SirWired's Guide to Mouthwashes and Toothpastes

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sirwired
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SirWired's Guide to Mouthwashes and Toothpastes

#1 Post by sirwired »

I see a lot of questions here about mouthwashes and toothpastes. I figured a guide on the different mouthwashes and ingredients available might be handy... (This is my last overly-long "Guide" post! Honest!) Here goes:

Obligatory note: I'm not a orthodontist, dentist, hygienist, technician, or even a receptionist at a dentist's office. Take this post with however much salt you usually sprinkle upon posts by random anonymous people on the internet. If you have questions, do not hesitate to ask an actual dental professional.

*******

Toothpastes

The toothpaste aisle has a ridiculous amount of selection, especially for a product with so few basic ingredients and properties. Every possible combination of ingredients wouldn't take up more than a few shelf-feet, but in order to crowd out competitors, there's a panoply of brands, flavors, names, etc.

For the record, my primary toothpaste was Prevident Sensitive 5000 (a prescription toothpaste) twice per day, and other brushings done with Colgate Sensitive Enamel Protect. I did not regularly use mouthwash.

Here's the lowdown on ingredients and properties:

[*] Sodium Fluoride: (NaF)
In the US, this is THE primary active cavity-fighting ingredient in most toothpastes. It is well-known to fight cavities by bonding with the calcium in your saliva to form a substance called Fluorapatite. This is harder than tooth enamel, and more resistant to the acids generated by plaque that cause cavities.

[*] Stannous Fluoride: (SnF)
This used to be more common decades ago, but has since been mostly replaced by NaF. The only common US brand I'm aware of that still uses it is some varieties of Crest Pro-Health. P&G believes it has some Anti-Gingivitis and Anti-Sensitivity use, but have never been able to get the ADA seal for those claims. (It is FDA listed for those purposes, but I believe that it may have been "grandfathered in", as it was used before OTC drugs required efficacy testing.) I take no position on if it works for anything beyond cavities. I will mention that there have been reports that it can cause staining in some people. Like the CPC-based rinses listed below, I think braces-wearers may be more susceptible to the staining effects, and therefore should probably avoid it.

[*] Sodium Monofluorphosphate: (Na2PO3F)
I don't personally know too much about this. I don't know of any major brand of toothpaste in the US that uses it, but it is common in Europe.

[*] Potassium Nitrate: (KNO3)
This is an anti-sensitivity ingredient. It's a little unclear on precisely how it works (whatever it is, it's not an anesthetic or painkiller), but there is enough evidence to support it that it's very common in "Sensitive" toothpastes. I personally used "Sensitive" toothpaste the entire time I was in braces. It takes some time to see any effect. Once you are out of braces, you should not continue using it unless your general dentist gives you the okay; you don't want to mask problems with your teeth with your toothpaste. It has kind of a funny taste; it'll remind you faintly of gunpowder for the simple reason that KNO3 (a.k.a. Saltpeter) is one of the ingredients in gunpowder.

[*] Triclosan: (Colgate Total)
This is an anti-bacterial drug that is a common ingredient used in topical products such as anti-bacterial soaps. While it's usefulness in soap is highly debated, Colgate claims that combining it with the PVM/MA Co-Polymer (in the inactive ingredients) allows it to persist in the mouth and maintain an anti-bacterial effect, helping to prevent both cavities and gingivitis moreso than normal fluoridated toothpaste. This was enough to clear FDA and ADA approval. Triclosan is a bactericide, not an antibiotic, so resistance is generally not a big worry. (As in, all those 'cillins would not work any differently even if a bacteria acquired resistance to Triclosan.)

[*] Prescription Toothpaste
You can ask your Orthodontist or Dentist for an Rx for prescription toothpaste. This has Fluoride content about 5x that of OTC toothpaste. It is not available OTC because this level of fluoride could indeed be quite harmful if swallowed in excessive amounts. While this is not a concern in adults that properly spit after brushing, that's why it's not sold at the drugstore, for fear parents will give it to kids without supervision. It's available in several formulations, including ones with Potassium Nitrate for sensitivity. If you have prescription drug coverage, (it's quite expensive if you pay full retail), you may want to give it a try.

On the opposite end of the spectrum...

