It has certainly happened to everyone to be in front of the supermarket section dedicated to toothpastes and not know which one to buy, so vast was the choice of products on offer. Often, in fact, entire walls are covered with boxes containing toothpastes that advertise with colored labels that each product is the best for dental hygiene. But is one toothpaste as good as another? What is toothpaste used for? And again, how to choose toothpaste based on personal needs? Let's try to clarify things a little.
Toothpaste, what is it for
Toothpaste is a paste or gel that contributes, together with toothbrushing and dental floss, to the care and hygiene of the oral cavity, helping to eliminate bacteria from the surface of the teeth and, in some cases, based on the ingredients it contains, also protects tooth enamel and gums.
Toothpaste, the ingredients that make the difference
As a basis, toothpastes are all similar to each other. The difference is made by some ingredients. For example, fluoride is one of the most sought after ingredients in toothpaste, because it protects tooth enamel and counteracts the damage caused by the bacteria responsible for tooth decay. There are anti-plaque and antibacterial toothpastes, which counteract the accumulation of plaque on the teeth, and there are whitening toothpastes, which contain abrasive agents designed to remove stains from the teeth caused, for example, by smoking, food, drinks or tartar. These toothpastes must be used with caution to avoid eroding the tooth enamel. In any case, it is the dentist who should guide us in choosing the type of toothpaste that best suits us and our needs.
Fluoride in toothpastes, what you need to know
Fluoride added to toothpastes actually helps reduce the formation of cavities, counteracting the demineralization of the enamel, promoting the remineralization of the enamel and inhibiting the metabolism of cariogenic bacteria (Wang et al, Med Sci Monit, 2019). An amount of 1000 or 1100 ppm of fluoride has shown benefits for adults. In children the matter is more delicate. In this case, beneficial effects are observed with 1500 ppm of fluoride (Levine et al, EBD, 2019). However, the risk is that the child, if he/she does not know how to brush his/her teeth correctly, could ingest fluoride and cause a condition of dental fluorosis, with the appearance of discoloration on the teeth and alterations in the shape and resistance of the teeth (Thornton Evans et al, MMWR Morb Mortal Wkly Rep., 2019). For this reason, it is important to teach correct brushing and use an amount of toothpaste no larger than a grain of rice for children under 3 years of age and no larger than a pea for children over 3 years of age and up to 6 years of age (Thornton Evans et al, MMWR Morb Mortal Wkly Rep., 2019).
Beware of sodium lauryl sulfate
Toothpastes may contain a particular type of detergent, called sodium lauryl sulfate. This substance is irritating and should not remain in the mouth for too long. In particular, in sensitive people it can cause mouth ulcers and inflammation of the oral cavity (Kasi et al, Am J Dent, 2022). Therefore, in the case of recurrent canker sores, the advice is to avoid or at least limit the use of toothpastes containing sodium lauryl sulfate.
Beware of triclosan
Toothpastes may contain triclosan, an antibacterial agent. Triclosan, if contained in toothpaste, appears on the label which lists all the ingredients used to prepare the product. The addition of triclosan allows the companies to specify that the toothpaste is antibacterial. Ok, but are we sure that it is a winning move for health? As evidenced by a very interesting article from Harvard University (Shmerling, Harvard Health Blog), the scientific world has started to ask itself several questions about the safety of triclosan, since there are many products that contain it, from soaps to hand detergents and, indeed, toothpastes. Analyzing urine samples showed that 75% had detectable levels of triclosan. Studies conducted in the laboratory, but not yet on humans, have raised suspicions that triclosan may increase resistance to bacteria and may influence the synthesis of hormones in the body. A very recent research conducted on 1800 women showed that higher values of triclosan in the urine are connected to an increased risk of osteoporosis, especially in menopausal women (Cai et al, JCEM, 2019). At present, only one study has reported that triclosan contained in toothpastes could reduce plaque and gum bleeding but, as indicated by the authors of the research themselves, the reduction in these symptoms is considered too small to be significant. In any case, the long-term effects of toothpaste containing triclosan have not been evaluated (Riley et al, Cochrane Database Syst Rev, 2013). Summing up what we have learned, to date no study has clearly demonstrated the benefits of triclosan for the oral cavity, while many studies demonstrate that this substance could cause problems in the long term. By this we do not mean to say that the hunt for toothpastes at home must now begin and, if they contain triclosan, they must be thrown away. Absolutely not. But we believe it is right to be informed and, for the next time we find ourselves choosing toothpaste, we can better evaluate the ingredients.
It is becoming increasingly easier to find natural toothpastes on the market, which do not contain fluoride or chemical agents such as triclosan or chlorhexidine. These toothpastes are made with plant extracts and essential oils and are considered safe and beneficial. For example, toothpastes based on chamomile, sage, arnica or echinacea have shown an anti-inflammatory action and are useful in combating gingivitis and periodontitis, while the essential oils of thyme, cinnamon, oregano and cloves have been found to be antibacterial, useful in inhibiting cariogenic bacteria (Kanoutè et al, J Public Health Afr, 2022).