Oral Care Products (“Smoke and Mirrors” - What works, what doesn’t, and what’s hype) by Richard Holstein, D.M.D., FADH – Princeton Pedodontics

Oral Care Products

(“Smoke and Mirrors” - What works, what doesn’t, and what’s hype)

by Richard Holstein, D.M.D., FADH – Princeton Pedodontics

            Every year, in this country alone, BILLIONS of dollars are spent on oral health care products. These include tooth brushes (manual and powered), irrigating devices (WaterPiks, etc.), toothpaste, mouthwashes, “tooth whiteners”, dental floss, etc. Some work well, some not so well, some not at all, and some are harmful. All of these claim to make you healthier and/or more attractive. Let’s understand the reality:

1.      TOOTH BRUSHES: These help to remove plaque from tooth surfaces. Plaque is a combination of food and bacteria. It causes gum disease and tooth decay – and should not stay on your teeth; it is harmful, unsightly and may cause bad breath. Only the TIPS OF THE BRISTLES of the toothbrush rub the surface of the tooth and help to remove plaque, not the sides. If the brush is old, or the bristles are bent (which is what happens when your 2-year-old chews on the brush), it will not work very well. Brushes should always be SOFT, with ROUNDED bristles. For the life of me, I do not know why anything else is sold. Anything more rigid than soft can cause gum irritation/recession and tooth wear. The average person can do a satisfactory job of brushing with a manual brush – but enough TIME must be spent to thoroughly clean the tooth surfaces (at least 2 minutes). Power brushes, such as the Sonicare, will generally do a better job, but are technique sensitive (use a very light touch over all tooth surfaces) – if you press too hard, the tips of the bristles will not vibrate on the tooth. Generally, a power brush will be more effective for children because of their more limited attention span. If a parent is brushing, a power brush gives you more control (particularly if your have to be a professional wrestler to brush your child’s teeth). Thorough brushing must occur AT LEAST TWICE A DAY, AFTER MEALS. The more the merrier (and healthier). Also remember that bacteria and viruses are transmitted on toothbrushes. Never share. If your child has a cold, sterilize the brush or buy a new one to prevent re-infection. Always clean the brush thoroughly after using it. Brushing will be almost as effective without toothpaste if you wish, but we’ll get to that in a minute.

2.      TOOTH PASTE: Tastes good, helps a bit. Notice that the “active” ingredient in almost all toothpastes is Fluoride. Fluoride, used topically and in water supplies, helps to significantly reduce tooth decay on smooth surfaces of teeth. If your child cannot (or will not) spit out the toothpaste, you may skip using it, or use toothpaste with no fluoride. Your child should be receiving an adequate systemic dose of fluoride in the water or by supplement from your Pediatrician or Pediatric Dentist. (If you live in New Jersey and drink well water, it is not fluoridated – you’ll need a prescription). Other than providing fluoride, toothpaste does little else. It’s abrasive, is very mild (or it would quickly wear down your teeth), but does help a bit to keep the surface of the tooth polished. Claims for “whitening” are dubious at best. Some pastes have Triclosan, an antimicrobial which has been shown to significantly reduce bacterial growth (this is not for children). A good-tasting tooth paste (taste is very subjective) may help to motivate your child to brush – but EATING it is not a great idea.

3.      DISCLOSING SOLUTION: Great, but messy. This is basically a food dye, which colors plaque so it can easily be seen. It is either blue or red, is very visible (if you look at your teeth in the mirror – which assumes that your child can actually see in the bathroom mirror when brushing), and can make a huge mess when spit out all over the bathroom. Parental guidance and training is strongly indicated (unless you have a stainless steel bathroom). It is used TWICE - BEFORE brushing to disclose the plaque, and again AFTER brushing to see if there is any plaque remaining. We do NOT favor disclosing solutions containing ALCOHOL. More about this later.

