Ask an expert: What do we really need in toothpaste and brushes?

From all-natural ingredients to herb-infused formulas, the world of toothpaste is getting complicated. We asked a dentist what our teeth really need.

Australian-based Keeko makes flouride-free toothpaste developed with natural ingredients. (Photo: Keeko)


Sick of Sensodyne? Crest not cutting it? That’s no problem.

Thanks to a number of new brands launching in the oral care category – a $32 billion market – it’s now easier than ever to buy a toothpaste that’s tailored to your specific needs.

Some brands are releasing products that help us keep our oral hygiene habits in check, such as Karmicare’s “biorhythmic” toothpastes, which come in different formulas for morning and evening brushing. Subscription services, including those offered by Floe, Ordo and Quip, are trying to take the pain out of purchasing oral hygiene products by never leaving us short of toothpaste or refills of electric toothbrush heads.

The likes of Wildist and Juni are focused on all-natural formulas and bamboo toothbrushes to reduce impact on the planet – and there are even some celebrity-backed options for those seeking an aspirational way to start and end the day. Twice, launched in 2018, is cofounded by Lenny Kravitz, while Kendall Jenner is the face of Moon, a slick oral care brand created in 2019.

Choosing the right toothpaste

But while a flurry of new toothpaste and toothbrush brands have come to market, it’s clear that there's still some confusion around the best approach when it comes to cleaning teeth.

According to Delta Dental, 31% of Americans brush their teeth less than the recommended twice a day. Forgetfulness, laziness, or disliking the overall experience are some of the reasons why.

Meanwhile, concerns around unnatural ingredients have encouraged some people to look for oral care alternatives. While Karmicare boasts that its formula doesn’t contain any “nasty fluoride,” many dentists would dismiss these concerns based on decades-old (and since debunked) fears surrounding the chemical.

So what is it that your teeth actually need to stay healthy? We asked Dr. Ryan Reichelt from New York-based dental chain Tend to explain.

When you brush your teeth, what’s making the most impact? The brushing, or the toothpaste?

Hands down, it’s the brushing. Just the physical, mechanical movement of removing plaque from your teeth is the biggest thing you can do. The toothpaste helps to break up the debris and the plaque that’s on the teeth.

What kind of toothbrush is best?

A manual toothbrush is always going to lose to a mechanical toothbrush. You should also always get a soft bristled toothbrush, because if it’s too hard you can actually start removing some of the enamel off your teeth – and that’s what we’re trying to protect.

What are the common ingredients that aid the cleaning of your teeth?

There’s calcium carbonate, different silicas – which are like tiny bits of glass – aluminum oxide... On a microscopic level, all of those enhance the brush strokes that you do. They scrape and pull off the plaque from the teeth.

What about fluoride?

Fluoride in dentistry is the biggest friend we have, and it’s one of the only ways we can reverse damage that’s been done [to teeth]. Fluoride remineralizes your teeth. What happens is, throughout the day the enamel starts breaking down if the pH level in your mouth becomes too acidic. Fluoride can remineralize and make the enamel harder.

When used properly, there should be no safety concerns. As long as you’re not sitting there eating a tube of toothpaste, there’s really nothing to worry about.

So what ingredients do natural toothpastes use?

The major difference you’re going to see between a Colgate and a natural toothpaste is the fluoride – that’s going to be missing. Some natural toothpastes use nano-hydroxyapatite (Nano-HAp). That can help mineralize and strengthen your enamel.

Those other ingredients we talked about, they help remove staining. A natural toothpaste may substitute those products with salt derivatives, or clay products, or volcanic ash.

If someone switches to natural toothpaste, are they any more likely to experience enamel erosion?

Yes and no. I worked at a holistic practice in my previous life, and I had a lot of patients that did not use fluoride at all. I’m supportive of that, so long as you’re doing all the other things properly. So what’s your diet like? Are you brushing, are you flossing? If you’re not eating too many processed sugars, you’re not snacking throughout the day, you can use a natural toothpaste. Your risk is not going to go up if you’re doing all those other things properly.

The problems come up when somebody isn’t doing all the right things – and now they have decay, and we can’t really do a whole lot.

What about toothpastes that are infused with herbs or vitamins? Do those ingredients help clean your teeth?

At a high level, probably not. But there is research out there to support some of these things. A huge trend was CBD toothpaste – and there is some research to show that it decreases gum inflammation.

In terms of extracts, there’s also some limited research to show that they do have antimicrobial properties. So oregano oils, cinnamon oils, they are truly antimicrobial. With vitamins, most of the research shows there’s benefit for your teeth and gums, but it’s more to do with the level of that vitamin in your blood. You’re probably not going to get that benefit if it’s in a toothpaste.

But if these ingredients make you more enthusiastic about brushing your teeth, go for it. It’s not going to harm anything.

Does your mouth need different things at night compared to the morning?

Maybe [those products are] just about getting people in the habit. One interesting thing is some of these morning toothpastes have Nano-HAp in there. That’s awesome, and it’s great for the teeth, but if I were to design it, I’d put it in the night toothpaste. Because the way it works – and fluoride – is through contact time. So usually at night you brush your teeth and go to bed, and it gets a chance to sit on the teeth.

How should someone choose their toothpaste?

Everybody has different needs. If someone’s not brushing their teeth because they don’t like the taste of it, and they can get a toothpaste with some extract that makes the whole experience a bit better, then that’s fantastic.

The main thing we always want to emphasize is that we need fluoride. One thing I worry about with [natural] products is that it almost makes it seem like, “Oh, I don’t need fluoride because there are these other ingredients.” That’s not the case.

But listen, if you’re going to brush more, I’m on board.

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