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.
Toothpaste with the best stain removal
Colgate Total (*Est. $3.50 for 7.8 oz.) is the toothpaste most often recommended by dentists for adults. Like other toothpastes that carry the seal of approval from the ADA, Colgate Total incorporates fluoride to prevent cavities and strengthen enamel. In addition, Colgate Total uses a broad-spectrum antibiotic, triclosan, to kill the bacteria that cause plaque and gum disease - also certified by the ADA. Dentists say that what makes Colgate Total the best toothpaste, however, is that it also incorporates a copolymer to keep the fluoride and triclosan actively protecting teeth and gums for up to 12 hours between brushings. Launched in Dec. 1997, Colgate Total has been certified by independent dental associations in 29 other countries as well.
Colgate Total has medium abrasiveness, with an RDA value of 70. Toothpastes range from 8 to 200 on the Relative Dentin Abrasivity (RDA) scale, so Colgate Total could be considered "medium low." You might assume that the more abrasive the toothpaste, the better it cleans, but studies show that increasing abrasiveness beyond a certain point actually decreases cleaning power, which is measured separately on the Pellicle Cleaning Ratio (PCR) scale. Some experts recommend erring in the direction of lower abrasiveness if you use an electric toothbrush, tend to overbrush or have receding gums or more vulnerable enamel. Enamel usually gets thinner with age, and some people just seem to have softer teeth. One dentist, Dr. Ellie Phillips, notes that drinking fruit juice or eating acidic foods can also temporarily make enamel more vulnerable to erosion. A very abrasive toothpaste can improve stain removal. However, it's plaque, not stains, that make the difference in oral health. This is where Colgate Total excels.
Experts say the gold standard for toothpaste is high cleaning power (PCR) combined with low abrasiveness (RDA). A few toothpaste companies, such as Cleure (*est. $8/4.5 oz.) brag about their ratios of PCR to RDA, but most companies share these figures only if you ask. The ADA has set standards for both figures, so if a toothpaste carries the ADA seal, you can at least be sure that it is within the approved ranges.
The triclosan in Colgate Total is a bit controversial, since some experts say we're overusing antibiotics, preventing our natural antibodies from developing. Though studies of hand soap show that chlorinated water can combine with triclosan to form chloroform, the ADA says this study isn't relevant to toothpaste, and most dentists agree. One dentist, Ellie Phillips, DDS, advises using a regular fluoride toothpaste instead, recommending Crest Cavity Protection (*Est. $4/8.2 oz.) as the best toothpaste for adults. Crest Cavity Protection carries the ADA seal and has an RDA of 95 -- more abrasive than Colgate Total, but still around the middle of the pack.
Experts say that any toothpaste that has fluoride is effective in combating tooth decay. If it also carries the ADA seal, this means the manufacturer's claims have been checked. The ADA does charge for applying for certification, so there are safe and effective toothpastes that don't carry the seal. However, not all toothpaste applications are approved, so the certification process is significant.
As a budget choice, dentist John V. Reitz recommends the ADA-approved Aquafresh Cavity Protection (*Est. $2.50/6.4 oz.) for cavity-prone patients, saying it cleans well but is low in abrasiveness so it doesn't cause sensitivity or erode enamel. The striped Whitening version is more abrasive but earns praise in a comparison review at Slate magazine, as "zesty and clean-feeling with good ease of squeeze and little aftertaste."
Colgate-Palmolive also makes budget toothpaste under the Ultra brite brand. Ultra brite Advanced Whitening (*Est. $2.25 for 6 oz.) toothpaste has fluoride, but doesn't carry the ADA seal. It does get top ranking in one comparison test for stain-removing ability. With an RDA of 145, this toothpaste is a lot more abrasive than the toothpastes discussed so far. In addition to hydrated silica (the abrasive in most toothpastes), Ultra brite boosts stain removal by adding alumina. A 1997 comparison review of toothpastes available in Europe concludes that this combination boosts cleaning power, not just abrasiveness.
As noted earlier, xylitol is the latest toothpaste ingredient to get widespread interest. Clinical studies go back much earlier, and one study shows that the combination of fluoride with xylitol is more effective than either ingredient alone. Xylitol is a natural sugar that mysteriously combats tooth decay and gum disease instead of enhancing it as most sugars do. Tom's of Maine makes several ADA-approved toothpastes that use this combination. Tom's of Maine Natural Fluoride Toothpaste Spearmint (*Est. $3.60/6 oz.) uses calcium carbonate (essentially chalk) as the abrasive, so it has lower stain-removing ability than toothpastes that use hydrated silica. This toothpaste gets mostly positive reviews from users, but some find the taste bitter and prefer the flavor of Tom's of Maine Natural Anticavity Baking Soda Fluoride Toothpaste, Peppermint (*Est. $3.60 for 6 oz.) .
Xlear Spry (*est. $4/4 oz.), which also combines fluoride with xylitol, gets some positive reviews but includes methylparaben as a preservative. Parabens have received some negative attention in recent years for estrogenic activity - meaning they can add to the risk of some cancers, including breast cancer. Consumer Reports Greener Choices recommends avoiding toothpastes and other personal care products that include methylparaben.