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  • Spring Hatfield, RDH

Let's Talk Toothpaste

If you are reading this as a professional or as a consumer, chances are you have a preferred toothpaste. Before I go any further let me give full disclosure, I am not affiliated with any toothpaste company or brand in any way, however, if you are a toothpaste company and would like to sponsor some of our study club meetings, hit me up. Sorry, didn’t mean to get off track. Back to toothpaste, there are tons of brands and different types for anything and everything from whitening, cavity control, tartar control, and sensitivity. It is overwhelming as a professional, I can’t imagine how overwhelming it is for a consumer with no knowledge of ingredients. Triclosan, potassium nitrate, baking soda, peroxide, fluoride (stannous, sodium, or sodium monofluorophosphate) or no fluoride (that is a whole other topic in itself). There is so much to dissect and understand. I decided to do a little research on the topic to better understand what the best product is to recommend for my patients, I’d like to share that with you.

First it is important to point out many toothpastes have the same active ingredient; therefore, I won’t be discussing every single brand available, I could write a book if I did that. I’ve chosen to discuss efficacy of certain ingredients in toothpaste. Let’s start with fluoride, there are three main types of fluoride used in toothpaste, stannous, sodium and sodium monofluorophosphate.

Sodium monofluorophosphate is found in Tom’s of Maine and many children’s toothpastes because it is less acutely toxic. Since children often swallow more toothpaste than adults, this seems to contribute to its use in children’s toothpaste. Research has been conducted comparing the efficacy of sodium monofluorophosphate and sodium fluoride which concluded that the anticaries efficacy is “as good” as sodium fluoride.

Sodium fluoride is widely used in toothpaste. It has been proven very effective in reducing caries. Some brands, such as Colgate Total use a combination of sodium fluoride and triclosan. Triclosan is an antibacterial agent, used to reduce gingivitis. Studies have shown that triclosan is effective in reducing gingivitis. The controversy that surrounds triclosan is that some research indicates that it may make bacteria more resistant to antibiotics. In addition, short term animal studies have shown that exposure to high doses of triclosan is associated with a decrease in the levels of some thyroid hormones. I would like to emphasize the part where it says “exposure to high doses” this is not a scare tactic. Toothpaste with sodium fluoride and triclosan has been proven to be highly effective for both caries management and the management of gingivitis. Potassium nitrate is another ingredient added to toothpastes containing sodium fluoride. You will find this as an active ingredient in Sensodyne and other desensitizing toothpastes. Potassium nitrate works by depolarizing nerves which causes them to be less sensitive to stimuli.

Stannous fluoride is anticaries, desensitizing, and has antimicrobial benefits as well. In the past, one of the biggest complaints with stannous fluoride is that it causes staining. Recently a new formula has been created that eliminates this factor. Because stannous fluoride is anticaries, antimicrobial and desensitizing, there is rarely, if ever any other active ingredient in toothpaste that contains stannous fluoride. Stannous fluoride is used in Paradontax, Crest products and most recently in Sensodyne Rapid Relief. In a study conducted in 2007, efficacy of stannous fluoride and sodium fluoride with triclosan toothpastes in reducing periodontitis and root caries was tested. The results state “The products are not statistically significantly different from each other. Both treatments resulted in similar remineralization for root caries lesions at study completion.” Other studies have shown that stannous fluoride is more effective in reducing sensitivity than potassium nitrate. If you have issues with gingivitis, caries and sensitivity, stannous fluoride toothpastes may be a good choice to prevent needing to buy multiple tubes of toothpaste.

Baking soda or sodium bicarbonate is found in Arm & Hammer toothpaste and some others brands as well. Research indicates that baking soda is effective in reducing gingivitis and has been proven to be more effective at plaque removal from hard to reach areas of the dentition, such as inter proximal (between teeth, for non-dental readers) than toothpaste that does not contain baking soda. The primary concern I’ve heard regarding baking soda is the abrasiveness. A study tested the RDA (radioactive or relative dentin abrasivity) of toothpastes that contain baking soda and the range was between 35 and 134, well within the safety limit of 250. You can read more on this study here.

Most toothpastes that have peroxide also have baking soda. Peroxide/baking soda toothpastes have been shown to reduce gingival bleeding, since the ingredients are combined there is no way to know if the peroxide enhances the reduction in bleeding or if it is strictly the action of the baking soda. Peroxide is also an effective whitening agent.

I hope this makes it easier to understand the active ingredients in toothpastes. I would love to hear your thoughts. What toothpaste do you prefer? Dental professionals to you have a favorite “go-to” toothpaste or do you recommend different toothpastes based on your patients needs? Leave me a comment. In the meantime, love, peace, and flossed teeth.