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.