4.      MOUTH WASH: Save your money. Advertising would have you believe that all people (particularly teenagers) are smelly, have bad breath, ugly hair, under-arm odor, poor posture and yellow teeth. Well, occasionally this may be true, but mouthwash isn’t going to help this. Most odors are related to mucous in the oro-pharyngeal area (way in the back of the mouth where a post-nasal drip drips) or strong food odors such as garlic and onions in the diet. By the way, if you rub garlic on the sole of your foot, you’ll be able to smell it on your breath in about an hour. The “flavor” in a mouthwash will, very briefly (think two minutes), mask this odor. BRUSHING is what you should be doing to remove food (which rots in the mouth if left unattended). Most mouth washes contain a lot of ALCOHOL. Alcohol kills germs (for a while – they multiply really fast), but will also disrupt cell structure in the mouth. MOUTH WASH DOES NOT REPLACE BRUSHING!!!!! It’s not a convenient shortcut (remember this, you teens and pre-teens) or substitute for a thorough brushing. When used chronically, alcohol-containing mouthwashes have been strongly linked to oral cancer (and that’ certainly not good). The only time that a mouthwash may be indicated is when a localized inflammation (think food wedgie between the teeth with associated pain and swelling) that you got because you didn’t floss as you should have, or an erupting, inflamed wisdom tooth (which is a totally different subject, and should be addressed by your dentist or Oral Surgeon). Mouthwash does NOT whiten teeth (more later). If you can’t brush, SWISH your mouth with WATER to dislodge some of the food.

5.      DENTAL FLOSS: Great stuff! When you brush (assuming you do), you only clean about 60% of the surface of your teeth. The other 40% is becoming a science project in between the teeth, breeding bacteria like crazy. This, if not controlled, will lead to periodontal (gum) disease, tooth decay and, (in advanced stages), bad breath and tooth loss. Flossing is an essential part of disease prevention and should be done at least once a day. We have found flossing to be most effective before bed. When you sleep, salivation decreases and bacterial activity increases.  As an aside, when your children eat sweet foods (think Apple Jacks, etc.) or sugary vitamins (think gummies), the sugar-saturated residue stay in between the teeth for up to 3 days (even with brushing). Think tooth decay. There is also a plethora of clinical evidence linking periodontal disease to increased cardiovascular disease. ONLY FLOSS THE TEETH YOU WANT TO KEEP (sic). Kids need parents to floss for them. Ask your Pediatric Dentist to address this issue in detail.

6.      TOOTH WHITENING (the biggie): READ THIS and proceed with caution! “Tooth Whitening” (bleaching) will only affect surface stains on the teeth; it will not, in reality, change the color of teeth (with very few exceptions). A child’s teeth have, for the most part, quite smooth surfaces that don’t stain easily if they are cleaned regularly and thoroughly (brushing and flossing). If your child’s teeth look yellow, they’re probably covered with plaque (some of which may have been there for a long, long time). REGULAR BRUSHING and visits to your Pediatric Dentist will keep your child’s teeth as white as they can be. As we get older, tiny surface cracks develop in the tooth enamel. Stains collect in these cracks and can make the teeth look discolored. It is almost impossible to remove stains from coffee, tobacco and tea from these cracks with a toothbrush and tooth paste because the bristle tips of the toothbrushes can’t reach them. Your dentist polishes the surface of your teeth during a regular professional cleaning (prophylaxis), helping to keep stains at a minimum. “Bleaching” inserts an oxygen radical into the stain molecule, changing it’s light-absorption characteristics, making the stain appear to disappear. THE STAIN IS STILL THERE, and will reappear once the oxygen radical releases itself. This may occur within a matter of weeks. If you don’t want stains, keep your teeth very clean and try to avoid heavily-pigmented substances. Strong tooth whiteners (think “professional bleaching’) can cause significant damage to healthy teeth, discolor certain filling materials, and make the surface of teeth porous (and more stainable). If you MUST try whitening, use something like White Strips; follow the directions and have patience. Shortcuts are not advisable. None of this, we repeat, substitutes for thorough and regular dental care. As an aside, perfectly normal teeth are often perceived as “yellow” because of a particularly pale complexion. Just as the frame around a picture influences how we see it, so skin color perceptually influences the apparent color of our teeth. Pale is good; skin cancer is bad. Be very careful and cautious before you let anyone bleach your teeth. Beware of the “quick fix”.

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