
Feb
TOOTHPASTE ABRASION: STOP BRUSHING WITH TOOTHPASTE!
I see wear at the gumline on the sides of my patient’s teeth every day. These are called NCCLs, non-carious cervical lesions. They are non-carious, meaning there is no decay, just wear.
I was taught three decades ago that this wear was due to Abfraction. Abfraction is the breakdown of the side of the tooth where the enamel meets the root due to the flexing from stress on the tooth when we clench or grind our teeth. However, the concept of Abfraction has never been proven. It was a theory accepted as fact through the years in the literature.
About 15 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 reason. They showed very clearly that the hydrated silica in toothpaste was the contributing factor to the wear I see at the root surface of so many teeth. They repeated their study about five years later, this time including the chewing surfaces of the teeth. They demonstrated that anywhere exposed dentin exists, silica will cause wear. This wear is the most common cause of tooth sensitivity. They tested different kinds of toothpaste with various amounts of silica and amazingly demonstrated that even small amounts of silica cause damage!
My patients often ask me what toothpaste I use. I don’t brush with toothpaste. Most toothpastes have silica in them and, therefore, cause a lot of wear. I have some gum recession, and I don’t want those exposed root areas to be damaged by silica. I stopped using toothpaste about nine years ago. I brush with a Philips Sonicare electric toothbrush moistened with water. Many of my colleagues, staff, and patients have done the same. I don’t miss the toothpaste.
To get the fluoride I need, I apply a fluoride paste to my teeth with my finger after I brush with water. I use a prescription paste with no silica, but any fluoride paste, even if it has silica in it, is fine because you’re not dragging it across your teeth with the bristles of a toothbrush. Sensodyne is great for that because it has potassium nitrate to treat sensitivity. After applying the paste, I swish it around with my tongue and spit out the excess. I DO NOT RINSE IT OUT. The research shows that not rinsing leaves the paste in contact longer and makes it more effective.
If you can’t get used to brushing with water and must use toothpaste, Sensodyne ProNamel is very low abrasive. It’s RDA (relative dentin abrasiveness) is 34. Water is a common ingredient in most toothpastes, which typically have a relative dentin abrasivity (RDA) rating between 100 and 150. Some go as high as 200. You can call the 800 number on any toothpaste tube and ask what the RDA is. I strongly recommend an RDA of 50 or below. And I don’t recommend ProNamel Gentle Whitening. Its RDA is about 113. That’s not gentle! Silica does help remove stains, so without it, you will get more food stains on your teeth. However, bleaching can safely remove those stains without harming your dentin.
The RDA of many toothpastes is available online. We have a list at our office that we would be happy to share with you. I have also published the studies of the two researchers, and I have their permission to share those studies. The physical action of dragging the silica on the toothbrush bristles across the tooth causes NCCLs and much of the sensitivity that patients experience. I’m hoping that more dentists will educate their patients about silica and that the informed public will eventually demand that manufacturers leave it out of toothpaste. Until then, watch out.
I use an electric toothbrush from Sonicare. Research shows that it cleans better than a manual brush and causes less wear, which is very important to me. For many years, I used an Oral-B Braun toothbrush. This is also a very good brush that cleans better than a manual brush and is also less abrasive. Both are good brushes. I would strongly recommend an electric brush.
We used to think that a poor-quality brush would cause more tooth abrasion, but studies on silica in toothpaste showed that the brush had little effect on wear. A good-quality, soft brush is still very important to prevent excessive gingival (gum) recession. That’s another reason I like the Sonicare. Sonicare’s up-and-down motion is similar to how we teach our patients to use a manual brush.
A couple of years ago, our government had to stop recommending the use of dental floss! That doesn’t mean they recommended not flossing. By law, they aren’t allowed to recommend something unless there is recent research on the subject. And there was apparently no research lately.
As a dentist, I’ve been informally researching flossing during my 39 years of practice. Every day, I see that people who floss get less gum disease and decay between their teeth. I see improvement in dental health when my patients start to floss. I see a worsening of dental health when someone can’t floss. We all should floss!
I used to avoid recommending a WaterPik water flosser solely because I was concerned that my patients wouldn’t floss if they got one. My opinion has changed. First, the waterflossers have improved. They’re stronger, and research says they can remove plaque. Second, as I’ve aged, I’ve noticed something. My gums have receded a bit, leaving spaces between my teeth where food gets caught.
Furthermore, some of those spaces are adjacent to concave areas between the teeth. Floss cannot clean a concave area. There are two options for those areas. One is a Proxabrush, which is like a tiny pipe cleaner on a handle. The second is a WaterPik Water flosser. Research shows that a WaterPik is great for implants, too. The space between the gums and the implant is often deeper than around a tooth, so a bit more care is necessary there.
The best way to clean between teeth is to floss, use a Proxabrush or a DentaPik, and then follow that by blasting those areas with a WaterPik Water’flosser. The floss or DentaPik loosens the plaque, and the WaterPik flushes it away while stimulating the gums. I highly recommend both. And WaterPik recently came out with the Sonic Fusion. It combines a sonic brush with a waterflosser. I gave one to a friend to try it out. He had recently had a stroke and had limited use of his right hand. He liked it and would recommend it. It seems to be a great product, and it comes with a 3-year warranty.
