Traits of Toothpaste

Toothpaste – it has been the foundation of the most basic of daily oral health routines dating back to ancient civilizations. But, how many people today actually know what makes up the concoction that we dab on our toothbrushes and scrub all over our teeth every morning and night? You’ll be happy to know that we’ve come a long way since the use of crushed bones and oyster shells, ashes, burnt eggshells and powder of ox hoof.

Toothpastes, also called dentifrices, are pastes, gels or powders that help remove plaque and strengthen tooth enamel. So, what are all of those substances listed on the side of the tube? The paste or gel itself takes its form from abrasives, water, humectants and binders. Other ingredients like detergents or surfactants; preservatives; flavor, color, and sweetening agents; fluoride; calcium phosphate; anti-bacterials; whiteners; and other agents may be added to provide certain properties to each specific toothpaste forumulation. All of these ingredients can be important for not only helping to prevent dental disease but also for giving the toothpaste the taste, appearance and feel in the mouth that makes a person want to brush with it.

Let’s take a closer look at some of the most common ingredients you will find in your toothpaste and why they are there.

Fluoride is the key active ingredient in toothpaste that has been demonstrated in numerous clinical trials to prevent tooth decay. Fluoride affects the bacteria that cause tooth decay, but its primary action is to incorporate into the tooth structure (enamel and dentin) making the tooth more resistant to acid attack by decay-causing bacteria. It actually repairs (remineralizes) the tooth enamel that gets damaged by the acid producing bacteria present in almost everyone’s mouth. Without fluoride in the toothpaste, the cavity-preventing benefit from brushing your teeth is severely limited. Very few people brush thoroughly enough to prevent cavities by brushing alone. Over-the-counter (OTC) toothpaste in the U.S. contains fluoride at approximately 1,100 parts-per-million (ppm). There are several different fluoride formulations and all are effective in helping to prevent tooth decay. Other remineralizing agents such as amorphous calcium phosphate have demonstrated some decay prevention ability and are now being added to some toothpastes.

Mild abrasives remove food debris and stains, as well as the sticky plaque that is always forming on the teeth. The goal is to make them abrasive enough for efficient cleaning, but not so abrasive as to damage the tooth enamel or the softer dentin or cementum that makes up the tooth root surface. Common abrasives you may see on your tube include calcium carbonate, sodium bicarbonate (baking soda), dehydrated silica gels, hydrated aluminum oxides, magnesium carbonate, phosphate salts and silicates.1

Humectants are organic compounds that hold water and help the toothpaste maintain its moisture even when exposed to air. Examples include glycerol, propylene, glycol and sorbitol.1

Binders or thickeners help keep the whole mix together in a nice paste or gel and stabilize this form. They provide the texture and flow to get the toothpaste onto the brush and keep it there. These include natural xanthum gums, seaweed colloids (carrageenan) and synthetic cellulose.1

Flavor, color and sweetening agents make brushing enjoyable by providing visual appeal, pleasing taste and fresher breath. Specific ingredients vary, but common flavorings include spearmint and peppermint, though nowadays there seems to be toothpaste available in flavors for every taste including strawberry, bubblegum, vanilla, green tea, fennel and bacon – even scotch and bourbon. For a sweet taste, artificial sweeteners like saccharin or natural sweeteners like xylitol are added since they do not promote tooth decay.

Antibacterial agents are added to reduce plaque growth, the sticky bacterial-laden film that forms constantly on the teeth and can eventually cause tooth decay and/or gingivitis and more serious gum diseases if not brushed away regularly. Some anti-plaque agents include triclosan and cetylpyridinum chloride.

Detergents in toothpaste create foaming action that helps the toothpaste coat the teeth. The foam helps reduce surface tension on the tooth, and makes cleaning easier and food particles or debris less likely to reattach to the tooth before it can be spit out. They include sodium lauryl (dodecyl) sulfate (SLS) and sodium N-Lauryl sarcosinate. 1 Some toothpaste users have been reported to develop canker sores as a result of an allergic reaction to SLS, but SLS-free toothpastes are available.

Preservatives prevent the growth of microbes in the toothpaste. Methyl paraben and sodium benzoate are also commonly found in food and beverage products.

