What Are Some Key Differences Among Toothpastes? Which Ones Should You Use?


Hi, I’m Dr. Rob Karlinsey, an oral health resource for clinicians, researchers, and laypeople alike. When I give presentations about preventive dentistry, which usually involves fluoride and remineralization, I’m often asked several questions. Because I’m finding that some of these questions are frequently asked and are relevant to today, I thought I’d prepare and share with you several unscripted Q&A videos regarding my opinions.

So here’s a common question I receive regarding toothpaste.

  1. Question: What are some key differences among toothpastes?
  1. Answer: Let’s start with:
    1. Facts on efficacy
      1. 25% reduction in caries from daily use of standard fluoride toothpastes
      2. 75% reduction in caries from daily use of prescription-strength fluoride toothpastes
    1. Some key differences among pastes
      1. Gel vs. paste
        1. Those with abrasives: pastes; those without: gels.
        2. Often gels are more acidic (so be careful)
        3. Gels tend to be ‘runny’ so from a texture perspective may not be appealing
        4. Gels often have limited flavors
      2. Abrasive level (RDA, REA)
        1. Generally those lower than 60 (on the RDA) scale are quite gentle. This includes gels (because there isn’t an abrasive system), along with baking soda, and very fine silicas
      3. Fluoride system
        1. Lots: sodium fluoride, sodium monofluorophosphate, stannous fluoride are especially popular in the US
        2. Which is best? Debatable. There have been very good reviews for each type having ‘superiority’
          1. Sodium fluoride plus silica is very popular (think 3M Clinpro Tooth Crème)
          2. Sodium MFP plus calcium carbonate (think some Colgate toothpastes)
          3. Stannous fluoride, now with polyphosphate (think Crest Pro Health)
      4. Remineralization combination systems
        1. Fluoride plus ACP, CPP-ACP, functionalized TCP. Hydroxyapatite, bioglass
      5. Whitening (physical vs. chemical)
        1. Polyphosphates, many silicas contribute to physical removal of organic residue
        2. Peroxides for chemical whitening
      6. Xylitol – really, what’s the benefit here?
        1. Really, xylitol is meant to change microbial makeup, or at least not contribute to acid production
        2. In a toothpaste? From a professional perspective, I’m not convinced. I mean, even lozenges, mints and gums can produce marginal benefits, and usually is dependent on the flow of saliva. Thus, while I’m not going to rule it out, I find it odd that if xylitol toothpaste did work, then surely it would be discussed in the existing body of xylitol knowledge, which spans more than 50 years; however, it isn’t, so I have significant doubts regarding its anti-cavity benefits. For it truly to show a benefit, it would have to be tested against a ‘gold-standard’ fluoride toothpaste in several clinical trials
      7. SLS – is really that detrimental?
        1. SLS is a commonly used detergent – useful in cleansing, and is especially noteworthy in foaming.
        2. Commonly used as ‘gold standard’ for detecting skin sensitivity (patch-testing) – one reason is that degree of sensitivity is based on dose
        3. As such, at a high SLS loading level, even with someone with a high-threshold for SLS-based sensitivity would experience irritations.
        4. In short, sensitivity is likely based on level of SLS in the product – and not all products have the same amount. A good indicator is the amount of foaming, as many believe a high-foaming paste is ‘working’.
      8. Fluoride-free: If it doesn’t have fluoride, probably more for cosmetic benefits, but be careful of potential problems (i.e., too abrasive, may cause irritations, or may simply be ineffective)
    1. If you don’t like the paste profile, probably won’t use the paste as much as you should
    2. This means, for example, the flavor and mouthfeel characteristics must be appealing.
    1. For daily use but oversight with kids is a must
      1. Please don’t eat toothpaste
      2. Probably be careful for kids less than 6 years of age. By the time a typical child in in 5th grade, should be responsible enough not to eat toothpaste (or, at least you would hope so).
    1. And above all, no matter which toothpaste you use, remember: spit, don’t rinse
      1. Especially important for those with sensitivity, orthodontia, history of decay
2018-03-04T19:16:36+00:002018|Media, Q&A|

Robert L. Karlinsey, PhD

Dr. Robert L. Karlinsey earned a BS in Physics and PhD in Chemical Physics, holds several patents, and has published in multiple fields including dentistry, chemistry, and materials science. His lifelong struggles with his own dental decay ultimately inspired him to investigate the remineralization of teeth.