Toothpaste Abrasion

Every day, I see wear at the gumline on the sides of my patients’ 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 ten years ago, two dentists in the Northwest suburbs of Chicago conducted a study that clearly showed that Abfraction was not the cause of this wear, or at 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 five 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.

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 fluoride, but fluoride can be easily obtained from an over-the-counter fluoride rinse or a prescription paste that my office can provide.

I’m 66, and I have some gum recession. I don’t want those areas damaged by silica. I stopped using toothpaste about ten years ago. I brush with a Phillips 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 fluoride I need, I apply toothpaste to my teeth with my finger after I brush. I spread it around with my tongue and spit out the excess. I DO NOT RINSE AFTERWARD! That is key. The fluoride and potassium nitrate (in Sensodyne and others to reduce sensitivity) stay in contact with the teeth longer this way and are more effective. 

If you find that you can’t brush without toothpaste, there are very few regularly available toothpastes I recommend. Sensodyne ProNamel is one of them. The RDA (relative dentin abrasiveness) is 34. The RDA of water is two. The RDA of most toothpastes is between 100 and 150. You can call the 800 number on the tube of any toothpaste and ask what the RDA is. I strongly recommend 50 or below. And I don’t recommend ProNamel Gentle Whitening. Its RDA is about 113. That’s not gentle!

The RDAs of many toothpastes are available online. We have 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 take the silica out of toothpaste. Until then, watch out for silica.

The only downside to brushing without toothpaste is that you will get more food stains between cleanings. Bleaching your teeth is completely safe and would help with the staining. There have been many studies that show bleaching is safe. We have bleach systems that I myself use at home, or Crest White Strips work well too. Both use the same active ingredient and are safe. Bleaching can cause transient sensitivity, but it usually doesn’t last, and the silica in toothpaste is the big culprit. Why manufacturers put silica in a sensitivity-reducing toothpaste is beyond me. I’m convinced that the silica is causing much of the sensitivity.

Toothbrushes

I use the electric toothbrush Phillips Sonicare. Research shows that it cleans better than a manual brush, and it causes less wear. That combination 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 a rechargeable electric brush. There are some regular battery-powered brushes available, but I’ve found that they are underpowered and not as effective.

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 tooth wear. A high-quality, soft brush is still very important for preventing excessive gingival (gum) recession. That’s another reason I like the Sonicare. Its up-and-down motion is best. That’s how we teach our patients to brush with a manual brush.

Flossing and the Waterpik Water Flosser

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 throughout my 40 years of practice. People who floss get less gum disease and decay between their teeth. I see improvements 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 not recommend 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 water flossers 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 I can store food for later. 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 proxibrush, which is like a tiny pipe cleaner on a handle. The second is a WaterPik Water Flosser. I highly recommend water flossing. 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.

Flossing (or using a DentaPik or proxibrush) followed by water flossing is the best way to clean between teeth, second only to a professional cleaning. The floss loosens the plaque, and the WaterPik flushes it away while also stimulating the gums. I highly recommend both. And WaterPik recently introduced the Sonic Fusion. It combines a sonic brush with a water flosser. 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 three-year warranty.

Bleaching

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 because no tooth structure is lost or altered. 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). For darker 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 provide tubes of carbamide peroxide for you to place in the trays. The trays are very comfortable, much like clear aligner trays. You wear the trays while sleeping overnight or for a minimum of two hours during the day. We also offer a stock-tray system that is less expensive. Those are worn during the daytime. And 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. They are a bit more difficult to use, and they use a stronger concentration of bleach. Be sure to follow directions. You don’t leave them in for as long.

I do not recommend whitening toothpaste! Almost all whitening toothpastes are far too abrasive. Anyone who has any exposed dentin, either from wear on the chewing surfaces or from gum recession, should not be using anything abrasive on their teeth. 

People notice the color of our teeth first and foremost, long before they notice how straight they are. So the first thing you should change if you wish to improve your smile is the tooth color. Bleaching is often the best way.

Sensitive Teeth

Our teeth are subjected to a very 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 at the very least switch to a low-abrasive sensitivity-reducing toothpaste like Sensodyne ProNamel. And there are prescription fluoride pastes for home use or desensitizing treatments at home or in the office that can help with sensitivity.

Acids from our diet or conditions like acid reflux, GERD, or bulimia could be causing sensitivity. Sodas, sports drinks, and energy drinks all contain citric acid. Even soda water is acidic. Watch your consumption of these drinks. Don’t sip them for long periods. Acid over time will damage teeth. Ask your physician about treating reflux, GERD,  or an eating disorder. And don’t brush right after vomiting. Rinse your mouth with water or bicarbonate of soda and wait 30 minutes before brushing.

Don’t chew ice, hard candy, or other rock-like things. These can cause tiny cracks in your teeth, making them sensitive. If you grind or clench while sleeping, wear a nightguard. Night grinding is the worst thing 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 can prevent fractures from worsening. If the damage is too great, root canal therapy or extraction may be necessary.

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