[*] Fluoride-free Toothpaste
I'll be blunt. When it comes to fighting cavities, Fluoride-Free toothpaste is little more than a nice-tasting mild abrasive, about as effective as 19th-century tooth powder. Unless you routinely swallow large amounts of toothpaste, Fluoride in toothpaste doses is completely harmless to your body, and it's utterly impossible to be allergic to it (it'd be like being allergic to carbon; it's just not possible.) Your kidneys can easily dispose of whatever you happen to absorb in your bloodstream that didn't soak into your teeth and you didn't spit out. (This is what your kidneys do to Fluoride that is present in the water supply, either naturally occurring, or added by a water authority. Naturally-occurring Fluoride is where the government got the idea to fluoridate water; tooth decay was dramatically less in communities with high amounts of fluoride in the water supply.) The way Fluoride works is well-known, easily understood, and readily demonstrated. (For the curious, the Fluoride ions in the toothpaste bond with calcium ions in your saliva, forming a coating on your teeth of a substance called Fluorapatite which fills in pits in your teeth caused by plaque acids. As an added bonus, it's actually harder than tooth enamel.) The introduction of fluoridated toothpaste and fluoridated water led to extremely dramatic reductions in tooth decay; it just works. Fluoridation is near the top of many lists of the greatest advances of all time in public health, right up there with functioning sewage systems and running potable water.

Fluorosis, which causes white spots that can form on teeth, (from toothpaste and municipal fluoridation) is not a concern. People paranoid about fluoride point out it's high rate of prevalence in communities with fluoridated water. What they fail to notice/point out is that assuming their kid isn't eating toothpaste like candy and drinking ACT like Kool-Aid, the only person that will ever spot it is a dentist using a loupe. It's an imperceptible cosmetic issue, nothing more. Decalcification spots from decay are a LOT easier to spot, and LOT more likely if you avoid Fluoride.

There may be some non-fluoride ingredients with at least some decay-fighting effect, but because fluoride works so well, none of them have been studied much, and none of them have FDA/ADA approval.

[*] Whitening Toothpaste
There are two kinds of whitening toothpastes: The kind with a small amount of a bleaching agent (usually a peroxide), and the kind that contains an extra amount of abrasives to polish off stains. Personally, I'm doubtful of how effective a peroxide in a toothpaste is. In actual bleaching products, it's not in contact with any other ingredients (which it might react with, depleting them) and they have a limited shelf life. A tiny amount of bleach, mixed with all sorts of other stuff, and sitting on a store shelf for a couple months... I don't know how much bleaching action is actually left.

The other kind that is extra abrasive, is a bad idea for braces wearers that need to brush their teeth several times daily (and it's not really a great idea for anyone else, but it's less harmful for those folks...)

How to tell which kind you have? Well, if the word "enamel" is in the name, it's probably a peroxide toothpaste with low abrasivity. If there's no peroxide, and it's a whitening toothpaste, it's probably higher in abrasives.

[*] Toothpaste abrasiveness
I touched on this in the above section, but it's worth pointing out separately. Orthodontic patients, due to needing to brush teeth four or more times a day, really need to not use a particularly abrasive toothpaste. If you Google "Toothpaste Abrasiveness" you get some charts listing common toothpastes and their "RDA" scores. Lower is better. I don't know how often those charts get updated, so if you are concerned about this, call the phone number on the toothpaste box and simply ask. They should have, or can send you, the current RDA score for the product. The word "enamel" in the name is usually a good sign, but not a requirement.

Of note here is that the lists I've seen flag Colgate "Tartar Control" products as being some of the most abrasive on the market (near the ADA allowed maximums), along with some "smokers" toothpastes.

[*] "Microbeads" (Polyethylene)
These have been in the news lately; they are small plastic beads that are present in some toothpastes (and some cosmetic products such as soaps and "scrubs".) After some bad publicity by a dental hygienist that was spotting them stuck in patients' gum tissue, both P&G (Crest) and Colgate have promised to eliminate them over time from the formulations that have them. That aside, they don't biodegrade and easily enter rivers, as they are not removed by sewage treatment. Fish then eat them... that is not good.

Just Say No to Polyethylene Microbeads. (Note: NOT the same as the Polyethylene Glycol (PEG) that is sometimes used in toothpaste for reasons I'm too lazy to look up. It's a common, and harmless, pharmaceutical ingredient)

[*] "Natural" Toothpastes
"Natural" toothpastes eliminate some of the more "chemical-sounding" ingredients. (Artificial sweeteners, dyes, foaming detergents, etc.) If you want to give one a try, I say go right ahead, as long as it still has Fluoride in it, and isn't too abrasive.

Mouthwashes

IMPORTANT: Dramatic constant stinkiness of the breath can be an indication of some other issue... if everyone around you seems to take a big step back whenever you talk, even just after you've brushed (and you haven't loaded up on Garlic), consult your dentist; don't just cover it up with mouthwash; it could be an indication of a serious problem, such as gum disease, an abscess, or something wrong with your adenoids or tonsils.

Firstly, despite what some of the packaging might have you believe, mouthwashes are in no way a substitute for brushing, flossing, or regular dental cleanings. They can be a useful supplement, but should never replace good dental hygiene. If you have halitosis problems, make sure to remember to scrub the surface of your tongue when brushing; this is a proven breath remedy that costs nothing.

