Picking a toothpaste isn't as easy as it used to be.
This once-lowly staple has become big business, with annual sales of $1.5 billion. Toothpastes today come in a dizzying range of colors, flavors, and formulations. There are trendy dispensers for products that purport to whiten teeth, sweeten breath, calm sensitive molars, and even stop gum disease.
"As recently as 10 to 12 years ago, there wasn't that much of a choice for patients," says Dr. Kenneth Burrell, D.D.S., senior director of the American Dental Association (ADA)'s Council on Scientific Affairs.
The number of manufacturers hasn't grown significantly, but each has a longer list of offerings. There are seven kinds of Crest, made by Proctor and Gamble, which are further divided into gels and pastes -- some with baking soda and some without. Colgate-Palmolive Co. makes more than a dozen kinds of toothpaste. At least eight other serious contenders offer multiple formulations.
An ADA survey found that while more than half the adults in this country are increasingly concerned with caring for their teeth and gums, 56 percent were confused about what dental products to buy.
Do you really need all the extras on the end of your toothbrush? Which ingredients do what?
"There's a lot of hype about different and new things toothpastes do," says Dr. Eric Spieler, D.M.D., a dentist in Philadelphia who also lectures at the University of Pennsylvania School of Dental Medicine. "You can brush with plain old Acme fluoride toothpaste and have gorgeous teeth. If you brush and floss, use a regular toothpaste with fluoride, and get regular dental checkups -- you'll do fine."
William van Dyk, D.D.S., an adjunct professor at the University of the Pacific in San Francisco and a dentist in San Pablo, California, says one difference is advertising. In the past, he explains, manufacturers emphasized various product attributes, such as spearmint taste or a clean, fresh feeling. Now, ad copy carries specific recommendations for conditions, such as gum disease or halitosis. "A lot of manufacturers are taking their claims to the public, instead of trying just to convince the dentist or hygienist," Dr. van Dyk says. "They are trying to go around the usual experts."
Of course, you may simply like the taste and feel of a premium product. This could easily translate into better oral health if it encourages you to brush. Parents may want to invest in a flavored children's toothpaste if it gets kids to brush.
Choosing a toothpaste is also highly personal, and may even tug some emotional strings. Lin Vickery of Lunenburg, Massachusetts, says she only buys "natural" children's toothpaste for her 4-year-old daughter because that's what her dentist recommends. But Lin also likes that the paste she buys has fewer artificial ingredients than others.
Any toothpaste you buy should contain certain ingredients proven to work. For signs of what to look for on your next shopping trip, click on one of the pages in this story at the top of this page.
This seal means a toothpaste is safe and that it does what it says it will do. It has undergone independent clinical studies required by the ADA. Claims, such as cavity fighting and tartar control, are backed by scientific findings. The ADA also reviews all toothpaste-advertising claims before the public sees them.
Only about 60 percent of the dental products initially submitted meet ADA standards, says Dr. Burrell, administrator of the committee that reviews and votes on products. Manufacturers must reapply for the seal every three years, or any time they alter a product's chemical composition.
Many dentists recommend only toothpastes with the ADA seal, and it apparently weighs heavily on consumers. Slightly more than half the adults polled by the ADA said the seal influences which brands they buy.
After 20 years of selling toothpaste, Tom's of Maine received its first Seal of Acceptance in 1995 for three of its natural fluoride pastes: spearmint, cinnamon, and fennel. The company decided to apply for the seal after receiving inquiries from customers asking why its pastes didn't carry it.
Tammy Jones, 34, of Kennedale, Texas, says she won't even consider buying a brand without the ADA seal. "I value my teeth too much."
Dentists now say everyone -- not just kids -- benefits from using toothpaste with fluoride, which strengthens teeth and reduces the incidence of cavities.
