Choosing Toothpaste

April 8, 2024, Kyle Isaacs

Young girl in pig tails squeezing a lot of toothpaste onto a tableEvery day, my patients ask me about toothpaste and which one they should use. There are so many options, which can be overwhelming when looking at the many products on the store shelves. Sometimes, different toothpaste companies will rename and change the packaging of a toothpaste to make it sound better than the last one, but often, the ingredients are the same. This makes decisions about what to buy even more confusing. Some companies claim their toothpaste will make your gums and teeth healthier, but how do you really know? What type of toothpaste do you use? How do you make the choice? Do your children have preferences? What are yours and the needs of your child? Are either of you at higher risk for cavities and need something special?

What are the ingredients in toothpastes and what do they do?

  • Fluoride or hydroxyapatite/nanohydroxyapatite – helps strengthen the enamel and prevent cavities.
  • Abrasives – help remove surface stains and food debris (some toothpaste abrasives are too abrasive, especially those with charcoal or whitening toothpaste).
  • Detergents or foaming agents help spread the toothpaste in your mouth. Commonly, sodium lauryl sulfate is used.
  • Flavors – are used to make the pastes taste good.
  • Humectants help prevent the pastes from getting dry.

Girl brushing her teeth with her grandmaSome pastes help with sensitive roots (not tooth decay), and others help with gingivitis. *Note: a paste alone will NOT prevent gingivitis. You still need to clean between and under the gums with some sort of tool, like dental floss. And even kids can get gingivitis; I see it often.

So, do you have to use toothpaste? What if you do not like toothpaste or you run out of it? I have heard of people not brushing because they cannot find a toothpaste flavor that they like. Other times, I have heard that people do not brush because they do not have access to water. A side note here: Just the act of brushing (with or without paste and water) removes a lot of the plaque or biofilm, which has bacteria in it that can cause cavities and gum disease. So, even if you do not have water, you can still brush. I also find that people use way too much toothpaste. You only need a pea-sized amount for ages six and older.

Let’s look at some recommendations from The American Dental Association (ADA).

For little ones, the ADA recommends seeing a dental provider to determine your child’s risk for tooth decay. This is when the dental provider looks in their mouth and gathers information so that they can make more specific recommendations about what toothpaste and how much to use.

Asian toddler brushing her teeth, looking at the cabinetThe ADA recommends using a fluoride toothpaste:

  1. Under two years old, use a smear or the size of a grain of rice and use water when brushing
  2. For ages 2-6, they recommend a pea-sized amount. (I usually recommend a petite pea-size)
  3. Always supervise young children when using toothpaste and brushing. (I always recommend that an adult brush their child’s teeth until the child can tie their shoes, and even then, it is good to check and make sure they did a good job.)
  4. Little ones can brush their own teeth, but their adults will also need to brush them as well.
  5. Floss when teeth are touching (I started flossing my kids even before their teeth touched to get them used to the process).

From the American Dental Association. On the left is a shmear, or the size of a grain of rice. On the right is a pea-sized amount of toothpaste.

Two yellow toothbrushes. On the left is a shmear, or the size of a grain of rice. On the right is a pea-sized amount of toothpaste.