Which toothpaste and toothbrush do I recommend?

Toothpaste

Before I answer, let’s look at the history of these items and reason we are using them in the first place.

The history of toothpaste goes back to 4000 BC in Egypt. Toothpaste or tooth powder did not become popular in the western world until the 19^th Century. Many concoctions were used for various supposed remedies. In Germany, fluoride was added to prevent decay in the 1890’s. In America toothpaste containing fluoride was first introduced in 1929, but was given a bad rap by the American Dental Association because the safety had not been studied. Research continued on fluoride and in 1960 Crest toothpaste received the ADA approval. Since then fluoride had been established as safe and effective in reducing tooth decay.

Toothbrush

Toothbrushes have been around since the beginning of time. Early man used chewed up twigs to clean teeth. The first manufactured toothbrush recorded was made of horsehair in China in the 1200’s.For the next several centuries till the 20^th century, toothbrushes utilized animal hair attached to a handle. In 1930 nylon replaced animal hair in toothbrushes. Tooth brushing did not become popular in the USA until after World War II as the soldiers were required to brush daily.

Floss

The history of floss is very short.

Many people may have used cotton thread, string, and fishing line, along with any other suitable object to help pick food out off their teeth. Floss had not been officially invented until the 19^th century. The first commercial floss was made of silk. Later this was replaced by nylon, polyethylene and Teflon. Flossing did not become popular until after World War II in the US and the rest of the world. Only 10 to 14% of the population flosses regularly.

Why do we use these products?

Historical perspective

For millennia toothbrushes and toothpaste were used for flavoring, breath control, beauty, rituals, and some assumed health benefits. Flossing was used to remove chunks of food only. Up until the last century, no real health connection between using a toothbrush, toothpaste, and floss had been scientifically established.

Today

Today, people are looking for products that freshen our breath, whiten our teeth as well as improve our oral health. It is estimated that people US the US spend over 10 billion of dollars on oral healthcare products. Thanks to modern mass marketing, oral hygiene products are highly commercialized. Cutting through the hype to find products that are truly beneficial is challenging. The main “hygiene” products are touted to, prevent decay, freshen breath, kill bacteria, whiten teeth, reduce plaque, reduce gingivitis, reduce tarter, and reduce sensitivity. To some degree different products can do this. The problem is how well they do this and what are the risks. I am not convinced that enough research has been done on many of these additives and their long term safety.

What are some of these additives?

It seems that marketing of toothpaste and for that matter most oral hygiene products requires that the manufacturer REINVENT their products constantly. In my opinion, these reformulated products are not necessarily better than the original. The addition of fluoride to a toothpaste is the only one that I am in favor of due to its ability to reduce tooth decay. The addition of Triclosan (an antibacterial agent) to reduce gingivitis and plaque formation may be harmful as well as leading to genetic mutation of bacterial strains that are resistant. The addition of sodium lauryl sulfate (a foaming agent) can lead to mouth sores and other problems with sensitive mouth and gums as it dries out the tissue. There is some promise with the addition of remineralization agents like tricalcium phosphate (TCP) which mimics the composition of tooth enamel. For sensitive teeth, there are a few products that use TCP, strontium chloride or potassium nitrate to seal up sensitive dentinal tubules in exposed tooth roots. These work fairly well. Flavoring, coloring and various abrasive agents are not necessary if you brush regularly. Whitening agents may have a minimal effect on tooth color but in my opinion are not necessary.

What is going on in your mouth?

Your mouth is like a garden filed with microorganisms. You usually inherit these from your parents at birth. You will always have bacteria in your mouth, and the goal of good oral hygiene is to control this garden and prevent it from damaging your body (teeth and gums etc.).

The bacteria form plaque on the teeth. Bacterial plaque that damage your tooth and gums live in a very sophisticated community called a biofilm. In this biofilm community, the various bacteria live synergistically helping and protecting each other. It takes about 24 hours for plaque to turn into a mature biofilm. The disruption of this plaque a couple of times a day by brushing and flossing keeps it from getting organized enough to do any damage.

What is the best way to disrupt the plaque?

The best method for this is a sonic toothbrush and flossing. Tongue scraping can also reduce the bacterial load in your mouth.

Saliva

Your saliva acts as a buffer (diluting and neutralizing agent). Saliva also has some antibacterial proteins to fight some bacterial infections. If you have low saliva flow (a dry mouth) due to a medical condition, or a medication that you take, the bacterial byproducts do more damage. Mouth breathers due to airway restrictions in the nose or allergies have the same problem with saliva not buffering and protecting the teeth and gums. Diet and hygiene are more critical for people with low saliva flow or dry mouth.

So what do I recommend and use?

For a toothbrush, I use and recommend a Sonicare® toothbrush as the sonic motion disrupts the biofilm on and between the teeth. Any floss will do. I prefer a xylitol and fluoride toothpaste by Carifree®. To kill germs and freshen breath, either a xylitol mouthwash by Carifree® or Listerine® mint are my favorites.

The Sonicare® disrupts biofilms on and between the teeth better than any toothbrush. It also can be useful in preventing gum recession and root notching due to its motion. Patients in our practice using Sonicare® brushes show improved gum health. Xylitol (a natural product) interferes with the acid producing bacteria’s function and helps reduce decay. It also is a great low calorie sweetener. I like Listerine® for its antibacterial properties and the ability to really freshen my breath.

If you cannot afford the Sonicare®, a soft bristle toothbrush is the next recommendation. Do not use any other powered brush that has a rotating head (these cause damage to tooth roots and gums and are very difficult to use properly).

Keep an open mind

In the future, I may change my opinion as scientific research provides new evidence for or against these and new products and additives. It is my continued hope that manufacturers will conduct proper studies on products prior to hyping them and bringing them to market.

Phillip C. Neal DDS