Most of the below products are available in generic versions, but I'll try and mention prominent brands for each of the washes. I only go into extensive detail on mouthwashes that are approved by the US Food and Drug Administration and/or the American Dental Association. (Despite the fact those institutions are US-only, their approval, or lack thereof, can nonetheless be useful to non-US residents.)

[*] Essential oil-based Antiseptic Mouthwashes (usually with alcohol) Active Ingredients are: Menthol, Thymol, Methyl Salicilate, and Eucalyptol.
Example Brand: Listerine Antiseptic (NOT Listerine Zero)

This is the first brand most people think of when they think "mouthwash". It's inexpensive (especially as a generic) available nearly everywhere, and both FDA and ADA approved. It has been around for decades and is actually pretty effective. It works through the essential oils coating the mouth (especially the sulcus (the "ditch" just within the gumline)) and providing an antiseptic effect for several hours. Contrary to popular belief, the alcohol in this product does not have any antiseptic effect; the concentration is not nearly high enough. The alcohol in the product exists to hold the oils "in suspension" so they don't uselessly float on the top of the bottle. (Alcohol is used the same way in perfume.) The other chemicals that can hold oil in suspension are "surfactants" (i.e. detergents), but those would keep the oils from coating your tissue, negating the long-term effect.

The ADA/FDA approvals are for anti-cavity and anti-gingivitis use.

The obvious drawback for orthodontic patients is that the alcohol is going to sting a bit if you have a raw spot anywhere in your mouth. It won't harm you, but it won't feel real nice either.

[*] Cetyl Pyrindium Chloride (CPC) mouthwashes
Example Brands: Crest Pro-Health, Cepacol, Colgate Total, and some ACT formulas have this (in addition to the Fluoride)

Like the Listerine-type mouthwashes, these ADA-approved rinses work by coating your tissue with a mild disinfectant. CPC is not an oil, so it does not require the stinging alcohol to dissolve it. The drawback to these products is that the CPC is known to cause staining in some people. I don't think any studies have been done on it, but I personally believe that braces-wearers may be more susceptible than the general population to the staining because brackets inhibit the natural "wiping" action of the teeth that might normally keep this from occurring. The staining can be removed during any regular professional tooth cleaning, but normal brushing will not remove it.

ADA/FDA approved for Anti-Gingivits and Anti-Cavity use.

[*] Fluoride (both Sodium Fluoride and Mono-fluro-phosphate)
Example Brands: ACT, Listerine Total Care Zero, Phos-Flur

These are anti-cavity rinses. They don't do much for your breath, but can be a useful supplement to the fluoride in your toothpaste and drinking water. They are especially useful if you rinse your toothpaste out of your mouth after brushing or do not have/drink fluoridated water. Note that some of these may include CPC. Speaking for myself, the CPC in ACT appeared to stain my teeth, so I stopped using it.

ADA/FDA approved for Anti-cavity use.

[*] Plax "Pre brushing rinse"
NO active ingredients. I only mention this one because whenever somebody (like Consumer Reports) has tested it, it's been found to be no more useful than swishing with water. It's never achieved the ADA seal, and has no FDA-listed use.

[*] Biotene
This mouthwash is marketed as a saliva-replacement for dry-mouth use. It doesn't have an "Active Ingredient" specifically called-out, but looking at the label, I expect it's the Glycerin in the stuff that helps to moisten your mouth. (Glycerin is a water-holding substance (a humectant)) If your braces are causing "lip incompetence" (meaning your lips don't seal at rest), this can be useful.

[*] Chlorhexidine Gluconate (CHG)
Example Brand: Peridex

At least in the US, this mouthwash is only available by prescription. Its most common use is after dental surgeries such as extractions, gum grafts, orthognathic surgery, etc. and as a supplement to periodontitis treatment. It is well-known to cause heavy staining (which is not merely cosmetic, and can only be removed with professional polishing), which is why it isn't an OTC product. It is similar to other disinfecting mouthwashes, but is more effective.

[*]Others
Scope, Closys, various natural products, Listerine Zero, any number of other products...
Don't depend on any of these to do anything other than temporarily freshen your breath. Officially, they cannot claim anti-cavity or anti-gingivitis use without using an FDA-approved ingredient. They can, however, make vague claims about "promoting dental health", "freshening breath", etc. Don't be fooled by claims about killing 99% of bacteria; that's not hard at all. What Listerine, CPC, or CHG based rinses get you is bacteria that STAY dead. If the ingredients don't persist in the mouth, the bacteria will quickly re-grow. There may be other ingredients that accomplish this, but for whatever reason, they have not received FDA approval.

