The purpose of this article is informational only and should not be taken as personalized medical advice. The information provided here is based on research as well as my personal experiences as a dentist and mother.
“What toothpaste should I buy?”
“Flouride or no fluoride?”
“What toothpastes do I pick for my kids?”
“How effective is whitening toothpaste?”
“Of course, I should pick a brand that has the ADA seal, right?”
“What do I use if I have sensitive teeth?”
As a dentist that’s also a parent, I get these questions quite a bit. My standard answer right out of dental school used to be, “Any brand you can find at the big box stores is fine–and preferably, you should pick one that has the seal of the American Dental Association.” Thankfully, I’ve grown a lot in the 10+ years I’ve been a doctor, and my answers to these questions have changed. A LOT.
Here’s the thing with toothpastes: as with many household items, you have to see what’s IN the toothpaste that’s going to make the difference. The answers may surprise you. I know they surprised me.
Why do toothpaste ingredients matter, if you’re just spitting it out? In short, the tissue in your mouth is the most absorptive of all tissue types, so even if it’s just for a few minutes, you’re absorbing varying amounts of chemicals every day, which can have a pretty big cumulative impact. Here’s a few of the ingredients to avoid when choosing a toothpaste:
SLS/SLES: a detergent used to give toothpaste it’s foamy quality. Contrary to popular belief, your toothpaste doesn’t actually need to foam to do an adequate job. Many products are tested on animals to determine what level of this chemical can be added before dermatitis develops. It can also cause ulcers.
Artificial dyes: used to make the toothpaste appear visually appealing and are known carcinogens (cancer-causing chemicals)
Parabens: preservative used in many cosmetic products as well as toothpastes. Cannot be metabolized by the body, but can build up in our tissues over time and predispose one to cancer.
Carrageenan: a thickener to give toothpaste it’s “gel” like quality. Used for visual appeal; does not increase efficacy of the product. Inflammatory to skin, joints and gut and also carcinogenic
Propylene Glycol: a water-soluble compound in the alcohol family, commonly found in antifreeze. The jury is out on just how harmful this product actually is, but one thing is for sure. It’s not natural, meaning your body won’t actually know what to do with it if absorbed. So, it’s best to avoid it if we don’t know it’s safe.
As crazy as it sounds, there was no class on toothpaste during dental school. There were, however, many sponsored lunch and learns by well-known toothpaste brands. It’s no wonder a lot of dental professionals don’t give toothpaste a second thought. We’re creatures of comfort and habit. We buy what we know, and many of us recommend big name brands without giving it a second thought.
If your toothpaste has any of the above ingredients, which many brands do (even the ones that say they’re natural), I encourage you to switch when it’s time to buy more toothpaste. Brands I suggest are Bite (the berry flavor, and only for kids who are age 5 and up), Hello, RiseWell or Babyganics (for kids/family) and specifically for adults, Bite (the charcoal and mint ones are pretty strong tasting), Coral, TheraBreath, Young Living, and Twice are good.
So, what do I use for MY family? Bite toothpaste and RiseWell. Because I already use Young Living essential oils, theirs was the brand of toothpaste I tried first when I decided to “ditch and switch”. My kids liked the Young Living kids’ toothpaste, and my husband and I used their Thieves line. Many products claim to have essential oils in them, but with YL, I know that the essential oils that are used are 100% pure, therapeutic-grade, and of the highest quality. As for RiseWell, what sets them apart is that they have hydroxyapatite (nHA) in their products (I’ll explain what that is shortly.), and they put all their research out for their consumers to see for themselves. My kids love the taste of the kids’ toothpaste, and their floss has nHA woven right into it., along with xylitol, which is a great way to also kill bacteria. Their mouthwash is wonderful, too, but it’s a bit strong, so I’d recommend diluting it first. Use code DESAI10 to get a discount on your RiseWell products here! Bite is one that we really love, for more than the non-toxicity and great taste. Like RiseWell, it also has nHA. However, Bite is also focused on caring for our environment. All of their operations are carried out in zero carbon emissions manner, and the packaging is compostable/recyclable. Since Bite is made into tablets and not paste, there are no plastic tubes to throw away, and eliminates the need for using stabilizers for water in their formulations. You can check out this amazing, socially-conscious company here.
A few things I’ve noted since switching toothpastes: My teeth are noticeably whiter, thanks to the citrus oils (in the Young Living line) and the nHA in Bite and Risewell. Also, my son used to get terrible aphthous ulcers (sores in his mouth) when he would get the slightest amount of sleep disruption–almost every 6-8 weeks. Since switching, he has gotten significantly less, and he’s had plenty of nights where his schedule has gotten thrown off and consequently has gotten less sleep. The only thing that is different is the switch in toothpaste. I can only presume that because his new toothpaste lacks SLS, his oral tissues aren’t as irritated. My observations are anecdotal, but I’m glad that I’ve been able to see a difference for my family, even if it is subjective. And after all, the reasons we switched were based off of research articles that are scientific.
LET’S TALK ABOUT FLOURIDE
Flouride is included in a lot of toothpastes for two big reasons: the anti-cavity effect and the anti-sensitivity effect.
