Toothpaste and Toothpowder and Remineralizing Claims, Oh My!

Toothpaste is in chaos. With a more naturally inclined consumer and ever-increasing fluoride health concerns, demand has created a new wave of commercially available products. Loads of different ingredients and an internet full of at-home recipes have created a lot of confusion.

    It’s confusing for dentists too. Everyone seems to be throwing every good ingredient they know in a tube and making all sorts of claims that make sense but don’t have any data to back them up. As healthcare providers, we look online to our database of medical research, PubMed (PubMed.gov). PubMed comprises more than 28 million citations for biomedical literature from MEDLINE, life science journals, and online books. Usually, where the U.S. falls behind in more natural-ingredient studies, India excels. Citations may include links to full-text content from PubMed Central and publisher websites. This is a compilation of the medical and dental journals that are published around the world.

    Many holistic toothpaste ingredients are essential oils and sugar alcohols to kill the bacteria and the yeast, most specifically candida albicans that covers the bacteria. There is also a poorly understood inflammatory mechanism with regard to tooth decay. How these holistic toothpastes may “remineralize” is by helping to recreate the right balance so that the body can naturally repair itself.

    In fact, charcoal and bentonite clay products are extremely popular right now. We know that charcoal can help with drug overdose and so it can detox, and we know that clays have trace minerals, and antifungal and antimicrobial properties. It should make sense that these properties help our teeth, at least indirectly, by making our mouths healthier. It is very difficult, however, to find supportive studies. The American Dental Association (ADA) did a review of the literature on charcoal and bentonite clay products (not to say I agree with every stance of the ADA). Of their qualifying studies, more studies actually showed harm than those that supported positive benefits with regard to wear and tooth decay. For the hype, there should be a substantial amount of clinical evidence, even if it doesn’t come from the U.S.

    In an ideal world, there are three things the consumer wants in an anti-cavity toothpaste: a neutral or alkaline pH; low abrasiveness (and even these amounts are contested); and a science-proven nontoxic, truly remineralizing product.

    Tooth decay is a complicated process. We have calcium and phosphorous together in hydroxyapatite that makes up our tooth enamel. Acid attacks teeth all day from our food, beverages and the bacteria in our mouth. Certain people have more acid production from the bacteria and get even more acid from gastric juices. Saliva is supposed to buffer the acid, and be supersaturated in calcium and phosphorous to replace the lost mineral. Although every mouth is different, the most commonly used figure is a pH of 5.5 to dissolve tooth enamel. What most consumers don’t realize is that most natural preservatives need a very acidic pH to be effective, leading to a pH lower than 5.5. We don’t want to brush our teeth with a demineralizing solution, especially if we have to rely on the saliva alone as the only calcium source with which to remineralize.

    We brush to remove the food, drink and bacterial plaque, using abrasives like calcium carbonate, charcoals, clays, sodium bicarbonate, and hydrated silicas. Every commercially available product should have had testing to determine its relative dentin abrasivity (RDA). Usually, this number is not easily available from the packaging, but discovered with a quick online search or phone call to the manufacturer. Any RDA greater than seven has the ability to remove dentin. Especially if you battle sensitivity, have recession, or brush hard, RDA can play into your progression of the wear on your teeth. Although the topic of abrasivity has a lot of argument back and forth, an RDA of 70 or less is generally considered low abrasive.

    There is one product that is commercially available that has been shown to remineralize deeper and in greater quantity than fluoride. The gold standard around much of the world, it is only recently visible in U.S. dental journals. Currently available almost exclusively online, nanohydroxyapatite should be the wave of the future.

    Nanohydroxyapatite remineralizes teeth. It is nanoparticle-sized calcium and phosphorous ions that are readily absorbed into the tooth. It is extremely effective in reducing dentin sensitivity and maintains whiteness of teeth by blocking the ability of stain to penetrate into the teeth. There is a wealth of data from around the world to support the claims. Nanohydroxyapatite was first developed by NASA in 1970 to help astronauts maintain bone and tooth density in space. The patent was bought by a Japanese company in 1978 and has been used in toothpastes around the world ever since. It also has been shown to be nontoxic. Yes, it is synthetically made, but because of that there is a lot of quality control. In study after study, it outperforms fluoride, with both quantity and depth of remineralization.

    Fluoride has historically been the gold standard for remineralization in the United States for its ability to create fluorapatite, a more acid-resistant structure than hydroxyapatite. Fluoride has a lot of toxic potential, however, and consumers are rightfully concerned, as ever-increasing research shows negative effects of fluoride consumption. Fluoride also relies on saliva to remineralize, and only remineralizes to a shallow depth surface of the tooth, where active carious lesions can still progress underneath, facing dentists with a problem coined “fluoride cavities.”

    Why hasn’t nanohydroxyapatite already outcompeted fluoride and become ubiquitous on shelves? Why has it never had Food and Drug Administration (FDA) approval for “anti-cavity” or “remineralizing” claims? This product is coming up frequently enough that dentists should be trying to access it for patients. The mainstream U.S. demand for fluoride alternatives is relatively new. Fluoride, much less expensive, already has drug classification and manufacturers can make claims on tubes. FDA testing is lengthy and expensive.

    Gone are the days when we blindly trust Big Pharma with our health. With the power of the internet and an ever globalized marketplace, consumers are able to take better control of what we put in our bodies. It’s an incredible opportunity to truly own our health care.

Dr. Joanna S. Dover is the principal dentist at Columbia Children’s Dentistry and Forest Drive Dental Care, located at 3731 Forest Dr., in Columbia. For more information, call 803-782-8786 or visit ForestDriveDental.com.