A topic of discussion that often comes up when someone finds out that I’m a Dental Hygienist is whether fluoridated toothpaste is necessary for them or their child. Before I became a Mother I really didn’t think twice about the ingredients in toothpaste. I took what I learned in dental hygiene school to be the way things were and how I should practice, after all that’s what was in the texts books. In fact, I think I would have raised a LOT of eyebrows had I come into a Dental Practice advocating that I wasn’t going to promote or use fluoride products. With that said, I have worked in both traditional practice as well as a holistic dental practice where fluoride was not used, so I have certainly seen both sides of it. I set out to practice Dental Hygiene armed with the knowledge I gained from school and recommended what I new to be of great benefit to my patients.
Once I became a Mom the way I viewed products that we used on a “day to day” basis changed. Given that my Son was so sensitive and had eczema I meticulously read every label before purchasing any product and even still after receiving it, I would test it out before diving right into it. I never would have thought life would be this way, that one day I would have to consider what ingredients are being put into the products I was purchasing and using for my family.
The use of Fluoride is somewhat of a hot topic. Locally it has been up for debate numerous times due to its use in our water system and its potential effect on our long term and overall health. Which poses the question, should we be using it daily in our toothpaste? Do we need fluoride to achieve optimal oral health?
I want to briefly discuss plaque formation for you to draw an accurate assessment of oral health. Plaque sticks tenaciously to teeth, some of the bacteria in plaque are fermenters, which means if given the chance they will begin to demineralize the enamel on your teeth, resulting in cavities. Disruption of this cycle is one of the biggest things you can do to achieve and maintain healthy teeth. The physical act of brushing your teeth provides most of the disruption of plaque that has formed along with daily flossing to eliminate leftover food particles in between your teeth. Brushing alone with plain water would disrupt plaque formation as well; toothpaste provides therapeutic qualities and abrasives to aid in reducing plaque and preventing cavities.
Generally speaking, regular toothpaste has two key ingredients, fluoride and a mild abrasive, which are bound together with thickeners, sweeteners, stabilizers and flavours. The abrasives in a particular toothpaste can vary – such as calcium carbonate and hydrated silica – however, they fulfill the same purpose, to polish your teeth and dislodge particles of food caught between them. Ever wonder why your teeth feel different after having them polished at the dental office? The abrasive that is used in the polishing paste is what gives you a slightly different feel then what you would expect from brushing at home.
Rather than highlighting particular brands, I want you to be armed with information that you can take with you to the store. If I focused on a couple brands, availability varies and you’ll end up discouraged faced with a million brands (well maybe not a million), but you get the picture – there is a LOT out there. In any event you can check the label and decide what ingredients are going to work best for you and your family, based on your current oral health needs.
Now here’s what to actually look for – the nitty gritty (no pun intended) 😉 on the ingredients in both fluoridated and non-fluoridated toothpaste. Use this as a guide to translate the ingredients you read on the label into what purpose it serves and decide if its right for you.
Here are the commonly found ingredients:
- Abrasives might be called calcium carbonate, calcium hydrogen phosphate, sodium bicarbonate, dicalcium phosphate dehydrate, silica or hydrated silica, hydrated aluminium oxides and sodium chloride. The abrasive added helps to disrupt plaque formation. Abrasives were originally very rough and included things such as crushed egg shells (which some people still use today), or crushed oyster shells, we are talking Roman Times here. Today the abrasives we use are much gentler and safer, preventing scratching or significant damage to your enamel.
- Detergents are said to help loosen plaque deposits from the tooth surface during brushing. They are the ingredient behind the foaming action you get while brushing. Commonly used detergents include sodium lauryl sulphate and sodium lauryl sarcosinate, which have been linking to skin irritation including canker sores. Others include cocamidopropyl betaine, lauryl polyglucose, poloxamer 407 and lauryl glucoside.
- Humectants add moisture to toothpaste and prevent it from hardening when it’s exposed to air. Common humectants that are added include sorbitol, polyethylene glycols, PEG 12 and glycerol.
- Preservatives most often added to help prevent the growth of microorganisms in toothpaste. Common preservatives include sodium benzoate or hydroxyl-benzoates, methyl paraben, and ethyl paraben. These can sometimes be targeted to help prevent gingivitis.
- Binders help to create the texture and thickness of toothpaste. They are used to stabilize toothpaste, preventing separation of the solids and liquids, one you might find in regular toothpaste is propylene glycol . Common binding agents in natural toothpaste include natural gums such as arabic, tragacanth, xanthan and carrageenan. Corn starch extract, methyl cellulose and cellulose may also be used.
