Quinte Dental Hygiene Clinic

Hi, I'm Elaine De Vouge, RDH
Owner of Quinte Dental Hygiene Clinic.

What Toothpaste Should I Use, Elaine?



photo of tubes of toothpaste
When it comes to toothpaste there is a bewildering array of choices!  There are two broad categories of toothpaste - those that are marketed as 'pastes' and those that are marketed as 'gels'. Some companies market under the name 'toothgel'. 

In addition to the choice of paste or gel, there are a number of other elements involved with toothpaste. These include:
- a variety of abrasive agents used in toothpaste
- the question of fluoride or no fluoride (and if you go for a fluoride based toothpaste, what type of fluoride)
- surfactants
- antibacterial agents
- flavorants
- remineralizers
- other miscellaneous ingredients

The main ingredients in toothpaste are water (typically 20 to 40%) and some kind of abrasive component which may constitute half or more of the typical toothpaste. Let's take a look at these various items.

Abrasives


Abrasives are insoluble particles and as such they help remove plaque from the teeth. There are number of possible abrasives that can be found in toothpaste products inducing aluminum hydroxide, calcium carbonate, calcium hydrogen phosphate (and there are a number of variations of this), various silicas, zeolites and hydroxyapatite. The links take you to Wikipedia where these substances are further explained if you are so interested.

What you want to be aware of is that abrasives cause a small amount of enamel erosion, called polishing action.

Surfactants


Some toothpastes but not all contain surfactants such as sodium lauryl sulfate (SLS) or other related surfactants, also known as detergents.  SLS is very commonly found in many personal care products such as shampoos.  The purpose of the surfactant is to act as a foaming agent primarily which enables more even distribution of the toothpaste and thereby improves its cleansing properties.

Antibacterial Agents


In the U.K, but less so in North American, you find triclosan added to toothpastes.  Triclosan is an antibacterial and anti fungal agent. The chemical name for it is polychloro phenix phenol which is why I prefer to use the term Triclosan!  Triclosan is currently being evaluated by the U.S. FDA and by Health Canada.   It does appear to have an anti-gingivitis effect and studies by the Environmental Protection Agency (EPA) have found Triclosan to be an effective antibacterial.  There are a number of health concerns being raised with Triclosan so the use of this antibacterial agent should be carefully be considered

Flavourants


Toothpaste, of course, comes in a wide range of colors and flavours which are primarily intended to encourage the use of the product.  There common flavourants are:

- Peppermint
- Spearmint
- Wintergreen

There are many, many other flavors of course including anise, bubblegum, cinnamon, lavender, ginger, vanilla and lemon. There are even some more 'exotic' flavors such as peanut butter, iced tea and whiskey!   And of course you can purchase unflavoured toothpastes.

Remineralizers


Some toothpastes contain remineralizers to help build back teeth enamel. Typically these are hydroxyapatite or calcium phosphate.

Other Miscellaneous Ingredients


Some toothpastes include ingredients to help suppress the tendency of the toothpaste to dry out.  Sugar alcohols such as glycerol, sorbitol or xyilitol are used for this purpose. There are others.  Some toothpastes include ingredients to reduce tooth sensitivity. Strontium chloride and potassium nitrate are common ingredients for this.   Finally some toothpaste include ingredients to minimize the formation of tartar, typically sodium polyphosphate.

Fluoride


No discussion of toothpaste would be complete without talking about fluoride!  It is still a somewhat contentious topic.  

It should be noted that taken in large quantities, fluoride-containing toothpaste can be very toxic. However the risk of using fluoride is generally considered low enough that the use of fluoride containing toothpaste (1350 to 1500 ppm fluoride) is advised for all ages. For younger children a smaller volume of toothpaste is recommended and for very young children (less than three) just a tiny amount need be used.  A valid concern for young children is the ingestion of toothpaste containing fluoride which can lead to dental fluorosis. Dental fluorosis is a discoloration of the enamel. In mild forms it presents itself as unnoticeable tiny white streaks or specks in the enamel. In more severe forms, the appearance of the tooth will be marred by discoloration or brown markings. Also the enamel may get pitted, rough and hard to clean. These spots and stains left by fluorosis are permanent and may darken over time.

Another thing to keep in mind with respect to fluoride is that you are exposed to it in a wide variety of ways. Fluoride is added to municipal water supplies, routinely added to mouthwashes, even soft drinks and canned goods. 

