Toothpaste! Which one is best for me?

tooth paste close up pink

Toothpaste! Which one is best for me?

Do we need ‘pearly white crystals’ – or is it all marketing spin?

One of the most common questions we face as dentists is; “Which toothpaste is the best for me?”

When you head to the oral care section at your local supermarket or pharmacy, you are bombarded with so much marketing slogans from “advanced formulas”, “extreme-clean”, “triple action” and what you call “natural” toothpastes. Its hard to tell which one will suit you, or is it as simple as, they all do the same thing.

So coming back to the original question, lets explore what toothpaste is and the different types.

What’s in toothpaste?

Toothpaste sole action is to remove plaque and prevent cavities (with developments in sensitivity reduction).  The majority of toothpastes contain basically the same key ingredients, with a slight modification to each formulae but with the same sole purpose of plaque removal and to prevent cavities.

Toothpaste has two essential ingredients, fluoride and a gentle abrasive, tied together with stabilisers, thickeners, sweeteners, and additives. 

Toothpaste typically contains a combination of ingredients that work together to clean and protect your teeth. While specific formulations may vary between brands and types of toothpaste, common components include:

  1. Abrasives:
    • Purpose: Abrasives help remove plaque, surface stains, and debris from the teeth.
    • Examples: Calcium carbonate, hydrated silica, dicalcium phosphate.
  2. Fluoride:
    • Purpose: Fluoride is a key ingredient for preventing tooth decay. It strengthens tooth enamel and helps repair early stages of decay.
    • Examples: Sodium fluoride, sodium monofluorophosphate.
  3. Humectants:
    • Purpose: Humectants keep the toothpaste from drying out and maintain its texture.
    • Examples: Glycerol, sorbitol.
  4. Binders:
    • Purpose: Binders give the toothpaste its smooth texture and hold the ingredients together.
    • Examples: Xanthan gum, carrageenan.
  5. Detergents (Surfactants):
    • Purpose: Surfactants create foam and help distribute the toothpaste evenly in the mouth.
    • Examples: Sodium lauryl sulfate.
  6. Flavoring Agents:
    • Purpose: Flavoring agents enhance the taste of the toothpaste, making it more pleasant to use.
    • Examples: Peppermint, spearmint, fruit flavors.
  7. Sweeteners:
    • Purpose: Sweeteners improve the taste and make the toothpaste more palatable.
    • Examples: Saccharin, sorbitol.
  8. Thickeners:
    • Purpose: Thickeners contribute to the toothpaste’s consistency.
    • Examples: Carrageenan, cellulose gum.
  9. Preservatives:
    • Purpose: Preservatives help prevent bacterial growth and maintain the stability of the toothpaste.
    • Examples: Parabens.
  10. Desensitizing Agents:
    • Purpose: Desensitizing agents, such as potassium nitrate or strontium chloride, may be included in toothpaste for individuals with tooth sensitivity.
  11. Whitening Agents:
    • Purpose: Whitening toothpaste may contain agents like hydrogen peroxide or baking soda to help remove surface stains.
  12. Anti-microbial Agents:
    • Purpose: Some toothpaste may include anti-microbial agents for additional protection against bacteria.
    • Examples: Triclosan (in some formulations).
  13. Natural or Herbal Ingredients:
    • Purpose: Natural toothpaste may incorporate herbal or plant-based ingredients for their potential antimicrobial properties.
    • Examples: Tea tree oil, neem.

It’s important to note that the specific combination and concentration of these ingredients can vary among different toothpaste formulations. Additionally, when choosing a toothpaste, individuals with specific oral health concerns or preferences (such as fluoride-free options or natural formulations) may select products tailored to their needs. Always check the product label for information on the active ingredients and their concentrations.

While the majority of toothpastes containing somewhat the same key ingredients, does that mean you can opt for the cheapest brand?

What type of toothpastes are there?