I think tooth whitening or bleaching is one of the best things to happen in dentistry. It certainly gives the biggest bang for the buck. In the past, the only way to change the color of one’s teeth was to add something over the existing tooth, such as a crown or a veneer. Bleaching is conservative in that no tooth structure is lost or changed. Although it can make teeth sensitive for a short time, this is usually short-lived, and there are ways to limit or prevent it. It’s been shown to be quite safe and effective, even for people with dark stains (like tetracycline stains). It may take some time, but it works.
We offer two types of bleaching systems. We can make custom trays for your teeth and give you tubes of carbamide peroxide to put in the trays. The trays are very comfortable, much like Invisalign trays. You wear the trays while sleeping overnight or for at least two hours during the day. We also offer a stock tray system, which is less expensive. These are worn during the daytime. Some of our nightguards can also be used for bleaching.
Crest White Strips are another option. They are very affordable and use the same carbamide peroxide as our bleach trays. However, they are a bit more difficult to use and use a stronger concentration of bleach. Be sure to follow directions and not leave them in for too long.
I do not recommend whitening toothpaste! Most whitening toothpaste is far too abrasive. Anyone with exposed dentin, either from wear on the chewing surfaces or from gum recession, should not use anything abrasive on their teeth.
People notice the color of our teeth first, before the alignment. So, if you wish to improve your smile, the first thing you should change is the color. Bleaching is often the best way.
Our teeth are subjected to a harsh environment, including abrasives, acids, bacterial plaque, extreme temperature changes, and pressure from chewing, grinding, and clenching. It’s no wonder that some of us have sensitive teeth. We don’t have to suffer with sensitive teeth. There are several things that will help.
First, it’s important to determine what is causing the sensitivity and try to eliminate the cause. Often, the abrasiveness of the toothpaste is to blame. Stop brushing with toothpaste or switch to a low-abrasive sensitivity-reducing toothpaste like Sensodyne ProNamel. Prescription fluoride pastes for home use or desensitizing treatments in the office can also help with sensitivity.
Acids, either in what we consume or from acid reflux, GERD, or bulimia, could be causing sensitivity. Sodas, sports drinks, and energy drinks all have citric acid in them. Watch your consumption of these drinks. Don’t sip them for long periods. If you must have them, be smart about it. Enjoy the beverage relatively quickly, then sip water the rest of the time. Acid, over time, will damage teeth. Ask your physician about treating reflux or an eating disorder. Don’t brush right after vomiting. Rinse your mouth with water or bicarbonate of soda and wait 30 minutes before brushing to avoid abrading the acid-weakened enamel and dentin.
Don’t chew ice, hard candy, or other rock-like things. These can cause tiny cracks in your teeth that can make them sensitive. If you grind or clench while sleeping, wear a nightguard. Grinding and clenching are the worst things for our teeth. It causes cracks that often lead to sensitivity, fractured tooth syndrome, and even tooth loss. If sensitivity persists, seek help. Sometimes, a crown will prevent fractures from getting worse. Root canal therapy or extraction may be necessary if the damage is too great.
To learn more, call our team at Park Avenue Dental Care in Homewood, Illinois, at (708) 792-2779.
Dr. James J. Kreuz, D.D.S., is a seasoned dentist with over 50 years of practice in Homewood, having graduated from the University of Illinois College of Dentistry. His extensive experience underscores his expertise in the field. Dr. Kreuz is a dedicated professional whose longstanding practice and commitment to patient care establish his authority and trustworthiness. Outside dentistry, he is a passionate musician, performing with the Joliet American Legion Band and other local groups. He has toured Europe with The Blue Lake International Band, showcasing his diverse talents and dedication to community involvement.
Dr. Gregory J. Duffner, D.D.S., is an esteemed dentist with a rich background in both physics and dentistry. He graduated from Loyola University with a physics degree and earned his dental degree from the University of Illinois. Practicing in Homewood since 1985, Dr. Duffner collaborates with Dr. Kreuz to provide exceptional dental care. A dedicated community advocate, he bicycles for the National MS Society and has organized significant charity rides, including a cross-country effort for Mercy Housing. Dr. Duffner’s expertise, community involvement, and commitment to philanthropy establish his authority and trustworthiness in the field.
Dr. Alexander J. Dolinar, DMD, brings over eight years of dental experience to our practice, including roles in community health and private prosthodontics. He graduated with honors from Midwestern University College of Dental Medicine, where he was a Class Representative for the Chicago Dental Society and a Planning Leader for Delta Sigma Delta Mission Trips. Dr. Dolinar holds a Master’s in Biology and a Bachelor’s in Molecular and Cellular Biology. He is actively involved in dental associations and has volunteered extensively, showcasing his commitment to advanced care and community service. His skills and compassionate approach ensure high-quality care for all patients.
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