Louise H Connolly MD
Why an article about toothpaste? What's the big deal anyway? Just like all doctors preach "diet and exercise", all dentists preach "brush and floss". So, are you doing it? After every meal? Are you sure you are getting your back teeth? Are you brushing long enough? "Gargle cough" you answer, and you leave with a free toothbrush and a sample of Crest. If the bill is really high, you have only yourself (or maybe your mother) to blame. Really, I don't know how many people out there have Pepsodent Perfect oral hygiene.
Yes, just what toothpaste you use matters. And all those claims for whiter teeth, fresher breath, and antimicrobial special effects don't matter. The toothpaste isn't in your mouth long enough to differentially whiten or freshen things. And the antimicrobial properties are directly related to how long you brush. You can't just super concentrate things here and get a 20 second effect. So please pick something that you really like to have in your mouth. And brush longer.
Then you have to look out for these toxic additives. Sodium laureth sulfate, triclosan, propylene glycol, trisodium phosphate and others. We don't want these additives in our blood stream or our mouths. ADA approved? The ADA is looking at the efficacy of active ingredients, not the presence of artificial ingredients. I'd also like to point out that most treatments for the mouth are meant to be spit out. There are two reasons why this is so. First, why isolate a pathogenic filled toxic slurry in your toothpaste, mouth wash, oil pulling or whatever, and then allow it to populate your gut. The second point is that those active ingredients used to clean your mouth and teeth are often not good for your body. Fluoride is a perfect example. Now, the opposite may also be true: things good for the body may not be good for the mouth. Green tea can stain your teeth. Sucking on a lemon all day or frequent use of apple cider vinegar in the mouth can erode enamel.
Fluoride especially is a hotly debated contentious additive. I think this is related to what is good for the mouth may not be good for the body. Just for example, prenatal fluoride exposure from drinking water in China lowered IQ scores in the offspring. Ouch! Fluoride use in osteoporosis made bones look stronger but they were more easily fractured. Ouch again! So fluoride in the mouth is one thing.....just don't swallow! Some people may really need fluoride. I think the dose used is another key factor.
Caries can be reduced with Prevident 5000 toothpaste. Prescription toothpaste with fluoride from your dentist.
Abrasives are at least 50% of most toothpastes and are responsible for removing biofilms and plaque. There are many different types which can be finely or coarsely ground. Ones I would avoid are aluminum hydroxide, synthetic calcium hydroxyphosphates, triclosan, and zeolites. Most toothpaste boxes list an abrasive index (RDA) on the box. It's impossible to tell just how abrasive a toothpaste is by looking at the ingredients. It depends also on how they are milled. Do not exceed 50% abrasiveness index because then you risk tooth demineralization. You don't want cleaner whiter teeth if you are making them more prone to decay.
Other additives worth mentioning. Whitening agents either contain bleach or harsh abrasives. "Antibacterial" toothpastes often contain triclosan which is carcinogenic in large quantities. Zinc chloride, however, is my antibacterial of choice. Both are ADA approved. Foaming and anti-caking agents include SLS, and polyols (glycerol, glycol, glycerol) are simply meant to enhance the brushing experience. They do nothing good for you and they all can cause problems. Remineralizing agents often contain nano-sized mineral crystals - if these extremely small particles actually adhere to your teeth, great! But again, don't swallow! These crystals are extremely sharp and may damage intestinal mucosa.
.Okay, lets get down to the basics. What brands are best?
There are pros and cons here. If you are going to exclude fluoride in exchange for a less toxic mixture, you've got to be sure the toothpaste is really clean and that your included ingredients measure up. Many common "natural" brands just don't make the grade. Check your labels! It's your mouth we're dealing with here.
And I need to say this again. There is a lot to be said for how long you brush. How long. It's the mechanical action of brushing your teeth, electric, manual, or both, that counts. Most people don't brush long enough. If that's you, figure out what toothpaste will make you brush longer. Try some of the following and see. One word of caution. A few of you brush too long! This can be a problem for your enamel if you use harsh abrasives.
1) The simplest/cleanest commercial toothpaste (if you don't want to make your own) is Earthpaste. It contains only five ingredients in a combination which balances salivary PH and inhibits Strep mutans. You can buy it with or without menthol, whatever you like. This is a good paste for those without problems.
2) Recaldent is an ingredient you can look for in alternative toothpastes if you have problem teeth. It contains a little fluoride and some calcium and phosphate to help remineralize teeth.
3) Carifree is something similar to recaldent with calcium and phosphorous to remineralize teeth but which also balances salivary PH and contains an antimicrobial.
This might work better for you, especially if you like brushing with it.
4) Tooth Builder is a popular fluoride free antibacterial remineralizing tooth paste for those who really don't want any fluoride.
5) Dr Brommers is also an excellent toothpaste free of potentially toxic ingredients and which comes in a variety of flavors.
6) OraWellness Heal Thy Mouth Brushing Blend. This is a liquid that can be added to toothpaste, added to coconut oil for oil pulling, or even used as a mouthwash. It is a mixture of antimicrobial oils. Oil and water don't mix, right? Your mouth bacteria have a lipid soluble outer membrane. So the oil and the bacterial membrane naturally segregate together in the mouth and are more easily discarded together.
7) Crest Cavity Protection Regular Paste. What!! Well, I wanted to include something for the more traditional of my readers. Yes this has the usual suspect additives but it's active ingredients are of the right type and strength. First, this toothpaste bears the ADA seal of approval. Second, it contains the right amount and type of fluoride. Sodium fluoride is the best. Stannous (tin based) fluoride can discolor teeth. Third, it has no harsh abrasives, only finely ground silica which is a good biofilm disruptor. Harsh abrasives can damage your enamel as you brush. Avoid chalk, coarsely ground silica and glycerin.
Top Choices for Other Traditional Products:
Xylitol. Zellie's lozenges, mints, rinses, and gums contain 100% Xylitol, nothing else. No problematic ingredients, no low concentration of Xylitol. Try this and similar products. See what you are comfortable using. Xylitol directly inhibits strep mutans. It's also an excellent anticaking agent. So I would include it in my toothpaste.
Listerine Cool Mint Mouth Wash. Actually this contains three essential oils - that's it! No alcohol, glycerin antiseptics and other dubious ingredients. Eucalyptus, menthol, and thyme oils. (Eucalyptol 0.092%, Menthol 0.042%, Methyl salicylate 0.060%, Thymol 0.064%) ADA approved with numerous clinical studies showing benefit. Most other mouthwashes contain alcohol, glycerin antiseptics and artificial flavors. They lack verification of benefit and can be problematic.
That's it for now. I hope this list has been somewhat useful. At least it might help with your toothpaste selection. But I don't think that poor oral health is rooted in a toothpaste deficiency. So stay tuned for my next exciting post entitled "Beyond Toothpaste." It's a real thriller. After that, I'll be starting my "Brain Health" series as you requested.