Proof Panel: Toothpaste
It’s a basic necessity. Brushing your teeth several times daily helps keep them clean, free of plaque-forming bacteria, and freshens the breath. In the UK, we spend lb217 million a year just on toothpaste.
Brushing, like most daily tasks, can be boring, so manufacturers now advertise toothpaste so as to suggest it ‘s a beauty or luxury product rather than a matter of personal hygiene. This encourages consumers to buy more and at a higher price, and also draws attention away from ingredients. What ‘s actually in toothpaste is not something most people concern themselves with – though perhaps they should.
Dental decay and gum disease affect more than just the mouth. Periodontal disease is linked with other conditions such as heart disease (J Periodontol, 1996; 67: S1138-42); the association is even stronger than for risk factors like smoking and high cholesterol (J Am Dent Assoc, 1998; 129: 301-11). Poor oral health is also related to stroke, peripheral vascular disease, diabetes and preterm pregnancy.
However, toothpaste is not actually necessary for clean teeth. Dry-brushing is just as effective. Abrasives in toothpaste, such as chalk or silica, help but, essentially, the function of toothpaste is to deliver ‘active ingredients’ like fluoride, and antibacterials like triclosan, to the teeth and gums. That’s why modern toothpastes contain glue-like agents such as PVM/MA co-polymer to keep the active ingredients in contact with the teeth after rinsing.
For beauty and health, we rely on the active ingredients; yet, many of these may be doing more harm than good.
Fluoride myths
Many consumers buy toothpastes with fluoride believing it protects teeth. But there ‘s little convincing evidence of this. Unlike true nutrients, such as calcium and magnesium, no human disease – including tooth decay – will result from a fluoride ‘deficiency’.
In fact, fluoride is a systemic poison, and there is enough in the average family toothpaste to kill a small child if ingested (J Public Health Dent, 1997; 57: 150-8). The US and Sweden – but not the UK – require that fluoride toothpastes be labelled with a special poisons warning.
Fluoride can cause sensitivity/allergy-type reactions and is now suspected in a host of illnesses, including gastric reflux, bone disorders, diabetes, thyroid dysfunction and mental impairment. Fluoride from toothpaste, tablets and water before age six is also a major risk factor for fluorosis, which mottles and discolours teeth (Pediatr Dent, 2000; 22: 269-77).
Both animal and human studies show a clear relationship between oral cancer and fluoride (Townsend Lett Docs, 1990; 89: 864-5; Yiamouyiannis J, Fluoride: The Aging Factor, Delaware, OH: Health Action Press, 1993). More recently, fluoride has been found to activate and interfere with G-proteins, chemical messengers vital to hormone and neurotransmitter function (see box, page 2).
Foaming mad
Other ingredients in standard toothpastes are also worrying. Many contain the synthetic industrial-strength detergent
sodium lauryl sulphate (SLS), a suspected GI or liver toxicant. SLS is also associated with mouth ulcers (Compend Contin Educ Dent, 1997; 18: 1238-40), and can irritate the mucous lining of the mouth – relevant given the fluoride/cancer link. It may even increase uptake of other, more harmful substances in the mouth (Int J Occup Med, 2000; 6: 138-42, 143-7).
Triclosan, a common antibacterial in toothpaste, is sometimes added to counteract SLS (Scand J Dent Res, 1993; 101: 192-5), yet the two combined can become an even more powerful irritant (Toxicol Lett, 1997; 91: 189-96). Triclosan is also associated with the rise in resistant ‘superbugs’.
Used in antibacterial/antiplaque formulas, triclosan can reduce plaque buildup (Am J Dent, 1989; 2: 231-7) but, although tartar-control formulas may prevent 40-50 per cent of new tartar buildup, they can do nothing for plaque that is already present.
Abrasives are also potentially harmful. Case reports show that fine granules of silica and other abrasives can collect beneath the gums to form granulomas – small nodules of inflamed tissue (Dermatology, 2001; 203: 177-9; Ann Periodontol, 1999; 4: 20-31). These lesions can mimic gingivitis, and may also leave the gums more vulnerable to infection.
The products
Toothpaste alternatives can be purchased in healthfood shops, by mail order and on the Net – though some aren ‘t all that ‘alternative’. Many contain SLS, fluoride or preservatives such as parabens, a potential hormone-disrupter.
We asked 10 PROOF! Panel members to test seven natural toothpastes in a range of formulations – foaming and non-foaming, gels and pastes, as well as those for sensitive teeth and gums. Most, but not all, were mint-flavoured.
The panel assessed each on the basis of labelling and packaging, naturalness of ingredients, taste, look, smell, how clean it made the mouth feel and for how long, and adverse effects. For each criterion, the products were awarded points out of a possible 100, and the scores combined to produce an overall score. (Value for money was not included as toothpaste is used at different rates. But most alternatives were competitively priced at around 3-4 p/mL.)
Labels using words like ‘natural’ and ‘organic’ inspired confidence, and phrases like ‘vegan’, ‘suitable for vegetarians’ or ‘no animal ingredients’ were reassuring. In this respect, AloeDent lets users down with its rather vague “100% natural origin” claim. With chitosan, it’s not suitable for vegans, but vegetarians may find it acceptable. AloeDent Sensitive appears to be suitable for vegetarians, but a clearer statement would have helped.