Be skeptical, at best, of any claims made by a product that does not explicitly list "Drug Facts" (which implies FDA approval) and lacks an ADA seal. (The ADA does not perform testing, but only approves the seal for products backed up by solid science, they maintain veto power over all advertising of products with the seal, and their advertising rules are more stringent than the FDA's. Their approval is useful for claims not under FDA jurisdiction, like dry mouth, cosmetic benefits, toothbrush performance, etc.) NOTE: "Supplement Facts" are not the same as "Drug Facts"; "Supplement Facts" are just a listing of ingredients and amounts... those ingredients don't necessarily do what the seller says they do, and the FDA does not regulate safety, efficacy, manufacturing standards, or anything other than the product actually containing what's on the label.

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djspeece
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#2 Post by djspeece »

Very helpful, Sirwired! I'll request that Lynn add this to the "library" of stickies.
Dan

Pain is inevitable. Suffering is optional. -- Buddist saying

ItsFreyja
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#3 Post by ItsFreyja »

Agreed; most informative. I've had dentists warn me about too-abrasive toothpaste but did not know there was a standardized and available measure of that characteristic. Thank you!

bbsadmin
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#4 Post by bbsadmin »

Great post, SirWired! And now it's a sticky! :thumbsup:
I'm the owner/admin of this site. Had ceramic uppers, metal lowers ~3 years in my early 40's. Now in Hawley retainers at night!

Eve255
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#5 Post by Eve255 »

I like Corsodyl mothwash, that's what many dentists recommend in the U.K.

sirwired
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#6 Post by sirwired »

Cosodyl is a CHG-based mouthwash. I would not necessarily recommend it for braces-wearers because of the high potential for staining absent a clear indication for their use, such as periodontitis. (CHG-based rinses are not even available in the US without a prescription.)

crossbitten
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#7 Post by crossbitten »

sometimes when i gargle with mouthwash, the insides of my cheeks sting
i don't feel any cuts or stinging afterwards
could it be because of the braces?...
and is this common?

sirwired
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#8 Post by sirwired »

Anybody with braces will have irritated lips and cheeks pretty much all the time, even with the calluses that build up. The mouthwash you are using probably has alcohol in it, which accounts for the sting. Switch to one without it and things should be better.

Eve255
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#9 Post by Eve255 »

sirwired wrote:Cosodyl is a CHG-based mouthwash. I would not necessarily recommend it for braces-wearers because of the high potential for staining absent a clear indication for their use, such as periodontitis. (CHG-based rinses are not even available in the US without a prescription.)

Oh I didn't realise (I haven't actually got my braces in yet). Thanks for the info and putting that right.

Viconia
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#10 Post by Viconia »

Thanks for your latest very informative guide Sirwired,

Can I just ask if you know what category Vitis orthodontic mouthwash falls into? My ortho gave me a load of this brand but I can't really see it mentioned anywhere nor find any decent reviews.
Do you know of it and if you do, which category would it fall into?
Fully braced on the 31st of July 2015 with Suresmile linguals on upper arch, and American Orthodontics 'Radiance' on lower arch.
Sentence: 18 months with early release at 14 months for good behaviour.

sirwired
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#11 Post by sirwired »

Viconia wrote:Thanks for your latest very informative guide Sirwired,

Can I just ask if you know what category Vitis orthodontic mouthwash falls into? My ortho gave me a load of this brand but I can't really see it mentioned anywhere nor find any decent reviews.
Do you know of it and if you do, which category would it fall into?
Google reveals a website for the product (http://www.dentaid.com/en/vitis/vitis-o ... wash/id107) The major active ingredient is CPC. You are welcome to try it, but be on the lookout for staining.

lilyflower
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#12 Post by lilyflower »

I've been using Colgate Total pre-Invisalign and am continuing with it since I've had no problems and haven't had a cavity in YEARS. I've also used it on my aligners a few times with no problem.

I do recommend that anyone who has Invisalign or another clear aligner product look into biotene mouthwash to help with that "dry mouth" feeling. The regular one can be used up to 5 times a day (and does not stain aligners so you can leave it in) and it does provide some lubricating properties without any burning (it's pretty much clear).
The problems:
Lower crowding, a slightly rotated upper canine and a deep bite

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Invisalign G5 started Oct 12, 2015
Attachments: 21
Total number of trays: 28 upper, 38 lower
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Nolaterals
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#13 Post by Nolaterals »

Thanks for the detailed post! I'm in the market for a new toothpaste.

Skortho
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#14 Post by Skortho »

Very informative, thank you

Ravenclaw
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Re: SirWired's Guide to Mouthwashes and Toothpastes

#15 Post by Ravenclaw »

This is immensely helpful. Thanks.

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