Toothpaste: Why So Many? How to Choose? A dentist cracks the toothpaste code for you
Here is a video about why cereal (so many options!?) is bad for your teeth. That’s even more important to understand than what I’m about to tell you about toothpaste.
Disclaimer: The information presented in this article is for educational purposes only and is NOT intended or implied as a substitute for professional medical advice, diagnosis, or treatment from your dentist, physician, or any other healthcare professional. You should NOT use the information presented here for diagnosing or treating any health problem or disease. Never disregard advice from your personal medical care provider(s) or delay contacting your dentist/other healthcare providers because of anything you read or heard here. Reading this article and/or utilizing any of the information presented in any way does NOT create a doctor-patient relationship between you and the article creator or with any of the healthcare professionals in any way affiliated with this article. You use this information at your own risk. You should contact your dentist/healthcare professionals before beginning any new treatment or practice to address a health problem or improve your health. The author is not responsible for information on external websites linked to from this article or for the information on external websites that link to this article.
Humans have been scrubbing their teeth with stuff since at least 5000 BC. That’s like, *counting on fingers and toes silently to myself* …over 7000 years ago? 2+5, that’s 7? I sure hope that’s right. Otherwise, I’m gonna lose a lotta credibility up top here. Burnt eggshells. Burnt bread. Ground-up bricks. Charcoal. Crushed bones and shells. Cocaine in the ’80s.¹ We’ve been scrubbing our teeth with all sorts of stuff for a long time.
Somehow, after all that scrubbing, we’ve still never really been able to make up our minds as a society about what exactly we should scrub our teeth with. And as is the case with everything else in a free market capitalist society such as America the beautiful, this confusion leads to an explosion of different products, all claiming to be the exact miracle cure you need to properly shoeshine your pearly whites.
I realize you may not be aware of the bitter toothpaste wars occurring on dental social media sites worldwide, and for good reason. Why would you give a hoot about dentists duking it out over flavoring agents and measures of abrasiveness? Still, I personally fear for the day when toothpaste tensions snap, creating an irreparable schism in the dental community. Politics is getting more and more polarized these days. Perhaps it is only a matter of time before mint and cinnamon are at each other’s throats in a bitter² fight to the death?
Toothpaste skepticism and cynicism aside, there are some legitimate variations from one miracle paste to the next. I’ll try to break it down for you so you can make the right decision for your particular mouth specifications.
Think about how small a grain of rice is. Think about how small a pea is. Those giant globs of toothpaste you see covering brushes in pictures on toothpaste boxes and on commercials? That’s all nonsense. Unnecessary. Save your toothpaste. Save your money. Save your teeth.
What the heck is in toothpaste anyway/why the heck do we use it?
Fluoride — This is in toothpaste to help prevent cavities. Fluoride gets absorbed by your teeth, and it makes them stronger so that it takes more/a stronger acid to break the tooth down. Acid is what causes cavities. Acid can come from the foods and drinks you have. Acid can come up from your stomach if you have gastric reflux. Bacteria in your mouth can turn the food you eat into acid.
You want to have sodium fluoride as an active ingredient in any toothpaste you use. There are “natural” toothpastes that don’t have fluoride. If you use those, you are making yourself more vulnerable to acid. You can still avoid cavities entirely by having an excellent tooth-healthy diet, but you’re making it harder on yourself.
Ingredients that Fight Sensitivity — Some people struggle with teeth that are cold sensitive. If that’s you, look for potassium nitrate or stannous fluoride as active ingredients on your toothpaste. You will need to consistently use these products for a few weeks before you see any noticeable change in cold sensitivity. If you stop using them, the sensitivity will often return. If you don’t want to use these types of toothpaste for whatever reason, you could talk with your dentist about having some white filling material placed to cover sensitive areas. Sometimes you need a gum tissue graft procedure to cover an exposed tooth root surface.
