How safe is your toothpaste?

By Prof. Johan Hartshorne (B.Sc., B.Ch.D., M.Ch.D., M.P.A., Ph.D. (Stell), FFPH.RCP (UK)

Intercare Tyger Valley Medical and Dental Centre & Visiting Professor, Department of Periodontics & Oral Medicine, University of Pretoria.

Toothpaste is an essential part of one’s daily oral hygiene and oral health care. But what makes one toothpaste brand different from another and how safe is it?

Using toothpaste that is very abrasive may harm your teeth by stripping away the protective enamel layer, causing tooth sensitivity and notching of the tooth at the gum line, thus compromising the structural integrity of the tooth. It also removes or damages the glaze (lustre) of restorations, porcelain crowns and veneers. Toothpastes indicated for ‘stain removal’ or ‘teeth whitening’ contain greater amounts of silica and are generally also considered more abrasive.

Toothpaste’s abrasiveness is measured as the RDA value (Radioactive Dentin Abrasion or Relative Dentine Abrasiveness). The higher the RDA value, the more abrasive it is and the greater the risk of loss of tooth enamel and tooth sensitivity. Toothpaste with and RDA value of 80 or less are recommended as tooth enamel friendly.

Other toothpaste ingredients that may be harmful are:

    • Antibacterial agents such as Triclosan, zinc salts and chlorhexidine gluconate. These medications are used in toothpaste to fight off harmful bacteria to reduce gum infection and bleeding gums. Long-term use of any antibacterial ingredient may, however, cause more problems than benefits by promoting antibiotic resistant bacteria.
    • Sensitivity reducing salts such as Sodium lauryl sulphate (SLS). This is a detergent that also acts as a foaming agent. It may cause or contribute towards mouth ulcers, dry mouth and the irritation of the oral mucosa. It is better to find and use a SLS free toothpaste.
    • Don’t be fooled by label claims, read the ingredients and decide for yourself which toothpaste is best for you. Ultimately it’s the action of the toothbrush that helps remove the plaque on your teeth and gums.
    • Choose toothpaste that is less abrasive (RDA <80) if the necks of your teeth are exposed or if you are experiencing tooth sensitivity. You may try:

*Elmex Sensitive Plus

*Colgate Regular

*Colgate Total



    • If you are a high risk for tooth decay (i.e., acid reflux, high use of fizzy drinks, or elderly) you should routinely use a toothpaste containing fluoride.
    • Patients with active root caries lesions and with risk of lesion progression should use fluoride toothpaste containing 5000ppm fluoride (prescribed by their dentist only), frequent fluoride mouth rinsing, and topical application of fluoride varnish two to four times a year.
    • Gel toothpastes are generally less abrasive.

Toothpastes are primarily designed for preventive purposes and maintaining good oral hygiene and not to treat specific conditions or diseases. Should you experience any discomfort when brushing your teeth, it is best to consult a dentist. Serious dental problems can be prevented by early detection of potential dangerous oral diseases.

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