As dentists, we encounter a pretty large amount of questions from our patients regarding their oral health and how to keep their teeth and their families’ teeth safe and clean, but perhaps the most common question that we are asked is “What kind of toothpaste should I use?”
We are probably asked that question on a daily basis, but the answer is far from standard. Each patient is unique, and each mouth needs a specific type of toothpaste that would be best suited for them.
So how are we – as dentists – supposed to answer that critical question?
First of all, we all know that toothpaste is an adjunct, meaning that the key part of the oral hygiene regimen is the brushing action together with the flossing, and the use of toothpaste, in general, is not really a necessity; however, it certainly helps. Toothpaste provides a foaming action that facilitates the removal of food debris and plaque due to their soaping ingredients, provide a nice smell and fresh feeling owing to their added tastes and flavors, and some of them have active ingredients that could treat specific problems, such as Fluorides in treatment of sensitivity, and abrasives in treatment of heavy stains as we would encounter with smokers.
A few of these ingredients have raised some red flags in recent years. The manufacturers of toothpaste claim that these ingredients are a necessity when it comes to active cleaning and disinfection of your teeth and mouth, but research has shown otherwise. Some of these ingredients are:
SLS (Sodium Lauryl Sulfate):
SLS is an ingredient added to toothpaste to act as a chelating agent, facilitating the blending of all the ingredients together. It is also a surfactant and enables the toothpaste to stick to the surface of the teeth for longer by lowering the surface tension of the compound. SLS is also effective in counteracting the formation of Sulfur compounds, and so is effective in preventing bad breath. These benefits may seem important, but studies have shown that SLS has quite a few side effects, that could render its risk more than its reward. These side effects include gum irritation, skin irritation, mouth sores, nausea, vomiting and diarrhea, and some studies even tackled the possibility of SLS as a causative agent for mouth cancer.
Triclosan is an antibacterial agent, which you might think is great, but it really isn’t. Triclosan is very effective in killing certain kinds of bacteria, and as we know that the oral environment has more than 500 species of bacteria and other germs living in harmony and canceling each other’s’ effects, so if Triclosan is successful in decreasing the population of certain species, this will cause the other species to grow and thrive, disrupting the oral environment and leading to diseases such as Candida and fungal infections. In addition, animal testing has shown that Triclosan could disrupt the hormonal balance of the body, which could lead to detrimental effects such as weakening the heart muscles and bone deformation.
Fluoride is the main active ingredient in almost every toothpaste in the market. It forms a protective layer on the tooth shielding it from the harmful effects of the bacteria and decreasing the sensitivity of the teeth. But Fluoride is not without harmful effects, particularly for children. Because children tend to swallow the toothpaste – especially if they are unsupervised – the Fluoride is deposited in heavy amounts in the developing teeth, resulting in what is known as Fluorosis, and as we know that could be as simple as white spots on the enamel, or as complicated as chipped and brittle teeth. Ingestion of large volumes of Fluoride also puts the child at risk of Fluoride toxicity, which could be fatal if not treated promptly.
In the age of Google search and the incredible array of knowledge available everywhere, we should expect that most of our patients already know this information, and therefore we as dentists should be the leading authority on prescribing the best toothpaste for each case.
Personally, I like to follow the guidelines of the NHS of the UK. Toothpaste containing 1000 to 1500 PPM Fluoride, free from Triclosan and if possible, SLS free toothpaste is the choice I would make for most adult patients. Children less than 16 years of age would need a lower concentration of Fluoride or risk Fluorosis and patients with high caries index would need more, in addition to other means such as Fluoride varnish or Fluoridated mouth wash.