Toothpastes and mouthwashes: which kinds help, and which kinds harm?

You almost certainly brush your teeth. You might use mouthwash. A lot of people floss for three weeks at a time, often in January.

There are a lot of options for oral hygiene; variations of the above, and many alternatives too. This is a big topic, so rather than try to squeeze it all in one, this will be a several-part series.

For today, let’s look at toothpastes and mouthwashes, to start!

Toothpaste options

Toothpastes may contain one, some, or all of the following, so here are some notes on those:

Fluoride

Most toothpastes contain fluoride; this is generally recognized as safe though is not without its controversies. The fluoride content is the reason it’s recommended not to swallow toothpaste, though.

The fluoride in toothpaste can cause some small problems if overused; if you see unusually white patches on your teeth (your teeth are supposed to be ivory-colored, not truly white), that is probably a case of localized overcalcification because of the fluoride, and yes, you can have too much of a good thing.

Overall, the benefits are considered to far outweigh the risks, though.

Baking soda

Whether by itself or as part of a toothpaste, baking soda is a safe and effective choice, not just for cosmetic purposes, but for boosting genuine oral hygiene too:

• Enhanced plaque removal to improve gingival health: 3-month randomized clinical study of the effects of baking soda toothpaste on plaque and gingivitis
• The effects of two baking-soda toothpastes in enhancing mechanical plaque removal and improving gingival health: A 6-month randomized clinical study
• The efficacy of baking soda dentifrice in controlling plaque and gingivitis: A systematic review

Activated charcoal

Activated charcoal is great at removing many chemicals from things it touches. That includes the kind you might see on your teeth in the form of stains.

A topical aside on safety: activated charcoal is a common ingredient in a lot of black-colored Halloween-themed foods and drinks around this time of year. Beware, if you ingest these, there’s a good chance of it also cleaning out any meds you are taking. Ask your pharmacist about your own personal meds, but meds that (ingested) activated charcoal will usually remove include:

• Oral HRT / contraceptives
• Antidepressants (many kinds)
• Heart medications (at least several major kinds)

Toothpaste, assuming you are spitting-not-swallowing, won’t remove your medications though. Nor, in case you were worrying, will it strip tooth enamel, even if you have extant tooth enamel erosion:

Source: Activated charcoal toothpastes do not increase erosive tooth wear

However, it’s of no special extra help when it comes to oral hygiene itself, just removing stains.

So, if you’d like to use it for cosmetic reasons, go right ahead. If not, no need.

Hydrogen peroxide

This is generally not a good idea, speaking for the health. For whitening, yes, it works. But for health, not so much:

Hydrogen peroxide-based products alter inflammatory and tissue damage-related proteins in the gingival crevicular fluid of healthy volunteers: a randomized trial

To be clear, when they say “alter”, they mean “in a bad way”. It increases inflammation and tissue damage.

If buying commercially-available whitening toothpaste made with hydrogen peroxide, the academic answer is that it’s a lottery, because brands’ proprietorial compounding processes vary widely and constantly with little oversight and even less transparency:

Is whitening toothpaste safe for dental health?: RDA-PE method

Mouthwash options

In the case of fluoride and hydrogen peroxide, the same advice (for and against) goes as per toothpaste.

Alcohol

There has been some concern about the potential carcinogenic effect of alcohol-based mouthwashes. According to the best current science, this one’s not an easy yes-or-no, but rather:

• If there are no other cancer risk factors, it does not seem to increase cancer risk
• If there are other cancer risk factors, it does make the risk worse

Read more:

• Does the use of alcohol mouthwash increase the risk of developing oral cancer?
• Alcohol-based mouthwash as a risk factor of oral cancer: A systematic review

Non-Alcohol

Non-alcoholic mouthwashes are not without their concerns either. In this case, the potential problem is changing the oral microbiome (we are supposed to have one!), and specifically, that the spread of what it kills and what it doesn’t may result in an imbalance that causes a lowering of the pH of the mouth.

Put differently: it makes your saliva more acidic.