Whiteners, desensitizers and tartar preventers Other agents appear in toothpastes that make specific claims for whitening (carbamide peroxide or hydrogen peroxide); desensitizing sensitive root surfaces (potassium nitrate, arginine bicarbonate/calcium carbonate complex); and preventing tartar/calculus buildup (tetrapotassium pyrophosphate/tetra and disodium pyrophosphates, sodium hexametaphosphate). Even though some whitening toothpastes contain similar chemicals to those used in dental office bleaching, these toothpaste products work primarily by removing surface stains and don’t typically change the basic tooth shade like bleaching strips or bleaching treatments at a dental office.

For best tooth decay prevention, we recommend brushing with fluoride toothpaste at least twice a day. So, when is the best time to become one with your favorite toothpaste? Preferably right before bed and in the morning, but soon after meals is also very effective.

1 American Dental Association. Toothpaste. http://www.ada.org/1322.aspx Accessed January 2013.

The Tooth Fairy Loosened Her Purse Strings in 2012

How much are kids getting for lost baby teeth these days? The average gift from the Tooth Fairy was $2.42 last year, up 32 cents from $2.10 in 2011, according to The Original Tooth Fairy Poll® sponsored by Delta Dental.1 The most common amount left under the pillow was $1 (51 percent).

According to the poll, the Tooth Fairy was even more generous with kids who lost their first tooth, leaving more money for the first tooth in 46 percent of homes. On average, the amount given for the first tooth was $3.49.

Leaving gifts from the Tooth Fairy is a great way to help make losing teeth less scary and enjoyable for kids. Delta Dental encourages parents to use the Tooth Fairy as an opportunity to talk about good oral health even before a child loses the first tooth. Caring for baby teeth is important, as they help children chew and speak properly and hold space for permanent teeth.

In 2012, the Tooth Fairy visited nearly 90 percent of U.S. homes with children who lost a tooth. Delta Dental suggests the following ways parents can use the Tooth Fairy as a teachable moment:

• Introduce the Tooth Fairy early on. Kids will start losing baby teeth around age 6. Before this age, parents can teach kids about the Tooth Fairy and let them know that good oral health habits and healthy teeth make her happy. Use this as an opportunity to brush up on a child’s everyday dental routine. Kids not wanting to brush and floss? Remind them the Tooth Fairy is more generous for healthy baby teeth, not teeth with cavities. This will help get kids excited about taking care of their teeth.

• Leave a note reinforcing good habits. A personalized note from the Tooth Fairy could be nearly as exciting for kids as the gift itself. Parents should include tips for important oral health habits that the Tooth Fairy wants kids to practice, such as brushing twice a day, flossing once a day and visiting the dentist twice a year. And, of course, parents should give the Tooth Fairy a special name. After all, Flossie or Twinkle is a bit more exciting than just Tooth Fairy!

• Give oral health gifts. Although the Tooth Fairy left cash for kids in 98 percent of homes she visited, two percent of children received toys, candy, gum or other gifts. Consider forgoing cash and providing oral health gifts instead, like a new toothbrush or fun-flavored toothpaste. For readers, there are numerous children’s books about Tooth Fairy adventures in bookstores or online. The days of jamming a tiny tooth underneath a huge pillow and making the Tooth Fairy blindly grope around under a heavy sleeping head are gone. Special pillows with tiny, tooth-sized pockets attached are now available online, with themes ranging from princesses to ninjas and beyond. Some of the pillows can even be customized with your little gap-toothed child’s name. Or if a parent, er, ahem, the Tooth Fairy, is feeling generous, kids could receive both cash and a new toothbrush.

For more information, visit http://www.theoriginaltoothfairypoll.com. To get a sense of the taste and style choices of the Tooth Fairy and for some fun ideas, parents can follow her on Pinterest at http://www.pinterest.com/origtoothfairy.

New Survey: Kids Need Brushing up on Oral Health

Although cavities are nearly 100 percent preventable, more than one out of four American caregivers reported that their children had a cavity filled in the past year. This was among the findings of a new survey1 of nearly 1,000 caregivers released today by Delta Dental in conjunction with National Children’s Dental Health Month. Among children who had a cavity in the past year, 53 percent had two or more cavities.

