What is the best toothpaste? This is the inevitable question as you stare at the aisle of seemingly endless toothpaste choices. Whitening, fluoride, tarter control, herbal, natural, sensitivity, cavity control… the list goes on and on with options and ingredients marketed to appear to be the best and most important. Competition is so strong that companies are continually changing formulations and marketing new and improved features that make choosing a toothpaste an ever-changing challenge.
Years ago, in dental school I was taught to advise patients that the best toothpaste for them is whichever one they will use that contains the proper amount of fluoride. It was simple and still holds true to a degree even today. But with the expansion of available toothpastes there are more nuanced options and several that can damage your teeth.
Before you choose the best toothpaste based on your individual needs, you first need to rule out the ones that will damage your teeth. Toothpaste has many ingredients, but the harmful ones we are concerned about is hydrated silica and similar fillers. These are the ‘grit’ of toothpaste, basically sand which cleans debris off teeth. The grittier a toothpaste, the more debris can be removed, but also the more damaging to teeth. Think of it like sandpaper; the coarser the more damaging. Similarly, the more grit in toothpaste the coarser the cleaning action.
It’s not always easy to determine which toothpastes are less gritty, but there is a scale used to rate them – the Relative Dentin Abrasivity (RDA) scale. This isn’t a number that is placed on the toothpaste packaging, so you must seek this information out. A simple internet search for toothpaste RDA will bring up charts to help you choose. An RDA value under 70 is considered the safe zone, though if your favorite toothpaste is close to 70 then the difference is likely minimal. The rule still holds, the best toothpaste is the one you will use, so continue to use your favorite unless it is far outside the safe zone.
For reference, below is a list of just a few of the toothpastes with RDA values in the safe zone (lower is the least abrasive):
· Toothbrush with plain water – 4
· Plain baking soda – 7
· Pronamel – 34
· Arm and Hammer Dental Care – 35
· Crest with Scope – 51
· Colgate Total 70
Many toothpastes companies’ market and advertise whitening formulations with great success. To do this most of them have high RDA values that are damaging; therefore it is advised to be cautious in choosing whitening toothpastes. There are a few whitening toothpastes that are in the safe zone: Arm and Hammer Mentadent Advance Whitening, Colgate Enamel Care Advanced Whitening, Crest with Scope Whitening, and Arm and Hammer Advance White Sensitive. In general, toothpaste isn’t overly effective in whitening your teeth, so be careful not to buy into the marketing and damage your teeth with overly abrasive paste.
There are four other subcategories of toothpaste that may be best depending on your individual situation. Prescription fluoride toothpaste is effective if you have a high risk of cavities. Sensitive toothpastes may help control sensitivity to temperatures and sweets. Natural options may be needed if you have a sensitivity to any ingredients in mainstream toothpaste. The most common sensitivity is to sodium lauryl sulfate which is a foaming agent. Tom’s of Maine is a popular choice to avoid the potentially irritating sodium lauryl sulfate that can cause mouth sores and tenderness.
Once you’ve determined a brand of toothpaste that it won’t damage your teeth, make sure you are using it correctly. Ignore the ads that show large ribbons of paste on a toothbrush. You never need more than a pea size amount of toothpaste. Make sure you brush for a full two minutes brushing around all the surfaces of all the teeth. Finally, avoid rinsing the toothpaste off your teeth, eating, or drinking for 30 minutes after brushing. Think of it as medicine for your teeth. To be effective, toothpaste needs to have time in contact with your teeth for the fluoride to slow or stop cavities.