Needless to say, that can cause its own problems for teeth. The research on this is still emerging, with regard to whether the benefits outweigh the problems, but the fact that it has this effect seems to be a consensus. Here’s an example paper; there are others:

Effects of Chlorhexidine mouthwash on the oral microbiome

Flossing, scraping, and alternatives

These are important (and varied, and interesting) enough to merit their own main feature, rather than squeezing them in at the end.

So, watch this space for a main feature on these soon!

Out-Cheating “Cheat Days” (Or Even Just “Cheat Meals”)

If you are in the habit of eating healthily, the idea of a “cheat day” probably isn’t appealing—because you simply don’t crave junk food; it’s not what your gut is used to.

Nevertheless, sometimes cheat days, or at least cheat meals, choose us rather than the other way around. If your social group is having a pizza night or meeting up at the burger bar, probably you’re going to be having a meal that’s not ideal.

So, what to do about it?

Well, first of all, relax. If it really is an exception and not a regular occurrence, it’s not going to have a big health impact. Assuming that your basic dietary requirements are taken care of (e.g. free from allergens as necessary, vegan/vegetarian if that’s appropriate for you, adhering to any religious restrictions that are important to you, etc), then you’re going to have a good time, which is what scientists call a “pro-social activity” and is not a terrible thing.

See also: Is Fast Food Really All That Bad? ← answer: yes it is, but the harm is cumulative and won’t all happen the instant you take a bite of a chicken nugget

Think positive

No, not in the “think positive thoughts” sense (though feel free, if that’s your thing), but rather: focus on adding things rather than subtracting things.

It’s said:

❝It’s not the calories in your food that make the biggest impact on your health; it’s the food in your calories❞e

…and that’s generally true. The same goes for “bad things” in the food, e.g. added sugar, salt, seed oils, etc. They really are bad! But, in this case you’re going to be eating them and they’re going to be nearly impossible to avoid in the social scenarios we described. So, forget that sunk treasure, and instead, add nutrients.

10almonds tip: added nutrients remain added nutrients, even if the sources were not glowing with health-appeal and/or you ate them alongside something unhealthy:

• Those breaded garlic mushrooms are still full of magnesium and fiber and ergothioneine.
• The chili-and-mint peas that came as an overpriced optional side-dish with your burger are still full of protein, fiber, and a stack of polyphenols.

…and so on. And, the more time you spend eating those things, the less time you spend eating the real empty-calorie foods.

Fix the flaw

We set out to offer this guide without arguing for abstemiousness or making healthy substitutions, because we assume you knew already that you can not eat things, and as for substitutions, often they are not practical, especially if dining out or ordering in.

Also, sometimes even when home-cooking something unhealthy, taking the bad ingredient out takes some of the joy out with it.

Writers example: I once incorrectly tried to solve the fat conundrum of my favorite shchi (recipe here) by trying purely steaming the vegetables instead of my usual frying/sautéing them, and let’s just say, that errant-and-swiftly-abandoned version got recorded in my nutrition-tracker app as “sad shchi”.

So instead, fix the flaw by countering it if possible:

• The meal is devoid of fiber? Preload with some dried figs (you can never have too many dried figs in your pantry)
• The meal is high in saturated fat? Enjoy fiber before/during/after, per what’s convenient for you. Fiber helps clear out excess cholesterol, which is usually the main issue with saturated fat.
• The meal is salty? Double down on your hydration before, during, and after. If that sounds like a chore, then remember, it’s more fun than getting bloated (which results, counterintuitively, from dehydration—because your body detects the salt, and panics and tries to retain as much water as possible to restore homeostasis, resulting in bloating) and hypertensive (which results from the combination of the blood having too much salt and too little water, and cells retaining too much water and pressing inwards because it is the cells themselves that are bloated). So, tending to your hydration can help mitigate all of the above.
• The meal is full of high-GI carbs? Preload with fiber, enjoy the carbs together with fats, and have something acidic (e.g. some kind of vinegar, or citrus fruit) with it if that’s a reasonable option. _{^{Yes, this does mean that a Whiskey Sour is better for your blood sugars than an Old Fashioned, by the way, and/but no, it doesn’t make either of them healthy.}}
• The meal is inflammatory? Doing all of the above things will help, as will eating it slowly/mindfully, which latter makes it less of a shock to your system.

See also: How To Get More Nutrition From The Same Food

Enjoy!