Though fluoride was touted as a major public health win in the 20th century because of it’s anti-cavity effect, it isn’t the magic fix that it’s made out to be. Most people don’t brush as well as they should or floss as often as they should–either because no one has taken the time to show them how, they don’t have access to quality dental care, or they just don’t care enough to learn how. But even if you were the best brusher in the world, what you eat and when you eat can still leave you with a mouth FULL of cavities. Flouride is a topic that could be a whole other blog post, but in an attempt to keep things clear, informative and still somewhat brief, suffice it to say that it’s important to avoid avoid fast food/processed food as much as possible; you can’t go wrong if your diet is full of whole, plant-sourced food. This isn’t to say you should never eat meat or dairy (again, a topic for another day) or enjoy a slice of cake once in a while. I’m just saying that sticking to an all or mostly whole food, plant-based diet will cut out nasty chemicals and hidden sugars, dyes and other chemicals, the most important one for caries (the fancy word for tooth decay) prevention being refined sugars. As for drinks, the same goes for them. In the US and globally, lots of people sip on sodas, energy drinks, sweet teas, coffee, or a combination all day long. That constant exposure of sugar to your teeth takes away any fighting chance your saliva has to buffer the acidic environment caused by these sugary drinks, leading to cavities, along with other systemic diseases such as diabetes, which leads to increased risk of developing cardiac disease, neuropathy, retinopathy, and so on. In short, your diet matters way more than we as healthcare providers (and consequently, society) originally gave it credit for, and can easily override the therapeutic effects of fluoride, be it from toothpaste, water, or fluoride varnishes administered by your dental professional.
Here’s the thing with these toothpastes that don’t have those nasty chemicals: many of them lack fluoride, as many consider it toxic, or debatably so at least. Flouride is a surprisingly polarizing topic, especially if it’s questioned with dental professionals. Most of us have been trained with the believe fluoride is the end all, be all. It’s good for cavity prevention, and shouldn’t be questioned. But in all the research I’ve done, here’s what I found: your body doesn’t actually NEED fluoride like it does potassium, sodium, or calcium. There is no deficiency syndrome associated with lack of fluoride. There are, however, problems that can arise both orally and systemically if you get too much fluoride–ranging anywhere from dental fluorosis to brittle bones (The fluoride ion can inhibit calcium ions from being properly absorbed into your bones, and too much of it can actually change the structure of your bones on a microscopic level.) Does fluoride help fight tooth decay? Absolutely. It has a highly therapeutic effect, but because of it’s potentially negative systemic side effects, fluoride is best used locally and topically only, and avoided in water and diet if possible.
So, with regard to fluoride in toothpaste, it is certainly not an ingredient that is necessary, especially if the toothpaste you are using has xylitol (a sugar that actually kills cavity-causing bacteria), if you are brushing twice daily (2 minutes, twice a day upon waking and before bed), and have a diet low in processed and refined sugars. Drinking plain water throughout the day also helps signifiantly, as it will neutralize acid bursts and help hydrate your body well enough to produce adequate amounts of acid-buffering saliva.
THE SAFER ALTERNATIVE TO FLOURIDE
Every heard of nano-hydroxyapatite? It’s a crystalline structure that makes up the majority of your enamel, dentin, and bones. When placed in the oral cavity, it can fight against cavities similar to the way flouride does–by remineralizing soft spots in the enamel. The reason it’s safer is that it’s completely bioavailable and has NO systemic side effects like the ones associated with fluoride–so even if your kids (or you) accidentally swallow it, it’s not a problem. HA has been the gold-standard in Japan for years, and is finally making it’s way Stateside. Similar to fluoride, nHA is wonderful for both its anti cavity and anti sensitivity benefits.
WHITENING TOOTHPASTES
I always use caution with big brand toothpastes that claim whitening benefits. Many of them are extremely abrasive, stripping away the top layer of stained enamel on teeth, until over time, the protective enamel layer has thinned, leading to sensitivity along with the teeth appearing yellow because the underlying dentin is showing through. Additionally, many toothpastes that claim whitening is because they have plastic microbeads in them. You may be spitting out most of your toothpaste, but everyone swallows a tiny amount–and if you’re using a toothpaste with microbeads of plastic, you’re swallowing that, too. And just imagine what harm the plastic is doing to the wildlife when it goes down your drain and out to main water sources.
Like with anything else, the key is prevention. If you’re eating a diet that’s free of additives and processed chemicals, your teeth won’t be predisposed to discoloration. Avoiding heavy consumption of tea, coffee, and other beverages like them will prevent stains, too. So will not smoking. If you’re really set on whitening, you may consider oil pulling (known also to prevent gum disease and bad breath), citrus essential oils (beware–only therapeutic grade, pure ones from companies like Young Living), or seek the advice of your dentist. Here’s more on ways to naturally whiten your teeth that talks about oil pulling, just for good measure.
THE ADA SEAL
The widely-recognized American Dental Association seal of acceptance is something many look for–including dental professionals. However, the brands of toothpaste my family uses, along with many or all of the ones I’ve listed above–are sans seal. Is that a cause for concern? In short, no, and here’s why. (This is something that really is difficult to explain in words, let alone be brief with. However, here’s my attempt.)
