries is to keep tooth surfaces free of dental plaque. Good brushing and flossing, along with professional dental cleanings, are the best ways to do this. Another way to prevent dental caries is to remineralize caries in their early stages. Most brands of toothpaste include fluoride in their formulas to help remineralize these early caries.
Fluoride binds with the tooth’s structure and helps to strengthen it against the acid made by bacteria. New active ingredients added to toothpastes, such as nano-hydroxyapatite, also work similarly.
A sweetener called Xylitol also helps to prevent cavities, but in a different way. Bacteria will not use Xylitol as a food source and without food, any bacteria on the teeth will die. With no bacterial activity, cavities will not form. However, if bacterial activity is too high, then the active ingredients found in toothpaste will not help all that much.
What Are Your Goals For Your Teeth?
The key thing to remember is that toothpaste plays a supportive role. Toothpaste alone cannot treat dental disease, or improve the look of your teeth.
If you are not pleased with the color of your teeth, you may want to whiten them. And if so, it makes sense for you to look for a toothpaste that claims to whiten teeth. But beware.
What this claim really means, is that the abrasives in the toothpaste are there to remove the extrinsic (outer) stains. This makes the teeth appear whiter. Charcoal is a good example of this. Others may also include optical whiteners or peroxide, to lighten these stains.
What toothpaste will not do is change the color of your teeth on the inside. In order to whiten your teeth internally, you need a whitening treatment with some form of peroxide. This whitening is not harmful to the teeth and is very effective.
Or if you have gum disease, then maybe you are looking for a toothpaste to treat it. Many toothpastes claim to have ingredients that address gum disease. This means they have antibacterial agents designed to temporarily reduce the number of bad bacteria. Please keep in mind that gum disease requires professional attention to treat it.
To properly treat gum disease, the teeth and gums must be free of bacterial deposits. Toothpastes and rinses cannot remove the bacterial deposits. So using an antibacterial rinse or toothpaste will only give short term relief at best. Without treatment, gum disease will get worse. Even while using antibacterial rinses and toothpastes.
There is good news, though. Once bacterial plaque and tartar have been professionally removed, toothpaste ingredients can aid healing. These active ingredients can help with tooth remineralization and gum health.
Toothpaste Ingredients Explained
Do you ever wonder what the hard-to-pronounce ingredients on your toothpaste package really do? Compare this list of common toothpaste ingredients to your own toothpaste:
Common Ingredients Found In Toothpaste & What They Do
|Active Ingredient Types||Description/Examples|
|Antiplaque & Anti-gingivitis agents||These are agents that fight plaque formation by reducing bacteria, and which contain anti-inflammatory properties. For example: triclosan, stannous chloride/fluoride and zinc citrate/chloride, zinc salts, 4-isopropyl-3-methylphenol (IPMP)|
|Antimalodor agents||These are used to suppress sulfur-like mouth odors. They use zinc salts to change the volatile sulfur compounds (VSCs) into non-volatile zinc salts.|
|Anticalculus & antitartar agents||Ingredients that remove plaque and early tartar through mechanical abrasion. They also prevent tartar crystals. For example: sodium or potassium salts of the pyrophosphate, tripolyphosphate or hexametaphosphate, zinc phosphate|
|Whitening agents||Used to give the appearance of whiter teeth by (1) removing stains from surfaces mechanically with phosphate salts, papain and peroxides; (2) providing optical whitening like Blue Covarine. Other examples: Charcoal, baking soda|
|Antisensitivity agents||Used to relieve dentinal hypersensitivity by (1) blocking the dentinal tubules like strontium acetate or chloride, stannous fluoride, sodium phosphosilicate and arginine bicarbonate with calcium carbonate. Or (2) by nerve desensitization, via potassium nitrate or citrate|
|Antierosion agents||These offer a protective layer to the enamel and dentin. Such as stannous fluoride and/or chloride.|
|Abrasives||Used to clean the tooth surface, as they are harder than the stain, but softer than enamel. Such as hydrated silica and calcium carbonate, dicalcium phosphate dihydrate, calcium pyrophosphate, sodium metaphosphate, alumina, perlite, nano-hydroxyapatite, sodium bicarbonate.|
|Surfactants||Detergents used to create the soapy or foamy reaction while brushing. Some patients cannot tolerate the action of these surfactants and develop canker sores, sloughing or other allergic reactions, like SLS, sodium lauroyl sarcosinate, sodium cocoyl sarcosinate. The exception is cocamidopropyl betaine, which does not foam as much as SLS, and does not cause oral irritations.|
Other Ingredients Found In Toothpaste & Their Function
Below is a further list of other ingredients commonly seen in toothpastes today.
