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Toothpaste — What's In It?

Squeezing out the facts

By Dr. George K. Stookey


Whitening Toothpastes

The effectiveness of whitening toothpastes on your teeth will depend on why they don't look white in the first place. Whitening toothpastes chemically or mechanically help to remove “extrinsic” stain — stain on the tooth surface. There is no evidence that they can whiten teeth that have “intrinsic” stain — internal discoloration — because they do not actually break down pigment or remove color from the teeth as bleaching agents can do. The only whitening agents in toothpastes are abrasives that help rub off stains (from coffee, tea or red wine for example), or enzymes that break down the proteins in stains (such as tanins present in wine and many fruit juices and food products). If you believe your teeth are not as white as they should be, your dentist can advise you on what whitening method would work best for you.

Because most toothpastes contain mild abrasives, they may not be strong enough to remove heavy external stains that need to be scaled and polished off professionally at your dental office.

Prevention of Tartar and Gum Inflammation

Some toothpastes proclaim an ability to control tartar and protect gum tissue; if the toothpaste bears the Seal of Acceptance from the American Dental Association these claimed benefits have been proven true in clinical trials. For example, pyrophosphates, made by heating phosphates (“pyro” – fire), have been shown to prevent tartar, the hardened (calcified) plaque, from forming on teeth. But it's important to remember that pyrophosphates, which are among the most soluble of the phosphate group of chemicals (a very important group of chemicals to life), cannot remove existing tartar. That can only be accomplished with a professional cleaning. Several toothpastes have been shown to prevent plaque formation and the development of gingivitis (gum disease) through the addition of different antibacterial agents. The idea is to reduce oral bacteria before they become incorporated into the plaque biofilm and inflame gum tissue, resulting in gingivitis. More recently triclosan, used for years in antibacterial soaps, as well as cetyl pyridinium chloride, an antibacterial agent used in mouthwashes, have been used in toothpaste to help control gingivitis. Stannous fluoride has been shown to provide antibacterial activity along with fluoride protection. However, it has the propensity to stain some people's teeth.

Reducing Sensitivity

Teeth can become overly sensitive when dentin, the bonelike material inside of them, becomes exposed. This can occur when the enamel erodes or when the gums recede and expose some of the tooth root, which is dentin covered by a thin layer of cementum. The dentin, which is living, contains nerves that transmit pain, making it especially sensitive to stimuli such as hot or cold food and even touch. Pain transmission can be blocked by potassium nitrate or strontium chloride, ingredients found in toothpastes designed to reduce sensitivity. Fluoride, too, is helpful in reducing sensitivity. It can take several weeks of use for these toothpastes to be effective although benefits are often seen with two to three weeks.

A Word About Herbal Toothpastes

Natural or herbal health and beauty products, including toothpastes, have become increasingly popular over the years, with many consumers believing that they are safer than those containing chemicals. These products tend not to have artificial sweeteners, flavors, colors or preservatives. They have not been studied to the same extent as more conventional toothpastes. However, one interesting study published in the Journal of the American Dental Association in 2004 evaluated 14 herbal toothpastes purchased in California health food stores and found that their ability to inhibit the growth of some types of oral bacteria varied widely; one toothpaste even appeared to be contaminated with a type of bacteria that was not part of the experiment. The study's authors suggested consumers look for the ADA seal on these types of products as a safeguard.


Although quite rare, there have been reports of purported allergies to toothpastes. While some have suggested the allergies were due to the presence of fluoride in the toothpastes, allergies to fluoride have never been proven. However, there are persons who have particular sensitivities to certain toothpaste ingredients that can result in inflamed or sore gum tissues, or white lesions (sores) inside the mouth that have a lace-like appearance. The ingredient that is most commonly noted in such instances is the flavoring system, and especially the ones that contain cinnamon. When such sensitivities are noted the recommendation is to switch to toothpaste with alternate flavors. This also applies to other products such as mouthwash and chewing gum. As noted above, sodium lauryl sulfate can also cause irritation in some people.

For A Safe And Healthy Smile

There's an old saying in dentistry: It's not the brush that keeps your teeth and gums healthy, but the hand that holds it. Brushing efficiently, meaning gently and purposefully once or twice a day, with a soft, microfine, multitufted brush held at a 45-degree angle to the gum line, until the tooth surface feels clean to your tongue is all you need to do — aided and abetted by your favorite toothpaste.

Toothbrush technique.
To brush correctly, hold a soft, microfine, multitufted brush at a 45-degree angle to your gum line, and brush gently until the tooth surface feels clean to your tongue.

Toothpastes are essential for proper dental hygiene and optimal dental health. Toothpaste manufacturers always try to identify unique components and/or benefits that may be used to differentiate their products from the competition and enhance sales. Consumers are often confused about the true benefits of specific products and wonder if the stated claims are really correct.

Perhaps the best advice for you as a consumer is to select products that bear the Seal of Acceptance from the American Dental Association. All health claims or advertised benefits of these products must be supported by research studies that have been reviewed and approved by the Council on Scientific Affairs of the American Dental Association. These toothpastes must impart the various benefits that are claimed on the packages as well as in any advertisements. If you have any questions about the kind of toothpaste that might meet a specific oral healthcare need, your dentist is a good source of information on what would be best for you.

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