All of our tested products scored high on label information, though Green People’s plain packaging let it down – 80 per cent of the panel found it “dull” or “hard to read”. Arrowmed’s and Weleda’s low-key packaging were also considered a bit too “functional”
Foam is not necessary to clean teeth and it could be argued that non-foaming brands without detergents are better. Most testers got used to the non-foaming brands (Green People, Sarakan, Weleda) easily. Weleda ‘s Plant Gel just scraped through as the favourite. The pink colour didn’t put people off, but several testers complained that they had to use more product to produce a clean-feeling mouth, which may make it less good value compared with the others. Sarakan ‘s unusual flavouring got a thumbs down from 80 per cent of the panel: “tasted of dental rinse” and “medicinal” were the most frequent complaints.
As for adverse effects, the few reported are worth noting. Tom’s Baking Soda toothpaste produced sensitive teeth in 20 per cent of the panel. A further 10 per cent said that Sarakan left a bad aftertaste.
Surprisingly, there was good agreement among our panellists as to which formulations were pleasant and effective, and which were not. We are all creatures of habit. Years of using foamy flavoured toothpastes have conditioned most of us to expect this, so toothpastes that looked, felt and tasted like conventional ones scored higher than those that didn ‘t.
The all-round winner was AloeDent, which made mouths feel fresh, used a mild detergent (sodium lauryl sarcosinate), was gentle on the gums and contained herbs as well as CoQ10 for gum health. New to the UK, Jason Sea Fresh came a close second, with many testers appreciating its long-lasting freshness and organic ingredients. Half our panel found Green People ‘s Eucalyptus and Aloe Vera disappointing: “Looks and smells like Polyfilla”; “Smell made me gag . . . like cement”; “Horrible colour . . . teeth felt clean, but mouth didn’t feel fresh” were typical comments.
AloeDent Original
Distributor: Optima Healthcare (01274 488 511)
Price: lb3.49 (250 mL)
Rating: *****
Containing CoQ10 and tea tree oil, this fluoride-free gel claims to soothe, protect and whiten. Panellists liked its strong peppermint and menthol flavour, and long-lasting freshness. It uses chitosan, proven to be antibacterial in toothpastes and mouth rinses (Acta Odontol Latinoam, 2002; 15: 3-9; Bull Tokyo Dent Coll, 2003; 44: 9-16).
Jason Sea Fresh
Distributor: Kinetic Enterprises (020 7435 5911)
Price: lb4.95 (170 g)
Rating: ****
The organic ingredients used here include blue-green algae, sea salt and trace minerals, Perilla seed extract (a proven antibacterial; Biosci Biotechnol Biochem, 2002; 66: 921-4) and powdered bamboo to augment the chalk and silica. It also uses less foaming agent (sodium cocyl glutamate, a mild detergent) than some of the others. This has a milder flavour than AloeDent ‘s, and is also suitable for vegans.
AloeDent Sensitive
Distributor: Optima Healthcare (01274 488 511)
Price: lb3.49 (100 mL)
Rating: ****
Regardless of whether testers had sensitive mouths or not, this was popular. Less expensive than the original, it uses vitamin K and Echinacea instead of CoQ10 and chitosan. It is also suitable for vegetarians.
Plant Gel
Distributor: Weleda (0115 944 8222)
Price: lb1.95 (75 mL)
Rating: ***
This pink gel is gentle on tooth enamel and may be useful for delicate gums. With a mild spearmint flavour, it is free from all the right things and suitable for vegans. But several panel members found that it didn ‘t feel right in the mouth, and one-third commented on its alcohol content, which could have a drying effect.
Organic Eucalyptus & Aloe Vera
Distributor: Green People (08702 401 444)
Price: lb2.99 (50 mL)
Rating: ***
The only certified organic toothpaste in our survey, this has all the hallmarks of a great alternative: no fluoride, no foam, no silica, no sweeteners and plenty of herbal ingredients. It was, however, very expensive and proved to be not as popular as expected due to its colour, taste (a peppermint flavour) and general presentation. It ‘s suitable for vegetarians, but not vegans.
Nature’s Baking Soda
Distributor: Tom’s of Maine/Healthy Sales (0140 378 6460)
Price: lb3.99 (85 mL)
Rating: **
Among the more popular alternative brands, unlike many of the others, this can be found in some supermarkets. It worked well, but few of our panel accepted SLS “derived from coconut oil”, and some found it too ‘wet’ coming out of the tube. It was perceived as drying in the mouth by 20 per cent and not all liked the taste, which was deemed more salty than minty. This is suitable for vegetarians and vegans.
Sarakan Original
Distributor: Arrowmed (01420 544 424)
Price: lb1.57 (50 mL)
Rating: **
Flavoured with natural oils of peppermint, clove and geranium, it also contains extract of Salvadora persica (also known as the toothbrush tree), shown in studies to have some plaque-removing ability (J Contemp Dent Pract, 2002; 3: 27-35). Although it has no fluoride, SLS or sweeteners, it does use methylparaben as a preservative; a few testers also questioned the colouring CI 77491 (from iron oxides and not likely to be harmful in a rinse-off product). Tasting mainly of cloves, it also includes two types of mint. It performed as well as any of the others, but lost a point because of its taste. This is suitable for vegans.
- This article first appeared in the September 2004 edition of Proof!.
