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The best toothpaste

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Introduction to Toothpaste

We found the most authoritative toothpaste recommendations at Consumer Reports, where editors test 41 toothpastes for stain removal, abrasiveness and fluoride content. Choice.com.au, the Australian equivalent to Consumer Reports, compares toothpastes only for their whitening ability. Much more informal comparison reviews at Grist and Slate magazines evaluate toothpastes mostly for taste, texture and the way the mouth feels after brushing - as do most consumer-written reviews published at sites such as Drugstore.com and Amazon.com. We also found good information from dentists who post articles and recommendations to blogs and oral-health websites.

Reading toothpaste reviews quickly reveals that consumers and dentists seem to have different priorities when choosing toothpaste. Most people look for good flavor, thickness (neither too runny nor too hard) and pleasant texture. People also want the mouth to feel clean after brushing, with sweet breath, and for teeth to look not only unstained, but as white as possible.

Dentists, on the other hand, say the best toothpaste is the one that protects teeth from cavities, softened enamel and plaque. If not removed at least every 24 hours, plaque hardens into tartar, which builds up and makes teeth and gums even more susceptible to decay - resulting in a negative cycle that can cause first gingivitis, then serious periodontal disease. In turn, quite a few experts believe that periodontal disease may cause systemic problems, including heart problems.

Where dentists and consumers do agree is that the best toothpaste should do no harm. We found quite a few complaints from sufferers with sensitive teeth, canker sores or problems with the soft tissues of the mouth. Just because a toothpaste prevents cavities does not mean it won't irritate your teeth, gums or the lining of your mouth. Crest Pro-Health toothpaste(*Est. $5/7.8 oz.), designed to control tartar, gets an especially high number of complaints from users. Some complain that the stannous fluoride stains their teeth, while others are sensitive to its tartar-control ingredient, sodium hexametaphosphate.

Quite a few dentists recommend avoiding tartar-control toothpastes since they can contribute to oral problems. In most mouths, tartar only builds up if plaque is left on the teeth for 24 hours or longer, so as long as you brush often enough with a fluoride toothpaste to control plaque, tartar should not accumulate.

Dentists and comparison reviews are skeptical of toothpastes that claim to whiten teeth. Furthermore, oral-health experts say that "whitening" toothpastes don't do anything extra for dental health, and most don't remove stains any better than regular fluoride toothpastes. Experts insist that no toothpaste can change the color of your teeth -- they can only work to remove stains so that your natural tooth color shows through. Neither the Food and Drug Administration (FDA) nor the American Dental Association (ADA) defines what "whitening" means, so any manufacturer can use the term on product labels. The only way to substantially whiten teeth is to see your dentist and receive a professional whitening treatment or try an over-the-counter whitening kit. (We have a separate report on teeth whitening.)

Xylitol is the latest toothpaste ingredient that's attracting scrutiny. Clinical studies confirm that this natural sugar aids in preventing cavities and gingivitis, rather than feeding harmful bacteria the way most sugars do. Studies show that xylitol plus fluoride is an especially beneficial combination.

However, most experts say that any toothpaste that contains fluoride is effective when used often and well enough. Although water fluoridation is still somewhat controversial, fluoride in toothpaste is considered not only safe, but essential. We discovered several sources that tell consumers that any toothpaste will do as long as it contains fluoride, especially if it has the ADA seal of approval.

Here's what the experts have to say about the different terms and claims you might see on toothpaste labels:

  • Get a fluoride toothpaste. Experts say brushing with a toothpaste that contains fluoride is important for preventing cavities. On the label, this may be called stannous fluoride, sodium fluoride or monofluoride phosphate (MFP). This is the ingredient all oral care professionals seem to agree upon as the basis for using commercial toothpastes. As long as the product has fluoride, it will help maintain oral health. However, stannous fluoride can stain teeth.
  • Look for the American Dental Association (ADA) Seal of Acceptance. The ADA awards its seal only after reviewing the "appropriate clinical and/or laboratory studies and scientific data." Any toothpaste with the ADA seal has been proven safe and effective for the claims on its label. Though there is a fee to apply, not all applications are approved.
  • Experts are mixed on tartar control formulas. The active tartar-control ingredient, tetrasodium pyrophosphate, has been proven to prevent tartar, but it can't remove tartar already on the teeth. Only a professional cleaning can do that. Some dentists say tartar-control pastes can cause mouth irritation, and do not do enough extra to warrant the risk of this irritation except for extremely tartar-prone patients.
  • "Whitening" toothpastes are over-hyped. While the ADA believes current levels of hydrogen peroxide in some whitening toothpastes are safe, some dental experts say peroxide can irritate and damage gum tissue. The bubbling may make you feel like you're getting a better cleaning, and when combined with baking soda, hydrogen peroxide does kill bacteria that cause gum problems. However, most experts say fluoride plus triclosan is a better bet. No toothpaste has been proven effective in actually changing the color of teeth. The whitening toothpastes merely clean surface stains and cannot change the underlying tooth color.
  • Sensitive formulas can help those with mouth pain. These work for mild cases of tooth hypersensitivity, but expect to wait four to six weeks before you feel any results. The ADA recognizes two effective ingredients in treating sensitive teeth and gums: strontium chloride and potassium nitrate. These "block the tube-like channels that pass through teeth and connect to nerves," thereby reducing "the ability of the nerves to transmit pain," says the ADA. Keep in mind that these won't work for tooth pain caused by cavities or tooth problems other than receding gums.
  • Avoid SLS if you have sensitive teeth or are prone to canker sores. Sodium lauryl sulfate can irritate the gums and lining of the mouth in some people. If you are prone to mouth sensitivity or canker sores, dentists recommend choosing a fluoride toothpaste that does not contain SLS.
  • Consider the level of abrasiveness. Abrasive ingredients are essential for removing plaque, and are usually in the form of hydrated silica or calcium carbonate. Polishing alumina added to hydrated silica is especially effective. All ADA-approved toothpastes are within certain limits, but the range is quite great. Some dentists advise erring in the direction of low abrasiveness.
  • Although toothpaste commercials often show actors squirting a huge, swirling amount of toothpaste on the brush, experts stress that you need no more than a pea-sized amount of toothpaste to do the job -- more than that is just product waste. Kids require even less.

 

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