Fluoride is, of course, added to toothpaste as the active ingredient to prevent cavities. Fluoride in toothpaste is viewed as being beneficial on the formation of dental enamel and bones.  

There are a number of types of fluoride that can be found in toothpastes, the most common of which is sodium fluoride.  There are  others though such as stannous fluoride, olaflur (which is an organic salt of fluoride) and sodium monoflurophosphate.  Some studies have shown stannous fluorides to be more effective than sodium fluoride in reducing the incidence of dental cavities and controlling gingivitis.

Other Health Concerns


Toothpaste is not intended to be swallowed. Doing so may cause nausea or diarrhea. SLS, discussed in Surfactants, may increase the frequency of mouth ulcers in some people as it can dry out the protective layer of oral tissues.  There are some concerns about cinnamon containing toothpastes causing plasma cell gingivitis. 

Taste


Toothpastes can alter taste perception. In particular, after using toothpaste, juices such as orange juice will likely have an unpleasant taste if the toothpaste contains stannous fluoride.  This is attributed to a chemical reaction between the stannous fluoride and the acetic acid found in juice.  SLS also alters taste perception generally making food taste more bitter.

Whitening Toothpastes


Many people seek out a toothpaste offering whitening properties and there are numerous manufacturers that make such claims. Many of the toothpastes marketed as whitening toothpastes have peroxide in them. Peroxide is used in many tooth bleaching gels.   However, it is the abrasive in these toothpastes that removes the stains, NOT the peroxide.  A whitening toothpaste will not alter the natural color of teeth or reverse discoloration by penetrating stains or decay. Rather the abrasive in the toothpaste can polish th teeth and additives such as sodium tripolyphosphate can help bread down and dissolve stains. Whitening toothpastes take time to make teeth appear whiter (typically two to four weeks). These toothpastes are generally considered safe for use twice a day but excessive use may damage tooth enamel.

Herbal Toothpastes


Many people are interested in herbal (or 'natural' toothpastes). The brand "Toms of Maine comes to mind as an example. These toothpastes do not contain dyes or artificial flavorings. Many of them do not have fluoride or SLS. Ingredients in these toothpastes may include such things as aloe, baking soda, eucalyptus oil, strawberry extract and/or essential oils.  Some people even make their own toothpaste using similar ingredients. An example recipe is listed below.

It should also be noted that toothpaste is not really essential for brushing one's teeth. Teeth can be cleaned with a wet toothbrush alone.


Natural Toothpaste Recipe

Ingredients:
Combine dry ingredients in a bowl and mix thoroughly with a non-metal spoon. Drip essential oils into the mixture and stir well to combine. Transfer to a small container or jar with a tight fitting lid.  To brush with tooth powder, simply dip your toothbrush into the powder, or carefully squirt onto a wet toothbrush. Brush teeth as usual. If you dip your toothbrush into the powder you should probably have your own personal jar!







What You Need To Know About Bad Breath

No one likes bad breath! And the first thing you want to know about bad breath is that when it's really bad it's known as halitosis. That's good in a way because halitosis sounds a lot better than "I've got breath so bad it will knock your socks off!"

Everyone has bad breath sometimes. Depending on the cause, getting rid of bad breath can be a relatively simple matter or it can be somewhat more complicated.

Of course you want to practice good daily oral hygiene to minimize plaque build up. Plaque is a nearly invisible bacteria film that, left unchecked, will contribute to bad breath.  A professional cleaning to remove tartar (hardened plaque) build-up should be done typically twice a year for most people. For some the root cause of halitosis may be cavities and/or gum disease which is, of course, more serious.

In some occasions, bad breath may be due to something in the lungs or gastrointestinal tract or some kind of systemic infection. Also, certain health problems such as sinus infections and diabetes can cause halitosis.

Obviously an Italian pasta dish loaded with garlic is going to cause temporary bad breath as well!

So what all should one do to get rid of bad breath?

Brush and Floss

As already mentioned but worth repeating, practicing good daily oral care is the first step and that means brushing and flossing. You should brush two to three times a day and floss once a day, minimum.  Why is this important?  Your mouth contains many, many bacteria! Millions in fact! But not only that, there is a very wide variety of bacteria types in your mouth. It might surprise you to know that over 700 types of bacteria have been identified in the mouth but less than half of these have been well studied by scientists.

The food you eat is the food supply for bacteria!  So you want to keep your mouth clean to minimize the food supply to bacteria.  Flossing and brushing will remove food trapped between your teeth and food that is caught in your gum line.  Left unchecked, this food is a breeding ground for bacteria with bad breath soon to follow.

