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What ingredients are in your toothpaste and what do they do?

Toothpaste ingredients have become more numerous and more complex in recent years as manufacturers try to add more oral health and cosmetic benefits to each tube. However mouth irritation and allergies are on the rise too. Here’s what you need to know.

A very short history of toothpaste

Toothpaste has been used in various forms as a dentifrice – a teeth cleaning product – since ancient times. There are various forms: powders, pastes, gels, and liquids. These days the majority are pastes or gels.

In the past 50 years or so, toothpaste has evolved from a product that simply helps to clean teeth and remove plaque, to a chemical agent with many different claimed oral health benefits. Let’s explore some of the major ingredients so you’ll be in the know!

Abrasives

Abrasives are the ingredients for polishing teeth and removing stains from tooth enamel. Ideally, toothpaste abrasives are strong enough to remove external stains and polish enamel well, without cutting or rubbing away the tooth structure. This can be difficult to get the balance right. So some types of toothpaste are more abrasive than others such as whitening and smokers toothpaste compared to kids toothpaste. All toothpaste need to have a relative dentine abrasivity (RDA) score of less than 250 to be safe.

Common ingredients included for abrasivity in many commercial toothpastes include hydrated silica and calcium carbonate. The concentration of these ingredients in toothpaste determines how abrasive it is – less than 30% is safer.

Baking soda (aka sodium bicarbonate), activated charcoal and salt are becoming popular in the past few years and among DIY makers. Baking soda has a very low abrasivity rating, while activated charcoal and crystalline salt are high to very high respectively. Always dissolve salt before using for oral health purposes to avoid abrasive damage. See our blog on activated charcoal for more details.

Our advice: for regular daily use we recommend a toothpaste that tooth decay prevention gingival health. One that isn’t specifically for whitening, smokers or sensitive teeth* to avoid the risk of tooth and gum damage such as recession and sensitivity from overuse.

*Yes we said sensitive toothpaste. We were surprised to learn that sensitive toothpastes generally have higher RDA scores than regular toothpastes, so they’re safest for short-term, sporadic use.

Oral health agents

We ’re talking about those ingredients that help promote tartar control, reduce plaque formation and gingivitis and help prevent tooth decay. The most common and effective are:

 

  • Fluoride: added for both its ability to help remineralise tooth structure after a bacterial acid attack and its direct antibacterial activity on specific acid producing and gum disease stimulating bacteria, it can be safely added to toothpaste up to 1500 ppm concentration.

  • Xylitol: this plant derived sugar alternative is as sweet as sugar for flavour AND is a prebiotic. Sugar metabolising bacteria cannot metabolise xylitol preventing acid production while promoting modification of the mouth microbiome.

  • Green tea: polyphenols and catechin extracts from green tea are increasingly being incorporated into toothpastes. These have demonstrated anti-inflammatory effects on the gums.

  • Tartar control ingredients: these phosphate-based compounds generally have a high pH to prevent calcification of dental plaque. High pH has been shown to promote gum inflammation with continual exposure.

  • Milk proteins: there’s been a lot of fanfare about casein protein (CPP-ACP) as a remineralisation agent and desensitizer. There are stand alone CPP-ACP products such as tooth mousse for this purpose that studies show work, however there is currently little evidence to support its use in toothpaste

  • Flavours: commonly these are essential oils such as mint or menthol which help with fresh breath

Our advice: preferably use toothpastes with fluoride and/or xylitol, plus or minus green tea. Fresh breath is best managed with good plaque removal more than flavour disguise, so focus on toothbrushing technique more. We’re not convinced the tartar control benefits outweigh the risk of gum inflammation, so use these with caution.

Whiteners

Teeth whitening in toothpaste could really be considered a misnomer. Most ingredients are in fact mechanical abrasives that help to remove stains, but don’t change tooth colour however can damage tooth structure and gums. Some include chemical bleaching compounds such as peroxide but the concentration is so low that it does little, if anything, to change tooth colour.

Our advice: give the toothpaste whiteners a miss and get a professional clean and whitening service with us once or twice a year for much better lasting results.

Desensitizers

Sensitive teeth to extremes of temperature is usually the result of exposed dentine – the inner part of teeth, under enamel and all of the root surfaces. This happens from wear, abrasion, erosion and gum recession that comes from toothbrushing, age and dietary and gut acids. It can be quite painful!

We’re going to get technical here: fluoride, milk proteins, strontium salts or bioglass  block the dentinal tubules, while potassium salts desensitize the nerves within the tubules.

As mentioned above, often these types of toothpastes are highly abrasive, presumably to help these specific ingredients work their magic in the tubules. Seems a little counterintuitive?

 

Our advice: sensitive toothpastes are ok for occasional short term use, but for chronically sensitive teeth a consult with us and a more definitive solution may be a better course of action.

Delivery agents

These are used to make toothpaste easy to use – a paste or gel is easier than powder, right?  Along with good shelf life, easy to transport and cheap. These ingredients include surfactants like sodium lauryl sulfate (SLS) that are foaming agents, glycerin, humectants, colouring agents, water and others.

Allergens

As toothpaste formulas become more complex, so too is the incidence of allergies or irritation to one or more of the ingredients. Commonly this presents as bleeding gums despite good oral hygiene techniques, mouth ulcers, cracked lips – especially the corners, and burning mouth symptoms. Common irritant ingredients include:

  • SLS – the foaming agent
  • Essential oils – more common in kids or with homemade toothpastes where the concentration may be much higher than commercial toothpastes.
  • Triclosan – this antibacterial chemical has been banned in the USA and is being slowly phased out in Australia too. There are various safety concerns over this ingredient as well as the impact it may have on the environment.

Our advice: if you experience any symptoms described above, look at changing your toothpaste to one that is free of these ingredients AND get a checkup with us to make sure the symptoms are not due to something more sinister than an allergy to your toothpaste.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/27513809
  2. https://www.ncbi.nlm.nih.gov/pubmed/27161350
  3. https://www.ncbi.nlm.nih.gov/pubmed/11819975
  4. https://www.ncbi.nlm.nih.gov/pubmed/29178759
  5. https://www.ncbi.nlm.nih.gov/pubmed/27352462
  6. https://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/triclosan/faq-20057861

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