- Flavours Artificial and Natural will often be indicated. You might see something like Cranberry extract, or other essential oils in a more natural toothpaste.
- Colour such as titanium dioxide for white, FD&C Blue No. 1, FD&C Green No. 3, FD&C Yellow No. 6.
- Sweeteners include sorbitol (which is also a humectant mentioned above), glycerol, xylitol, stevia, sucrose, and sodium saccharin.
- Fluoride Acidulated Phosphate Fluoride, Calcarea Fluorica, Fluorophosphate, Fluorure, Fluorure d’Hydrogène, Fluorure de Phosphate Acidulé, Fluorure de Sodium, Fluorure Stanneux, Fluoruro, Hydrogen Fluoride, Monofluorophosphate, MFP, Nombre Atomique 9, Sodium Fluoride, Sodium Monofluorophosphate, Stannous Fluoride.
- Triclosan Which “has” been shown to help prevent gingivitis and reduce plaque. However, the chemical has been linked to concerns over antibiotic resistance and endocrine disruption.
- Whitening Agents Hydrogen peroxide the active ingredient in most whitening toothpastes used t0 bleach teeth. Polyphosphates (such as pyrophosphates), have been added to keep highly pigmented food and drink from staining enamel. Some whitening toothpastes contain the chemical blue covarine, which adheres to the surface of the teeth. It is designed to create an optical illusion, making teeth appear less yellow. PVM/MA Copolymer is also used to help retain the active ingredients on the teeth.
- Desensitizers are added to relieve the discomfort of sensitive teeth. Potassium nitrate is a very common desensitizing agent used to reduces tooth sensitivity. Others you might find are stannous fluoride, sodium fluoride, potassium chloride, and strontium chloride.
- Other Additives such as Tetrasodium Pyrophosphate – which is used for tarter control in toothpaste. Mica provides aesthetic visuals to the finished product – this may give the paste a touch of a sparkle.
Ok – So all those ingredients can be a bit overwhelming, especially when faced with what you should ultimately choose while shopping. So if you really want to know if there IS a difference to fluoridated vs. non-fluoridated toothpaste, stick with me. Without getting too science-y, I was able to find an In Vitro Study assessing the anti-microbial activity of different toothpastes and mouth rinses. A total of 5 toothpastes and 5 mouth rinses were tested for their antimicrobial activity against three oral pathogens. S. Mutans (the name definitely sounds destructive) is one of the main opportunistic pathogens associated with dental caries. As I mentioned earlier, bacteria like to “ferment” and as a result they play a large role in carbohydrate fermentation, which results in acid production and can lead to the demineralization of tooth enamel. For many individuals, the primary oral hygiene method of tooth brushing is, “by itself, usually insufficient over a long period to provide a level of plaque control consistent with oral health.” According to the Dental Research Journal from NCBI. As a result antimicrobial agents have been added to aid in reducing the levels of oral bacteria.
So what was the outcome – It was found that “In the present study, the herbal formulations studied appeared to be equally effective as the fluoride formulations, but not superior to them.” What conclusion can we draw from all of this? Well its not all cut and dry, unfortunately. Just as every person is unique in what their dietary requirements might be, the same too goes for oral health requirements. Each individual must be looked at according to his or her current health needs. I loved this particular piece in the study “It is known that a balance exists in a person’s oral microbial population. If this balance is lost, opportunistic microorganisms can proliferate, enabling the initiation of disease processes.” This speaks to finding that balance; everything in our body is tied together. Often we think of oral health as a separate entity, although much can be said about what we see present in the oral cavity, manifesting from a possible imbalance. We need to find balance and use what is right for our particular needs. Could this be fluoridated toothpaste, possibly? If it meets your particular needs – if you or your child has a significant amount of dental caries, it might be the right choice for you. I can not tell you that you shouldn’t use fluoride nor will I say that a natural choice is the best. What will be best is based on a variety of factors related to your overall health history.
With all that said, whether you decide to brush with fluoride or not, ensure that you are brushing your teeth at least twice daily (again all depending on your needs), along with flossing. These two steps alone will put you in the right direction towards optimal oral health. Please also make sure that you are seeing your Dentist and Dental Hygienist regularly so they may guide you in the right direction based on your particular oral health needs.
What are your thoughts – Do you use a Natural or Regular Toothpaste? Please share with me below, I would appreciate any feedback!
Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press, 1999. Available at: http://books.nap.edu/books/0309063507/html/index.html
Position of the American Dietetic Association: the impact of fluoride on health. J Am Diet Assoc 2001;101:126-32..