The ADA began certifying products in an effort to help consumers and dental professionals alike make sound choices, and know which products are actually going to do what they say. However, consider this: there are some toothpastes that carry the ADA Seal that are fluoridated, and some that are not. Secondly, the ADA continues to award their seal to brands that have the above-listed ingredients in them–the same ingredients that other companies are avoiding in an effort to bring cleaner and safer products to the market. In parallel, there are cereals that you can get at any grocery store nationwide that carry the seal of the American Heart Association for the product’s ability to lower cholesterol, yet that same product is riddled with glycopvhosphates (a known carcinogen) as listed on the ingredients label on the back of the box. Another thought: the EU has banned over 1300 chemicals, and by contrast the FDA has banned a grand total of 8. Long story short–don’t place so much weight on whether or not a product has a seal. Read the labels. Do your research, and make informed choices of your own.
SENSITIVE TEETH
Many of you have reached out and asked what I recommend for sensitive teeth, and specifically, if I recommend a certain mainstream name brand of toothpaste for it. Here are my thoughts:
CHECK THE INGREDIENTS. If your sensitivity toothpaste has any of the above listed “no-no” ingredients in it, you may consider switching to one of the cleaner alternatives listed above.
The other things to consider when talking about dental sensitivity are diet, how and when you’re brushing, and any underlying undetected dental or medical issues.
Diet: A highly acidic diet can cause softening of the protective enamel layer. Over time this layer can wear away, exposing underlying dentin, which is can cause sensitivity. It’s important to abstain from sipping on sugary or acidic drinks and snacking all day, as this can be a major contributory factor to enamel erosion.
Oral Hygiene: It’s not just how often you brush, but how hard you brush and when you brush that matter, too. Remember, when brushing, your teeth and gums are strong, but delicate as well. Use gentle, circular motions while brushing. I always say to remember that we are brushing our teeth, not scrubbing the toilet. Additionally, WHEN you brush can effect your enamel. If you’re brushing immediately after a meal or throwing up, what’s happening is the acid caused by the bacteria in your mouth metabolizing the sugar in the food softens the enamel, making it very easy to literally brush away. The same goes for after you vomit. My suggestion is to rinse with water after eating or throwing up, and wait at least 20 minutes after eating or vomiting before brushing. This means that you may need to reconsider your morning routine. In this modern day and age, not many people have the time to wait 20-30 minutes after eating breakfast before heading off to work or school. I encourage all my patients and family to brush BEFORE breakfast and rinse with water after eating to avoid toothbrush abrasion (brushing away our protective enamel).
Other factors: Potential medical issues including but not limited to enamel erosion (and therefore dental sensitivity) are bulimia and GERD (heartburn). When the acid from your stomach comes up and into your mouth, it can soften the enamel of your teeth and cause it to dissolve away, leaving exposed dentin and cause sensitivity. Other reasons for dental sensitivity could be a fractured tooth, a cavity, or other reasons. Your dentist can diagnose if your symptoms are sensitivity due to toothbrush abraison or if there are other issues at hand, even medical issues like GERD. Of course, I encourage you to be honest and forthcoming about any and all symptoms you may have with your general dentist and physician and visit them regularly for well-checks.
Ok, so back to toothpaste recommendations for sensitivity. TheraBreath and Twice brands are two that do have flouride without any of the nasty ingredients in mainstream toothpaste. Fluoride is something that is helpful in lessening sensitivity, so maybe those two brands may be helpful. Though I can’t say this based on research or personal experience, I have had people tell me that they have felt relief from sensitivity with YL’s Thieves toothpaste as well, even though there is no fluoride in it. But, your safest bed is to go with a brand like Bite or RiseWell, because the nHA is effective and safe, as the nHA is 100% bioavailable. The key to remember with dental sensitivity is this–it is a symptom, not a diagnosis. Be sure and examine your lifestyle habits and see your dental and medical PCPs regularly of if you have specific concerns.
A FEW DETAILS TO TIE THINGS TOGETHER WITH REGARD TO OPTIMAL ORAL HEALTH
I know I presented a LOT of info here. Just a few more things:
How much toothpaste should you use? Contrary to popular marketing ads, you don’t need an entire toothbrush head full of paste. A pea-sized amount, even for adults, is fine. For a child that cannot spit, do NOT use a toothpaste with flouride in it, and use a half-pea sized amount. For a child less than three years of age, a rice-sized amount of toothpaste (again, NO flouride) is the choice to make.
Tongue scraping is something I highly recommend to help with bad breath. You can get plastic tongue scrapers, but the more environmentally friendly ones are like these are made of copper, known for it’s germ-fighting properties. Even kids can use tongue scrapers. Mine started using them under close supervision at age 4.
For more details on the information presented above, you can watch Episodes 1 and 2 of Tooth Talks, a show I co-host on Instagram Live with Dr. Deep Shah (@thesuperherodentist), attending faculty at University of Pensylvania School of Dental Medicine and Diplomate of the American Board of Pediatric Dentistry.