Toothpaste

Best toothpastes

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.

Toothpastes for sensitive teeth

All the toothpastes discussed so far include sodium lauryl sulfate (SLS) as a surfactant. It's what gives the toothpastes their pleasant foaminess. Some people find that it irritates their mouths, however, contributing to the incidence of canker sores or other mouth discomfort. Another problem dentists frequently encounter is sensitive teeth - teeth that hurt when touched by hot or cold food or drink.

A lot of things can cause canker sores and sensitive teeth, but most toothpastes designed for sensitive mouths and teeth don't include SLS, which can dry the gums and lining of the mouth. Some toothpastes for sensitive teeth made by Sensodyne and Rembrandt also contain potassium nitrate, an ingredient that can alleviate tooth sensitivity. Dentists say that some patients only need to use a toothpaste for sensitive teeth for a month or two, while others need to stay with it indefinitely.

For patients with sensitive teeth, quite a few dentists recommend Sensodyne toothpastes, which don't contain xylitol but do contain fluoride plus potassium nitrate (5%) to reduce sensitivity. Dr. Vu Le recommends Sensodyne Pronamel (*est. $5.50 for 4 oz.) , which also reduces one of the main causes of sensitivity, acid erosion of tooth enamel. Nor does it contain SLS, though a few users reviewing Pronamel toothpaste at Drugstore.com report that it irritates their gums anyway. Users also give it mixed reviews for taste and texture. This particular Sensodyne toothpaste isn't on the ADA-approved list. Sensodyne Fresh Impact (*est. $4.50/4 oz.) does carry their seal, but contains SLS, which can irritate some mouths.

Rembrandt Extra Gentle Mint (*est. $7/3 oz.) does not contain SLS, and does contain xylitol in addition to fluoride. The RDA isn't specified, but it contains aluminum hydroxide to boost stain removal. None of the Rembrandt toothpastes are on the ADA list, but the Extra Gentle toothpaste, also called Rembrandt Classic Canker Sore Extra Gentle, gets positive reviews from 70 users rating it at Drugstore.com - far more than most toothpastes reviewed there. Rembrandt Classic Sensitive (*est. $7/3 oz.) contains potassium nitrate to combat sensitivity, but sweetens with saccharin and sorbitol rather than xylitol and contains methylparaben - a preservative that quite a few experts suggest avoiding.

The more expensive Squigle Enamel Saver (*est. $8/4 oz.) isn't on the ADA list either. It doesn't have potassium nitrate and isn't designed for sensitive teeth, but it does have 36 percent xylitol - more xylitol than most toothpastes boast. The toothpaste's name stems from its low abrasiveness; the RDA is only 44. Squigle Enamel Saver earns very positive user-written reviews at Amazon.com, and several detailed single-product reviews also recommend it.

Tom's of Maine Natural Clean & Gentle SLS-free (*est. $4/5.2 oz.) has less xylitol but costs about half as much. It also has only mild abrasiveness, with an RDA in the 40s. It uses glycyrrhizin, a natural ingredient derived from licorice, for foaming. According to Dr. Weil, this ingredient is also a natural anti-inflammatory and a useful treatment for mouth sores.

Toothpastes without fluoride

Experts do agree that ingesting too much fluoride can cause fluorosis, which can cause white flecks on teeth, or even weak bones and susceptibility to fractures. Fluorosis is a significant health issue for babies and children whose teeth are still developing. On the other hand, some fluoride is important for helping a child develop strong teeth. Experts suggest monitoring the amount of fluoride an infant and small child ingests, since some bottle-fed babies can get fluoride in their formula if it's made with fluoridated water.

For adults, the small amount of fluoride in toothpaste is not enough to cause fluorosis. However, fluoride does build up in the body. Older adults with any chronic diseases might want to consult a doctor about whether or not to use a fluoride supplement or drink fluoridated water. Fluoride is also a natural ingredient in many foods, especially in tea. For most adults, the ADA says the benefits of fluoride toothpaste far outweigh any risks -- for that reason, no fluoride-free toothpastes are ADA approved.

Tom's of Maine Natural Antiplaque plus Whitening Gel Toothpaste, Spearmint (*est. $3.70/5.5 oz.) earns rave reviews from consumers rating toothpastes at Drugstore.com. Unlike some of the other toothpastes by Tom's of Maine, it contains SLS, which can dry and irritate the mouth. However, we found no complaints about this toothpaste. The more expensive Nature's Gate Herbal Crème de Anise Natural (*est. $5.20/6 oz.) also contains SLS but gets high ratings at Drugstore.com. Users say they love the licorice flavor.

XyliWhite (*est. $3.85/6.4 oz.) is less expensive, doesn't contain SLS and uses hydrated silica instead of calcium carbonate for better stain removal. XyliWhite is 25 percent xylitol, and also includes baking soda. Tea tree oil is included for its fungicidal and antibacteriological properties, and papain is used as a whitener. The RDA isn't specified.

Note that just because a toothpaste ingredient is "natural" or "herbal" does not mean that no one is sensitive or even allergic to it. (Think of poison ivy, a very natural and organic plant.) Some people say they're allergic, for example, to the seaweed-derived carrageenan which is often used as a thickening and smoothing agent. Health Canada warns that quite a few herbs can also trigger allergies.