The 2013 Delta Dental Children’s Oral Health Survey shows that not only are Americans unaware they can pass cavity-causing bacteria to children, but they also need to brush up on some critical children’s dental health habits, including basics such as brushing and flossing.

Parents and caregivers need to teach good oral health habits to children at a young age to help prevent cavities. Baby teeth are very important. They help children chew and speak properly and hold space for permanent teeth. If a child has healthy baby teeth, chances are he or she will have healthy adult teeth.

These are some of the oral health habits that fall short of what’s recommended by dental professionals:

• Survey shows: Seventy-five percent of caregivers say they share utensils such as a spoon, fork, or glass with a child.
• Delta Dental recommends: Parents and caregivers should eliminate saliva-transferring behaviors – such as sharing utensils and toothbrushes and cleaning a pacifier with their mouths – all activities which can pass harmful bacterial to a child.

• Survey shows: Forty-nine percent of Americans with a child four years or younger report that the child sometimes takes a nap or goes to bed with a bottle or sippy cup containing milk or juice.
• Delta Dental recommends: Parents and caregivers should not put a child to bed with a bottle of milk, juice, sweetened water or soft drinks, which can lead to baby bottle decay. Instead, caregivers should fill the bottle with water.

• Survey shows: For children who have visited the dentist, the average age at the first visit was 3 years old.
• Delta Dental recommends: Children should first visit the dentist within six months of getting the first tooth – and no later than the first birthday.

• Survey shows: Only 58 percent of children had their teeth brushed twice a day and 34 percent of children brush for less than two minutes.
• Delta Dental recommends: Children’s teeth should be brushed twice a day for at least two minutes each time. Parents should assist with this task until the kids are about 6 years old.

• Survey shows: Forty-three percent of parents or caregivers report that their children’s teeth are never flossed, and of children whose teeth are flossed, only 23 percent are flossed daily.
• Delta Dental recommends: Once any two teeth are touching, caregivers should floss, or help the child floss, once a day.

1 Morpace Inc. conducted the 2013 Delta Dental Children’s Oral Health Survey. Interviews were conducted nationally via the Internet with 926 primary caregivers of children from birth to age 11. For results based on the total sample of national adults, the margin of error is ±3.2 percentage points at a 95 percent confidence level.

Delta Dental’s Top 5 Oral Health Resolutions for 2013

With a new calendar year on the horizon, many people are engaging in that time-honored American tradition of making resolutions, vowing to improve certain aspects of their lives.

For individuals who aspire to better their oral health in 2013, Delta Dental offers the following suggestions to help make these resolutions work.

• Brush/floss regularly: The uncomplicated daily one-two punch of brushing twice a day with fluoride toothpaste and flossing once is still the foundation for maintaining healthy teeth and gums. The sooner you can brush following a meal, the better. The longer food stays stuck to your teeth, the more acid is produced that erodes tooth enamel.

• Visit a dentist in 2013: Don’t delay making an appointment for a check-up. Dentists do more than just check and clean teeth. They can also check for signs of serious oral health problems like oral cancer and gum disease, answer questions and provide advice for adults and children and alert patients to signs of potential medical conditions.

• Avoid tobacco products: According to the Centers for Disease Control and Prevention (CDC), half of the cases of severe gum disease in U.S. adults can be attributed to cigarette smoking, and the prevalence of gum disease is three times higher among smokers than non-smokers.1 Consuming products like cigarettes, cigars and smokeless tobacco is arguably the single most destructive oral health habit.

• Eat sweets in moderation: It was ancient Greek philosopher Aristotle who advised, “Moderation in all things” and that axiom rings especially true for sweet snacks. Tooth decay occurs when candy, cookies, sodas and other sweets, or simple carbohydrates like those in chips or crackers mix with bacteria in the sticky plaque that constantly forms on teeth to produce acid, which can destroy tooth enamel. Whenever possible, stick to having sweets with dinner and brush afterward if possible. Limit sugary snacks because the more times during the day that your teeth are exposed, the longer the acids attack.