Anti-bacterial Ingredients — You can’t remove all the bacteria from your mouth that cause cavities, but there is some evidence that these additives can reduce the bacteria that cause gum disease. Triclosan used to be an additive in some toothpaste for this purpose but has since been removed. The stannous fluoride mentioned above to help with sensitivity is also marketed as helping fight bacteria that cause gingivitis (mild gum disease).
Anti-tartar Ingredients — You’ve heard of steak tartare (that one is a slow build, but it gets quite fun at the end). This is not that. Nope, it’s not tartar sauce either. Also, not an ethnic group in the Ukraine. These ingredients are not anti-any ethnic group. They are equally dedicated to the prevention of tartar on teeth. If you tend to build up gritty, chunky tartar on your teeth, you can get an anti-tartar toothpaste. Tartar/calculus is what happens when the bacterial plaque on your teeth absorbs minerals like calcium from your saliva and hardens. Once plaque turns into tartar, it’s harder for you to remove. Another reason why it’s important to brush and floss your teeth properly each day so that plaque doesn’t have a chance to accumulate and make the tartar transition. Flossing is actually the best anti-tartar toothpaste ingredient there is. Too bad flossing doesn’t come in toothpaste form. Look for “pyrophosphates” (Does that mean they like, set off fireworks and burn stuff? Rad.) and zinc citrate as ingredients.
Also, if you build up lots of tartar on your teeth, that actually could mean you’re a little less prone to cavities. Why? Tartar is plaque that has calcium built into it. Acid from plaque breaking down sugar breaks down teeth. Teeth repair themselves from this breakdown by absorbing calcium. So if you have lots of tartar, that probably means you have a high concentration of calcium in your saliva, which means your teeth will repair acid damage a little better. So, tartar may have a silver lining. Still, it’s best not to tempt fate by ignoring tooth-healthy eating habits.
Abrasives — Every toothpaste will have some kind of abrasive in it. That’s for helping you “scratch” the plaque off your teeth. My advice to you is to use a low abrasive toothpaste. According to the American Dental Association, all toothpastes with a relative dentin (that’s the yellow layer of tooth underneath the white enamel) abrasiveness (RDA) of 250 or less are considered safe. Brush gently with a low abrasive toothpaste, or you can cause more damage over time.
Detergents — These help cause the toothpaste to foam and get all sudsy. People like suds I guess. Some people will have sensitivity allergic-type reactions to the sodium lauryl sulfate ingredient in toothpastes that have it. If this is a problem for you, you’ll notice “sloughing” of your gum/cheek tissue where it peels off in a whitish film. Just find a different toothpaste with fewer additives/ingredients.
Flavors — Some people will also have an adverse reaction to cinnamon-flavored toothpastes. Basically, if you have an adverse reaction to a toothpaste, switch to a different one with fewer ingredients listed. Otherwise, flavor doesn’t have any effect on your health.
Be Gorgeous! Be You!
“Whitening” Agents — Some toothpastes will boast that they contain peroxide that can help whiten your teeth. Unless you want to walk around brushing your teeth for at least 30 minutes to an hour at a time, I don’t think you’re going to see great results this way. “Whitening” toothpastes also tend to be more abrasive to your teeth. As I said above, that’s not good. You’ll wear and abrade your teeth over time, and they can become sensitive and look worse. Charcoal toothpaste will NOT whiten your teeth. Charcoal toothpaste is a marketing gimmick. I don’t understand why people get so excited about rubbing their teeth with charcoal. Maybe they’re lacing the stuff with cocaine? I don’t know. I don’t care. If you want to scrub your teeth with charcoal cocaine, whatever. It’s your body. It’s your temple. You worship it however you want to, friend. If you care about my opinion, I explain the best ways to whiten your teeth safely and effectively here. It’s pretty easy and inexpensive if you just follow the rules.
