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Doctor K: Choose toothpaste with fluoride (and don’t forget to floss)

By Anthony L. Komaroff and M.D. Universal Uclick

DEAR DOCTOR K: I’m confused by the many types of toothpaste on pharmacy shelves. What should I look for in a toothpaste?

DEAR READER: To prevent cavities and tooth decay, you need to brush away plaque – that sticky, bacteria-laden material that builds up on teeth. It’s best to brush at least twice daily: once after you eat breakfast, and then again before you go to sleep.

When it comes to plaque removal, your toothbrush does most of the heavy lifting. If you were forced to give up either the toothbrush or toothpaste, you’d give up the toothpaste. Fortunately, it’s easy to have both.

And toothpaste definitely helps, in several ways. It removes stains and leaves your mouth fresher. Commercial toothpastes are a concoction of abrasives, foaming agents, water and binders. Flavor, color and sweeteners are added. They may also contain agents to prevent cavities, combat gum disease, make teeth less sensitive or whiten teeth. Here are some ingredients you may see highlighted on labels:

– FLUORIDE. Choose a toothpaste that contains fluoride, which helps prevent tooth decay.

– TRICLOSAN. This ingredient helps fight the gum disease known as gingivitis. It also helps reduce plaque, inflammation and bleeding of the gums.

– ANTI-SENSITIVITY INGREDIENTS. Some toothpastes are designed to reduce sensitivity of teeth to heat and cold. It might take a few weeks of using an anti-sensitivity toothpaste before you notice any improvement. You can use anti-sensitivity toothpastes that also contain fluoride as your everyday toothpaste.

– ABRASIVES. When choosing a toothpaste, consider its level of abrasiveness. A little bit of roughness helps remove plaque and stains, but too much can strip away tooth enamel. Using a toothpaste that’s too abrasive can lead to permanent tooth damage, particularly around the gum line. If you don’t smoke and have few stains, a low-abrasive toothpaste is best for you. The American Dental Association (ADA) issues its Seal of Acceptance only for toothpastes that are mildly to moderately abrasive. So look for the ADA seal of approval on the tube.

– WHITENERS. Toothpaste makers have bombarded the marketplace with products that claim to whiten teeth. All whitening toothpastes contain mild abrasives that help remove surface stains. Whitening toothpastes that display the ADA Seal of Acceptance also have chemical or polishing agents that boost their stain-removal power.

A patient asked me once, “I know you’re not supposed to swallow the toothpaste, but is there any danger if you do?” Swallowing small amounts of toothpaste, which occasionally happens with all of us, carries no risk. However, some people apparently deliberately swallow larger amounts of toothpaste (don’t ask me why). That can cause problems. The fluoride and the triclosan, in large amounts, can cause abdominal symptoms and even more serious problems, including seizures.

Finally, don’t forget to floss regularly. No matter how thoroughly you brush your teeth, it’s impossible to reach the plaque and food debris that lodge under the gum line between your teeth. Your teeth and gums will thank you.

(This column ran originally in October 2014.)

Dr. Komaroff is a physician and professor at Harvard Medical School.

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