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!