|Active Ingredient Types||Description/Examples|
|Viscosity modifiers||Used to produce a gel phase and prevent ingredients from separating during long periods of storage. For instance: carboxymethylcellulose, hydroxyethylcellulose, carrageenan, xanthan gum, cellulose gum, thickening silicas (not to be confused with abrasive silica)|
|Humectants and dispersants||Used to prevent water separation, evaporation and keep the chemical gums, such as Xantham gum, uniformly dispersed in the toothpaste preparation. Examples include: polyethylene and polypropylene glycols, glycerin, sorbitol, xylitol, isomalt and erythritol.|
|Sweeteners||These are added to improve taste. But they can be used by bacteria as a food source, leading to further dental caries. Examples include: sucralose, sodium saccharin and sorbitol. The only exception is Xylitol, which cannot be used by bacteria.|
|Flavors||These mask the taste of other ingredients like surfactants, to improve taste. One common flavor that has been linked to allergic reactions is cinnamon.|
|Preservatives||Prevent bacterial growth during long-term storage eg. Sodium Benzoate and Parabens|
|Solvents||Used to make the ingredients form a cream or gel solution eg. Water and Ethanol|
|Polishing agents||These make the teeth feel smooth and shiny, eg. Mica and Sodium Hydroxide|
|Coloring||Toothpastes come in a variety of colors. Coloring is added to be pleasing to the eye of the consumer.|
|Cavity Prevention||Many toothpastes use cavity prevention as their strongest selling point. Fluoride rebuilds the tooth crystals. Calcium glycerophosphate, isomalt, sodium trimetaphosphate, remineralizing agents (enamelon technology) and nano-hydroxyapatite all rebuild the tooth crystals and Xylitol prevents dental caries by denying the bacteria a source of energy to continue working.|
What About Skipping Toothpaste Altogether?
Dry brushing is an alternative to using toothpaste. Dry brushing simply means brushing the teeth without any cream or paste. This brushing technique is more common than you think.
An example of dry brushing is using a chew stick. Many cultures have used chew sticks to clean their teeth for thousands of years. In fact, some cultures still do. Chew sticks work to clean the teeth without toothpaste.
So how exactly does one go about dry brushing? Just wet the toothbrush head and brush as usual without adding toothpaste. Food and plaque can be removed effectively with this brushing method, but the disadvantage is that you will not gain the benefits of active toothpaste ingredients such as fluoride.
However, if your mouth is well cleaned by dry brushing, this may be enough to keep dental disease under control. After all, many municipal and natural water sources provide fluoride in the drinking water. Otherwise, fluoride tablets and rinses are also available.
What Are The Best Toothpaste Options?
Since there are so many toothpaste options available, the tendency of consumers is to go with the companies that do the most advertising. This is understandable as big brands have the money to back large clinical trials and to advertise. We are, of course, thankful for their contributions to oral care products.
Years of research has taught us which ingredients in our toothpastes are necessary and which ones we could do without. As a result, many small batch manufacturers know this, and step up to the plate. They take the time to develop high quality oral care products. But most of all, their products contain quality ingredients that support your oral health and your total health.
Notice our recommended small-batch manufacturers that produce high-quality oral care products which support total health.
A refreshing toothpaste that works with your body, not against it. Boka pairs the best ingredients that nature and science has to offer, in order to heal your mouth and nourish your body. Further, Boka believes in making more effective products with safer ingredients, to have a positive impact on preventive health. Boka features the innovative nHa (nano-hydroxyapatite) to remineralize teeth. Boka is also sweetened with xylitol.
A small batch oral care products manufacturer, Grin has produced award winning toothpastes. This particular toothpaste is free from harsh chemicals and bleaching agents that can damage your teeth. Active ingredients include organic Sea Salt, Propolis, fluoride and Baking Soda, which all work together to restore your teeth’s natural whiteness. In addition, Grin toothpaste is sweetened with xylitol.
Twice Duo Premium Toothpaste uses scientifically proven ingredients to support oral health and wellness. The toothpastes are SLS free, reinforced with fluoride and also sweetened with xylitol. This set of two features a morning and an evening toothpaste. The Early Bird and Twilight toothpastes provide two completely different brushing experiences, to compliment your daily routine.
Choosing The Best Toothpaste – Conclusions
Choosing the best toothpaste for you and your family doesn’t have to be hard. Once you understand the purpose of toothpaste and your own oral care goals, the rest is easy. The most important thing to remember is that toothpaste only plays a supportive role. Your dental hygienist will work with you to help you achieve oral health. Once oral health is reached, the active ingredients in toothpastes with help you maintain it.
Lippert, Frank. (2013). An Introduction to Toothpaste – Its Purpose, History and Ingredients. Monographs in oral science. 23. 1-14. 10.1159/000350456.