Clean Your Tongue

There is some bacteria, in particular bacteria that is located on the top of the tongue closest to the throat, that helps fight bad breath. Other bacteria however have a very bad odour.  The type of bacteria more prevalent on your tongue could be the difference between nice breath and bad breath.
Cleaning your tongue can help!  The tongue has a rough surface and that surface provides an ideal home for dead cells, food debris, bacteria and bacterial by-products, all factors that contribute to nasty breath!  

Brushing your tongue after you have brushed your teeth can help.  The most effective tongue cleaning is done with a tongue cleaner though. A tongue cleaner is designed to scrape the surface of the tongue.

Drink Water

You've probably heard the term 'morning breath'?  Why is your breath in the morning worse than other times?  When you sleep you don't produce as much saliva as when you are awake. Saliva contains oxygen which deters the growth of bacteria.

Of course your mouth can become dry during the day too and hence 'morning breath' can persist well beyond the morning! The solution is to have plenty of saliva cleaning your mouth. Saliva is naturally anti-bacterial and it washes food particles away. So the key here is to stay hydrated by drinking plenty of water.

Smelly Food Choices

Of course what you eat can have a great impact on your breath! Most people know that onions and garlic will result in foul smelling breath.  Some other foods though that you might not suspect can also be the source of bad breath. Meat is a good example of that. The problem with meat is that meat particles often collect in the mouth, between the teeth, at the gum line and sometimes even under fillings or crowns. Meat is especially appealing to bacteria!

A very high protein diet where less than 100 grams of carbohydrates are eaten in a day can result in a condition called ketosis. Ketosis is a metabolic state in which your body starts to burn fat instead of sugar and one of the downsides to this that ketosis is well known for causing very bad breath.

Good Smell Foods

Some foods can make your breath smell good too. Fruits high in vitamin C such as melons, berries and oranges are good for your breath (and bad for bacteria).  Crunchy fruits and vegetables are also good. This would include apples, carrots and celery which are all high in fiber (which helps to remove food stuck in the teeth and stimulates saliva production).

Smelly Drinks Too

Not only can your food choices affect your breath but so can your drink choices. We've already talked about how bacteria love sugar so you've probably already guessed that pop is not a good choice for your breath.  But the other reason for pop being a bad choice is that it is acidic and any acidic drink (which would include coffee and alcoholic beverages) will release compounds into the bloodstream that  in turn release odour in the breath. Acidic drinks lower the pH level in the mouth and bacteria likes lower pH levels.

One thing you can do to counteract this is to rinse your mouth after drinking a high acidic drink with plain water. This will help to rebalance the pH level in your mouth.  This can be done after meals too (although brushing is recommended).

Natural Remedies

Green tea has antibacterial compounds.  Cinnamon has essential oils that fight bad breath. Mint, parsley, basil, cilantro and dill can provide some temporary relief because they have essential oils that are scented. As well they contain high levels of chlorophyll that provides longer term benefits for your breath.  Chlorophyll which is a green pigment found in plants (used to convert energy from light via a process known as photosynthesis) has properties which inhibits odours. Chlorophyll neutralizes internal body odours, hence ingesting concentrated chlorophyll via tablets or sublingual drops (drops that are placed under the tongue and absorbed there).

Temporary Cures

You might be tempted to use a mint to mask bad breath but this is similar to splashing on some cologne after you've been out for a long sweaty jog!  It might work for a short period of time but that's about it. Another thing to realize is that bacteria loves sugar. So if your mint contains sugar, you are only adding fuel to the fire so to speak.

You should also realize that the possible cause of bad breath is medical condition. Mouth odor is often associated with gum disease and tooth decay but also respiratory and sinus infections, bronchitis and diabetes as well as other issues such as kidney and liver problems.

Smoking

In addition to all of the other well known reasons not to smoke, bad breath is yet another one.  Cigarette smoking releases a wide ranging chemical cocktail into the mouth resulting in smokers having a higher incidence of oral infections and disease.  Smoking tends to dry out the mouth and as already discussed this leads to 'morning breath'.  Smokers tend to get quicker plaque buildup on the teeth and that often leads to bad breath.

Professional Teeth Cleaning

Having a professional cleaning twice a year will help minimize bad breath. Your professional dental hygienist will remove plaque and tartar build-up that you will not be able to do with just brushing and flossing alone. If you haven't been to your dentist or hygienist within six months, book an appointment today! 

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