• Wear a mouthguard during contact sports: It’s not just kids who play contact sports these days. Millions of adults participate in competitive sports leagues in which there can be significant risk of contact. Though there is insufficient evidence to suggest mouthguards prevent concussions, they do absorb and distribute the forces that impact the mouth, teeth, face and jaw when an athlete takes a shot to the face. Wearing a mouthguard can prevent chipped, fractured, displaced or dislodged teeth, fractured or displaced jaws, TMJ trauma, and lacerations to the lips and mouth that result from the edges of the teeth.

1 Preventing Cavities, Gum Disease, Tooth Loss, and Oral Cancer – 2011 At a Glance. http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm. Accessed 2012.

Don’t Beware the Dentist’s Chair

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 26 million Americans suffer from diabetes. Even more troubling, another 57 million – about a fourth of U.S. adults – have pre-diabetes, which means their blood sugar levels are higher than normal, but not yet high enough to be classified as diabetes. Delta Dental is reminding Americans during “National Diabetes Month” that regular dental visits are crucial for people with diabetes.

According to the American Diabetes Association, controlling blood sugar levels is a key to preventing many serious complications of diabetes such as heart disease, kidney disease and stroke. Research also suggests a two-way relationship between serious periodontal (gum) disease and diabetes. Not only are people with diabetes more susceptible to severe gum disease, but it may have the potential to affect blood glucose control and contribute to the progression of diabetes.1 People with diabetes tend to develop periodontal disease earlier in life, and more severely. Instead of losing their teeth from gum disease in their 60s, they might begin losing teeth in their mid-40s. Smokers with diabetes are especially at-risk for gum disease and tooth loss.

Unfortunately, studies have found that people with diabetes see their dentist less often than those without the disease.2 Dentist visits are crucial because oral diseases such as tooth decay and gum disease are often reversible if they are diagnosed early and preventive treatments are delivered. Dentists will also check for other common mouth conditions that afflict people with diabetes such as dry mouth, ulcers and infections. Mouth conditions may also be a sign that other medical conditions exist elsewhere in the body. Depending on their findings, the dentist might advise patients to seek medical attention.

Daily brushing and flossing, regular dental check-ups and good blood glucose control are the best defenses against periodontal disease. In addition, quitting smoking may be the most important thing that people can do to protect their oral and overall health. The good news is that with proper dental hygiene at home and regular visits to the dentist (at least twice annually), there’s no reason people with diabetes should have worse oral health than people without.

1 American Diabetes Association. News and Research. http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/oral-health-faqs.html Accessed October 2012.

2 Macek MD, Tomar SL. Dental care visits among dentate adults with diabetes and periodontitis. J Public Health Dent. 2009 Fall;69(4):284-9.

Vote for Good Oral Hygiene

My fellow citizens: If you are like most Americans, a toothbrush, a tube of toothpaste and a spool of dental floss are long-standing incumbents in your bathroom cabinet.

During Dental Hygiene Month, another candidate, mouthrinse (also known as mouthwash), is vying for a spot beside the aforementioned daily use products. Should you welcome it to this exclusive club?

For its part, mouthrinse has long campaigned on a cosmetic platform of simply reducing or eliminating bad breath and making your mouth feel fresh. The cosmetic mouthrinse caucus has a large and loyal following. People who use it like that it eliminates bad breath, morning mouth and pesky food particles when used after meals, and that it promises to meld easily into your morning or evening routine. These are noble ideals.

More recently, a new ideology, therapeutic mouthrinse, has tried to distance itself from the cosmetic party line. Therapeutic mouthrinse has on its slate active ingredients like fluoride to fight cavities, and anti-microbial agents (such as hydrogen peroxide) to combat plaque, gingivitis and other gum diseases.

Every candidate has its critics, however, and mouthrinse is no different. Some point out that cosmetic mouthwash has too limited an agenda, that it just masks bad breath but doesn’t reduce cavities, gingivitis or plaque. Others have questioned the harmful effects of some mouthrinse products’ high concentration of alcohol content (ranging anywhere from 6.6 percent to 26.9 percent). A small but vocal contingent believes that factor could be a risk for oral cancer, but so far the overall evidence does not support that conclusion.