“Calcium Containing” Toothpastes — You may see more expensive toothpastes marketed as having extra calcium. This 2019 study in the Journal of the American Dental Association reported that these more expensive toothpastes are not any better at repairing and protecting your teeth than regular over-the-counter fluoride toothpaste. You may see ingredients like beta-tricalcium phosphate, casein phosphopeptide, or amorphous calcium phosphate, or nano-hydroxyapatite. That all sounds very fancy and special, but it won’t repair or protect your teeth any better than fluoride. Worse, actually, if it doesn’t have fluoride in it.
There are prescription-strength fluoride toothpastes available from dentists. Why do you need a prescription for this extra strong fluoride toothpaste? Because not everyone needs an extra-strong toothpaste. If you have gum recession, tooth abrasion, dry mouth, or a history of lots of cavities, then a higher concentration fluoride toothpaste could make sense for you.
Whatever toothpaste you decide to use, you should only use a tiny amount of it at a time. Children under 2 years of age don’t need any toothpaste. Lightly clean their teeth with a soft bristle brush. A rice-sized smear of toothpaste can be used for kids from age 2 to age 3. Tell them to spit. Make sure they understand to spit it out. A pea-sized dot from there on out, including as an adult. Think about how small a grain of rice is. Think about how small a pea is. Those giant globs of toothpaste you see covering brushes in pictures on toothpaste boxes and on commercials? That’s all nonsense. Unnecessary. Save your toothpaste. Save your money. Save your teeth.
I feel like this goes without saying, but whatever the ingredients involved: Don’t swallow your toothpaste. That is very bad for you. Ingesting trace amounts, not a big deal, but you need to spit out the majority of it. Be thorough in doing that.
Ok, that’s way more than you wanted to know about toothpaste. There is so much effort being put into toothpaste in our world. Ready to read something wild?
Here is a 2016 systemic review (that means a bunch of science folk looked at lots of studies for evidence of something) that explains that toothpaste does not enhance plaque removal.
“Say WHAT? You just told me a bajillion things about toothpaste, and that -ish doesn’t even enhance plaque removal? I’m still not 100% sure what plaque removal is, but I’m outraged! Can we complain to someone on Twitter about this? Is this Elon Musk’s fault? Can we fire Steve Jobs? You say he’s dead already? Well, fiddle farts…Can we…can we fire, like, some random person who works at a Jiffy Lube or something? I’m distraught, and I need an outlet right now. Let’s just find some dude that works at a Jiffy Lube in Florida or Oregon and get him fired. That sounds like fun. #toothpastevengence. Help me get it trending everyone! #toothpastevengence.”⁴
Let me try to make sense of this for you. To prevent cavities, you need to get plaque off your teeth. Plaque is a clump of bacteria working together to wreck your teeth (at least when you feed them “enriched” flour and sugar). Brushing and flossing, even without toothpaste, can effectively remove plaque when you do both of those things the right way. I’m going to explain ideal brushing below. Here is a video on ideal flossing.
If brushing and flossing are so awesome, why even bother buying toothpaste? Fluoride. Brushing and flossing are the most important things. However, you won’t get the added kick of sweet, satisfying toothy protectiony goodness from fluoride being absorbed by your teeth without using a fluoride toothpaste. Especially if you have worn enamel or gum recession, you’re going to want that extra fluoride to protect against further erosion and cavities.
Here is a systemic review demonstrating that fluoride toothpastes reduce cavities. Another one. If you still hate fluoride and, by extension, me, you’re welcome to consider my more nuanced take on the subject here.
Ready for your bonus round?
“Boy howdy, am I ever!!!”
Wow. Gotta say, I love the enthusiasm. Never lose that. You’re a breath of fresh air—a shining light in an otherwise bleak, depressing universe.
Bonus Round: How to Brush Your Teeth
Now that you know everything there is to know about toothpaste, what about those goofy gizmos you use to apply the paste to your teefers?
If you want to earn your scouts merit badge for toothbrushing, do the following:
Use a SOFT bristle toothbrush. Not medium bristle. Not hard bristle. You want something that will be gentle on your gums, or you will get damaged and unsightly recession of the gum tissue. Too much of a good thing is bad, and that goes for toothbrushing too.