Important Features: Toothpaste

Here's what the experts have to say about the different terms and claims you might see on toothpaste labels:

• Get a fluoride toothpaste. Experts say brushing with a toothpaste that contains fluoride is important for preventing cavities. On the label, this may be called stannous fluoride, sodium fluoride or monofluoride phosphate (MFP). This is the ingredient all oral care professionals seem to agree upon as the basis for using commercial toothpastes. As long as the product has fluoride, it will help maintain oral health. However, stannous fluoride can stain teeth.

• Look for the American Dental Association (ADA) Seal of Acceptance. The ADA awards its seal only after reviewing the "appropriate clinical and/or laboratory studies and scientific data." Any toothpaste with the ADA seal has been proven safe and effective for the claims on its label. Though there is a fee to apply, not all applications are approved.

• Experts are mixed on tartar control formulas. The active tartar-control ingredient, tetrasodium pyrophosphate, has been proven to prevent tartar, but it can't remove tartar already on the teeth. Only a professional cleaning can do that. Some dentists say tartar-control pastes can cause mouth irritation, and do not do enough extra to warrant the risk of this irritation except for extremely tartar-prone patients.

• "Whitening" toothpastes are over-hyped. While the ADA believes current levels of hydrogen peroxide in some whitening toothpastes are safe, some dental experts say peroxide can irritate and damage gum tissue. The bubbling may make you feel like you're getting a better cleaning, and when combined with baking soda, hydrogen peroxide does kill bacteria that cause gum problems. However, most experts say fluoride plus triclosan is a better bet. No toothpaste has been proven effective in actually changing the color of teeth. The whitening toothpastes merely clean surface stains and cannot change the underlying tooth color.

• Sensitive formulas can help those with mouth pain. These work for mild cases of tooth hypersensitivity, but expect to wait four to six weeks before you feel any results. The ADA recognizes two effective ingredients in treating sensitive teeth and gums: strontium chloride and potassium nitrate. These "block the tube-like channels that pass through teeth and connect to nerves," thereby reducing "the ability of the nerves to transmit pain," says the ADA. Keep in mind that these won't work for tooth pain caused by cavities or tooth problems other than receding gums.

• Avoid SLS if you have sensitive teeth or are prone to canker sores. Sodium lauryl sulfate can irritate the gums and lining of the mouth in some people. If you are prone to mouth sensitivity or canker sores, dentists recommend choosing a fluoride toothpaste that does not contain SLS.

• Consider the level of abrasiveness. Abrasive ingredients are essential for removing plaque, and are usually in the form of hydrated silica or calcium carbonate. Polishing alumina added to hydrated silica is especially effective. All ADA-approved toothpastes are within certain limits, but the range is quite great. Some dentists advise erring in the direction of low abrasiveness.

• Although toothpaste commercials often show actors squirting a huge, swirling amount of toothpaste on the brush, experts stress that you need no more than a pea-sized amount of toothpaste to do the job -- more than that is just product waste. Kids require even less.

Our Consensus Report shows how many times products are top-ranked by reviewers included in our
All The Reviews Reviewed chart.

# of Picks	Model (with Retailer Links)	Details from Amazon.com
6	Colgate Total (*est. $3.50 for 7.8 oz.)	details
2	Squigle Enamel Saver (*est. $8/4 oz.)	details
2	Crest Cavity Protection (*est. $4/8.2 oz.)	details
2	Sensodyne Pronamel (*est. $5.50 for 4 oz.)	details
2	Aquafresh Cavity Protection (*est. $2.50/6.4 oz.)	details
1 each	AIM Whitening with Baking Soda , Aquafresh Whitening Striped Gel , Arm & Hammer Advanced White , Arm & Hammer Dental Care , Arm & Hammer Peroxicare , Colgate Cavity Protection , Colgate Tartar Control Whitening Gel , Colgate Total Whitening Gel , Colgate Total Advanced Clean , Crest Sensitivity , Crest Whitening Plus Scope , Colgate Whitening Plus Tartar Control, Desert Essence Natural Tea Tree Oil Toothpaste Mint , Dr. Ken's Maximum Care Spearmint Cool , Elmex Sensitive Plus, Gleem Sodium Fluoride , Jason , Jason Healthy Mouth Tea Tree Oil , Jason Natural Power Smile , Kiss My Face Triple Action Aloe Vera , Kiss My Face Whitening , Listerine Essential Care , Listerine Tartar Control Cool Mint , Mentadent Crystal Ice , Mentadent Original Toothpaste, Nature's Gate Natural Baking Soda and Anise Oil , Nature's Gate Natural Herbal Crème de Peppermint , Rembrandt Classic Canker Sore Toothpaste Extra Gentle Mint , Rembrandt Original, Rembrandt Premium Whitening Extra Gentle , Tom's of Maine , Tom's of Maine Natural Anti-plaque Plus Whitening Gel Spearmint (xylitol no fluoride) , Tom's of Maine Natural Anti-plaque Tartar Control Plus Whitening Peppermint , Tom's of Maine Sensitive , Ultra brite Advanced Whitening , Weleda , Weleda Plant , Xlear Spry

Note that although reviews may recommend several toothpastes from the same brand, that doesn't mean that every toothpaste from that brand gets high ratings. You can look at this chart and see an amazing lack of consensus among reviews, but among the hundreds of toothpastes available, five are actually recommended in more than one review - with Colgate Total recommended by more reviews from dentists than any other toothpaste. Ultra brite Advanced Whitening is deemed the best for stain removal, and Rembrandt Classic Canker Sore Toothpaste Extra Gentle Mint is helpful for people with sensitive teeth, and it contains xylitol -- an ingredient missing in Sensodyne.

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