The percentage of fluoride, in relation to other ingredients, generally falls in the range of 0.1 to 0.6 percent. (This information is printed on the package.) Parents of young children should choose a paste with fluoride at the lower end of the scale in case their children accidentally swallow a large quantity, ingesting more fluoride than they should, says Dr. Kimberly A. Loos, D.D.S., a dentist in Sunnyvale, California. Most dentists recommend children under age six brush with a match-head-size amount of toothpaste. Kids older than six can use more because they tend not to swallow it.
If left alone, plaque forms tartar, a hard, brownish deposit that appears on your teeth despite regular brushing. Tartar control toothpastes contain chemicals known as pyrophosphates, which help reduce tartar. Some dentists, such as Dr. van Dyk, recommend tartar control pastes to all patients with healthy teeth and gums.
But don't expect miracles, he says. "No toothpaste scours teeth like we wish it would," Dr. van Dyk says. Also, pyrophosphates can't remove tartar that's already formed. To do that, you need to have your teeth professionally cleaned by the dentist.
Many adults have a receding gum line, which leaves part of the root exposed. A receding gum line -- which becomes common after age 35 -- is generally a sign of brushing the teeth too hard or scrubbing them too frequently. It can also be caused by grinding your teeth.
Receding gums may also make teeth "sensitive" to cold and touch. Certain pastes, which contain potassium nitrate or strontium chloride, can quell the discomfort by buffering the nerve endings and shutting down pain signals.
Dentists often recommend pastes for sensitive teeth. Within a few weeks, patients may get enough relief to switch back to their regular brand, if they wish. People who don't notice an improvement should check with their dentist.
Most big-name manufacturers now offer at least one product with baking soda or a baking soda/peroxide combination. These added ingredients won't improve your oral health, according to the experts, although you'll probably enjoy brushing with them.
Both ingredients leave your mouth with a clean sensation, and the bubbles and fizz of peroxide make it feel as if your teeth are getting cleaner. "I think baking soda has a wonderful value in that it makes teeth feel really clean -- but it has no scientifically proven benefits," says Dr. van Dyk.
Whitening toothpastes may lighten superficial stains caused by coffee or tobacco, but they don't actually whiten teeth, says Dr. van Dyk. You may see some improvement, but nothing that rivals a professional bleaching system prescribed by a dentist, according to Dr. Spieler. There are no over-the-counter whitening toothpastes with the ADA Seal of Acceptance.
Over-the-counter whitening pastes also do little or nothing to improve the appearance of deeply discolored or tetracycline-stained teeth. Tetracycline, an antibiotic used to treat infections and control acne, has been known to discolor the teeth of some infants and children.
Most whitening formulas are abrasive, and -- used regularly for long periods of time -- may harm tooth enamel, says Dr. Loos. "I tell my patients if they want to use whitening toothpaste, fine; but not for all their brushing." Instead, she recommends brushing twice a day, once with a whitening paste and once with a regular paste.
This detergent is found in nearly every brand of toothpaste. Now, there's evidence SLS may aggravate canker sores. But these findings aren't conclusive and more research is needed to prove this link.
Some more expensive toothpastes are made without SLS. So, if you suffer from painful recurring canker sores, the added cost may be worth it, says Dr. Spieler. SLS is listed on the package. Patients also can ask their dentist which brands don't contain SLS.
You might gain peace of mind using "natural" toothpaste, even though it contains some ingredients many of us would consider artificial.
For instance, the abrasive used in one major "natural" brand is chalk, instead of the more widespread silica. "The term 'natural' is kind of relative," says Dr. Burrell. "It's natural within context."
Products designed to arrest gingivitis, or early gum disease, are the latest contenders in the toothpaste wars. The Food and Drug Administration recently approved one paste that aims to fight gingivitis, as well as cavities, tartar, and plaque. Some labels are marked as "antigingivitis" or "gum care."
The best advice: Look for the ingredient triclosan, which attacks bacteria so it can't form into plaque. The average person probably doesn't need this product, Dr. van Dyk says, but he recommends it to patients with early signs of gum disease.