Do NOT push hard when you brush. Again, GENTLE is the name of the game. You want to gently sweep up from the gums on the bottom teeth, down from the gums on the top teeth. You can angle the brush at about 45 degrees down toward the gums and lightly sweep so that some of the bristles clean the edges of the gum tissue. You should not be putting much of any pressure on the teeth when you brush.
If you want to be a grandmaster champion, brush your teeth twice a day for two minutes at a time. At a MINIMUM, you NEED to brush your teeth before you go to sleep at night. You want to get all the bacterial plaque and food debris off your teeth before you doze off. No falling asleep on the couch with a mouth full of cheese puffs and soda pop. I forbid it! Lots of people tend to breathe through their mouth at night, and this dries it out. We lose all the natural protective benefits of saliva at this time. Protect your teeth when they are at their most vulnerable by brushing before you go to bed.
You can be equally successful in removing bacterial plaque from teeth with a manual toothbrush and an electric/automatic toothbrush. It’s mostly a matter of personal preference which one you choose to use. The nice thing about an automatic brush is that you don’t have to worry about pushing too hard and beating up your gums. You just let the brush rest against the teeth and slowly move it around all the surfaces. Brushing for dummies. Very color by number. Very easy. I’ll be honest: I’m a dummy. I use an electric brush. Ain’t nothin’ wrong with that. Patients with braces may find a spin brush easier to use. Other patients who aren’t as coordinated or who have weakness/manual dexterity issues may find an electric toothbrush more effective for them.
Don’t share a toothbrush with anyone.³ You’re swapping mouth bacteria for no reason. People can carry different bacteria in their mouths, and some bacteria are more likely to contribute to causing cavities and gum disease than others. If you’re going to risk taking on extra bacteria in your life, you may as well at least get a smooch out of the deal.
It’s best to let your toothbrush dry out in open air in an upright position after use to limit the growth of bacteria. You may have heard that fecal (poopy poo) bacteria from flushing can get on your toothbrush when it’s out in the open. Might I suggest putting the toilet seat down before you flush? If you are a true blue germaphobe (Trust me, I relate to you. Not condescending here.), you can also periodically soak your toothbrush in some antibacterial mouthwash (I would suggest using an alcohol-based one for this purpose, even if you use an alcohol-free mouthwash to clean out your actual mouth) or hydrogen peroxide. Let’s be honest, though: there are other activities you engage in which may be increasing your risk of contact with fecal bacteria. “What? Huh? What do you mean? Me? Mwah?” Yea, ok. Sure. Whatever.
Treat yourself to a new toothbrush every 3–4 months. When the bristles start to discolor, get frayed, or lose their original upright position, it’s time to get a fresh brush.
Charcoal toothpaste is a marketing gimmick. I don’t understand why people get so excited about rubbing their teeth with charcoal. Maybe they’re lacing the stuff with cocaine? I don’t know. I don’t care. If you want to scrub your teeth with charcoal cocaine, whatever. It’s your body. It’s your temple. You worship it however you want to, friend. If you care about my opinion, I explain the best ways to whiten your teeth safely and effectively here. It’s pretty easy and inexpensive if you just follow the rules.
Summary
What toothpaste can do:
Deliver fluoride to your teeth, which protects you from cavities.
Help with cold sensitivity for some patients.
Reduce funky chunky tartar build-up on your chomp chomps.
Improve the experience of brushing your teeth by adding a pleasant flavor or a pleasing tactile sensation/sudsing action that is preferable to brushing with plain water.
What toothpaste can’t do:
It CANNOT whiten your teeth very well. Here is a better way to whiten your teeth.
Harm toothpaste can cause:
If you scrub too hard with the wrong kind, it can wear down your teeth.
You may have an adverse sensitivity reaction to some toothpastes. If it irritates your tongue, gums, or cheek tissues, you should switch to a different product.