These criticisms have led mouthwash to position itself as a dental hygiene populist product that can appeal to all people, introducing non-alcoholic varieties to please even the harshest critics. It has also rolled out exciting new flavors (like cinnamon, bubblegum and orange) to appeal to a block of voters who want fresh breath but desire more than just the taste of mint.

“Mouthrinses are not a substitute for brushing or flossing but they might be a useful addition to your daily oral hygiene routine,” said Dr. Bill Kohn, DDS, a mouthrinse campaign expert and Delta Dental’s vice president for dental science and policy. “At a minimum, most mouthrinses will at least provide temporary relief from bad breath. Check with your dentist if you have persistent bad breath or to see if you would benefit from a mouthrinse that has fluoride or anti-bacterial agents to protect against cavities or periodontal diseases.”

Top 10 Fright Night Facts

Did you know Americans consumed 24.7 pounds of candy per capita in 2010?1 That’s a lot of sugar to potentially cause cavities if left on the teeth of boys and ghouls too long. After eating candy, Delta Dental recommends a thorough brushing of teeth (or at least a big drink of water).

Since Halloween is a favorite holiday of many Americans, Delta Dental has compiled a list of the 10 best terrifically terrifying truths:

1. Americans purchase nearly 600 million pounds of candy for Halloween each year.2

2. Major pumpkin-producing states like California, Illinois, New York and Ohio helped America grow 1.1 billion pounds of pumpkins in 2010.3

3. Sixty percent of dentists polled for Delta Dental’s Tricky Treats survey said they give out candy on Halloween. Of the dentists who dispense candy, 79 percent choose chocolate, while just 13 percent hand out varieties like hard candy or lollipops. This confectionary choice is no accident. Chocolate dissolves quickly in the mouth and can be eaten easily, which decreases the amount of time sugar stays in contact with teeth.4

4. Americans spent nearly $6.9 billion on Halloween costumes, decorations and “entertainment”.2

5. About 50 percent of Americans decorated their homes or yards, 44 percent dressed in a costume, 34 percent attended a Halloween party and 23 percent visited a haunted house in 2011.2

6. In 2011, the three most popular costumes worn by children were Harry Potter, princess and Green Lantern. Classic characters like Winnie the Pooh, Elmo and the Smurfs were also among the top 10 favorites. Captain America, Green Lantern and Where’s Waldo were popular costume choices for adults.5

7. Nearly one out of four dentists said they do not hand out anything on Halloween, while five percent attack the holiday head on by handing out toothbrushes.4

8. Not everyone gives out candy on Halloween. Ideas include toothbrushes, pretzels, fruit (such as raisins), modeling clay and books.4

9. An estimated 41 million children between the ages of five and 14 went trick-or-treating across the U. S. in 2010.1

10. Candy corn, a popular treat commonly associated with Halloween, was created in the 1880s and popularized by farmers who appreciated its resemblance to kernels of corn. 6

To learn more about what dentists give out at Halloween and get their best advice for keeping kids’ teeth healthy, please visit http://www.trickytreats.org.

1 United State Census Bureau, 2010 Census. http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed August 2012.

2 National Retail Federation. Consumers Eager to Have a Frightfully Good Time This Halloween, According to NRF. http://www.nrf.com/modules.php?name=News&op=viewlive&sp_id=1197. Accessed August 2012.

3 USDA National Agricultural Statistics Service.
http://usda.mannlib.cornell.edu/usda/current/VegeSumm/VegeSumm-01-27-2011.pdf. Accessed August 2012.

4 Delta Dental conducted the 2011 Tricky Treats Halloween survey. Delta Dental network dentists were invited via e-mail to participate in the web-based survey. For results based on the total sample of 253, the margin of error is ±6.15 percentage points at a 95 percent confidence level.

5 Sortprice.com. Hollywood Blockbusters & Traditional Favorites Dominate SortPrice.com’s Annual Top 10 Halloween Costume Lists for 2011. http://www.sortprice.com/docs/Halloween-Popular-Costumes-for-2011. Accessed August 2012.

6 National Confectioners Association. Candy Corn. http://www.candyusa.com/FunStuff/CandyType.cfm?ItemNumber=1582. Accessed August 2012.