Like many industries, the toothpaste markets is dominated by 2 companies; that being Colgate Palmolive and GlaxoSmithKline. We have a whole array of different toothpastes on the market from whitening, plaque control, sensitive and pro-enamel toothpastes as well as products designed for children.

Here’s a summary of some of the toothpaste segments:

Teeth-whitening toothpaste

Teeth-whitening toothpaste have become a huge marketing tool and segment in the oral care aisle. These toothpastes do not work like traditional bleach you can purchase from your dentist, but generally work through micro-abrasion. They use abrasive particles, taking off a micro layer to remove stain. However, the risk of continual use of whitening toothpastes is the continual abrasive effect which leads to enamel damage. We generally suggest not using these types of toothpastes and the best way to have white teeth is having a dental clean, limit coloured liquids (eg coffee) and use professionally distributed dental bleach.

Children’s toothpaste

Children’s toothpaste have been well marketed with sponsored packaging from the wiggles to spiderman. They are similar to adult toothpaste with the majority of similar ingredients with the key difference being the concentration of fluoride, which is generally around half of the adult toothpaste.

Children are prone to swallow toothpaste (with my children not immune to this), we recommend parents only use toothpaste after 18 months and use only low-fluoride formulas up to the age to six to prevent fluorosis (caused by ingesting too much fluoride). The key is to only place the smallest amount on the brush, using mechanical movement as the main form of cleaning.

Sensitive Toothpastes

Sensitive toothpaste is designed to block the dentine tubules and minimise sensitivity when brushing. Sensitivity is generally due to gum recession and thinning of your enamel which exposes your dentine. 

The two leaders in this segment is Sensodyne and Colgate Sensitive toothpaste. They work using two different actions and generally one may work better than the other on different patients. We generally recommend trying both and choosing one that works best for your teeth.

Tartar control and enamel protect

Tartar or calculus is the build-up of plaque that has hardened over a period due to a lack of brushing. Once tartar has developed it can only be carefully removed by a dentist. 

The marketing team uses terms like pro-enamel and enamel protect to attract people. Fluoride is the armor to protect our teeth and all fluoridated toothpastes have similar concentration and protective mechanisms. Unless you need higher concentrate of fluoride due to a high caries risk, the mainstream brands will all provide you with the same protection with subtle differences.

Natural toothpaste

Another booming segment in the toothpaste market is ‘natural’, or ‘herbal’, toothpastes. Many of the “natural” or “herbal” products are made up of remarkably similar ingredients to their mainstream equivalents, but most were made without fluoride.

The most significant ingredient in toothpaste is fluoride, providing maximum protection to your teeth. Without fluoride, the mechanical removal of plaque must be perfect to maintain a low risk of caries.

In general practice, we find those that limit or completely remove fluoride out of there general oral care, end up having tooth decay.

Specialist toothpastes – Biotene and Neutraflor 5000

When you’re experiencing dry mouth (xerostomia) symptoms, we recommend a toothpaste that protects your teeth and is formulated to minimize irritation. Biotène toothpaste is free of sodium lauryl sulfate (SLS) and contains fluoride with the main active ingredient in its toothpaste sodium monofluorophosphate, and prior to the GlaxoSmithKline  acquisition it also contained enzymes including glucose oxidase, lactoferrin, lactoperoxidase and lysozyme. Now without those added enzymes, it may not be as effective in combating dry mouth.

For those with a high caries risk (due to lifestyle generally), we need extra protection for your teeth. The use of Neutraflor 5000 toothpaste twice daily replacing your regular toothpaste, will help strengthen and even reverse decay that is still in your enamel. It has 5 times the concentration of fluoride than normal toothpaste.

So which toothpaste is best for me?

If you generally don’t have any specific problems or in a high risk category, then generally we recommend any non-whitening fluoridated toothpaste. Colgate total is one of the leading toothpastes on the market and we highly recommend. All other mainstream toothpastes work similar, so it comes down to taste and budget.

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