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.