If you got tired of reading and scrolled all the way to the end of the article, I made this video just for you. It gives you all the same info, but it’s me talking into a camera instead of bleeding words out of my soul onto a page for you. Do you prefer a goofy man talking into a camera? Then this video is for you.
Hope this was helpful.
Thanks for reading.
P.S. — You may have noticed a photo of a bunch of cereal boxes to open this article. I couldn’t find one of an aisle full of toothpaste. Oh well, it gives me an opportunity to make you aware that cereal can be really bad for your teeth. Watch this video.
It’s sorta like a school of rainbow trout swimming upstream to the spawning grounds, no? Maybe they’ll give birth to an electric toothbrush. So many colors.
Footnotes:
¹ Ok, technically, this involves the gums as opposed to the teeth, and it wasn’t something that only happened in the ’80s. So sue me. The whole point was just to get you to read this footnote, and I succeeded in doing that. Now I feel pretty good about myself. Thank you.
I’ve never done cocaine. Not judging if you have. I have cocaine friends. I have cocaine extended family. It’s all love. Still, I would never do cocaine. I’m confident I couldn’t handle it. How do I know?
I have a messed-up esophagus. Before I got diagnosed with messed up esophagus-ness, it made me pass out because of how intense the pain got this one time, at band camp. Ok, it wasn’t at band camp. It was in the basement of a dental fraternity house while I was cutting plastic teeth with a drill. Anyway, I passed out. My heart rate was down in the ’20s, which isn’t exactly stellar. I mean, if I was training for the Tour de France, that might be impressive, but my bike at the time was one I had from when I was like 10 years old. It made it easier to get to and from class. Not exactly a Tour-worthy vehicle.
They ran a test at the hospital where they tilt you up on a table so that your body is upright but angled forward at maybe 30 degrees or so. If any hospital folk are reading this, you can help me out in the comments. Then they start giving you little doses of epinephrine to see how fast you pass out. I passed out really fast. I’ve never had a panic attack, but if I hadn’t passed out, I’m confident things might have gone in that direction. Luckily, my body wimped out on me real quick, and the rest of the hospital was spared me wandering the halls in confusion with my naked bum hanging out the back of a hospital gown, breathily asking everyone how I could get outta there.
As I see it, if I can’t handle a little epinephrine on a table jumping up my heart rate a tad while I’m surrounded by medical professionals, I don’t think I’m hardcore enough to do cocaine with you at a party. Sorry. I’m just not cocaine compatible.
² If you mixed mint and cinnamon together, that would probably come out weird, right? I don’t know if it would be bitter exactly. I don’t think it’s likely to be any good though. You don’t see mint and cinnamon mixed typically. Seems like there would be a reason for that.
³ My instinct is that no one actually does this, but then I remember all the weird stuff I’ve seen in this world, and I figure I would be remiss if I didn’t at least issue the warning. In case you’re wondering, you should also avoid sticking forks in electrical sockets. Ditto for trying to pet large bears in the wild. Or at a zoo. Don’t try to pet large bears. Don’t try to smooch large bears. Leave large bears alone. Now, small bears? We can talk about small bears. Not saying you can be reckless with small bears, but there is a little wiggle room there. Especially if you’re dealing with a panda or a koala. But don’t let any of that small bear confidence leak over into your attitude toward large bears. Continue to treat large bears with the respect they deserve, or you will very likely meet an untimely end. No one in this world will be surprised by your exit either. “Oh, he tried to pet a large bear? Makes sense. Wasn’t he the feller who used to share his toothbrush with his life partners? Yea, seems like the type who would go do a fool thing like petting a large bear. Real shocker there. Real mystery surprise. Not!”
⁴ If #toothpastevengence ever actually trends on Twitter, I’ll be a delighted man. You can find my absurd Twittering butt here. Be warned though: I’m very weird, and I don’t take the platform seriously at all 99% of the time. As you can tell, I’m more of a Medium fella. I maintain seriousness here almost 50% of the time, and I’m very proud of that level of concentration and restraint on my part.