Toothpaste Abrasion

by Gregory Duffner

Posted on November 14, 2019

Teeth that have been impacted from abrasion

Every day, I see wear at the gumline on the sides of my patient’s teeth.

I was taught three decades ago that this wear was due to something called Abfraction. Abfraction is the breakdown of the side of the tooth where the enamel meets the root due to the flexing stress on the tooth when we clench or grind our teeth. However, the concept of Abfraction was never proven.

About 10 years ago, two dentists in the Northwest suburbs of Chicago did a study that showed very clearly that Abfraction was not the cause of this wear, or at the very least not the main cause. They showed very clearly that the hydrated silica in toothpaste was the contributing factor in the wear I see at the root surface of so many teeth. They repeated their study about 5 years ago and included the chewing surfaces of the teeth. Anywhere that there is exposed dentin, silica will cause wear. Wear is a common cause of sensitivity

Teeth that are visibly loose due to years of abrasive toothpaste usage

My patients often ask me what toothpaste to use. Most toothpaste has too much silica in it and therefore causes a lot of wear. And many people are sensitive to the SLS (Sodium Laurel Sulfate) in toothpaste and can get frequent canker sores. The most important ingredient in toothpaste is the fluoride, but fluoride is easily obtained from an over the counter fluoride rinse or a prescription paste that my office can provide.

I'm 60, and I have some gum recession. I don't want those areas damaged from silica. I stopped using toothpaste about 4 years ago. I brush with a Sonicare electric brush moistened with water. Many of my colleagues, staff and patients have done the same. I don't miss the toothpaste. To get the flouride I need, I supplement with a prescription paste with no silica.

Teeth with clear visible damage due to the prolonged effects of abrasion

There are only two regularly available toothpastes I recommend; Sensodyne True White and Sensodyne ProNamel. Their RDA's (relative dentin abrasiveness) are 13 and 34 respectively. Water is 4. Most toothpaste is between 100 and 150. You can call the 800 number on the tube of any toothpaste and ask what is the RDA. I strongly recommend 50 or below. And I don't recommend ProNamel Gentle Whitening. It's RDA is about 113. That's not gentle!

The RDA of many toothpastes are available online. We hava a list at our office that we would be happy to share with you. I also have the studies published by the two researchers, and I have their permission to share them. I'm hoping that more dentists will educate their patients about silica and that the informed public will eventually demand that manufacturers put less silica in toothpaste. Until then, watch out for silica.

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