Do we really need it?
During a lecture given by Dr. Thomas Abrahamsen, a diplomat of the American Board of Prosthodontics, at the 2008 Yankee Dental Congress held in Boston, I witnessed the illumination of one of the most serious causes of tooth structure loss: abrasion of toothpaste through tooth-brushing. This loss of tooth structure has been a puzzle in dentistry since the invention of modern toothpaste. Awareness of this problem started in 1727, before mass production of toothpaste in the 1850’s, and continued to grow quietly during the 1900s.
In 2008, my staff and I were fortunate to have attended Dr. Abrahamsen’s course entitled “Etiology, Diagnosis, and Cure of the Non-Carious Loss of Tooth Structure”, during which we learned that the harmful effect of toothpaste and toothpaste abrasion in studies undertaken by Dr. Abrahamsen over the last six years (as well as in his thirty-five years of clinical observations).
The evidence presented by Dr. Abrahamsen in his lecture appears to me to be irrefutable and undeniable. It has explained everything that my hygienists and I have observed in over my thirty years of practice, but that we were unable to put together. We had all the pieces of the puzzle, but it took Dr. Abrahamsen to put them together.
How to fix the problem
Tooth structure loss is due to many factors, including: tooth decay, the grinding of teeth, various forms of erosion, and miscellaneous oral habits. However, as my staff and I learned at this course, for many people, significant tooth loss is also very often due to toothpaste abrasion.
Toothpastes contain various different substances for abrasion. In order to get bacteria and buildup off of enamel, toothpaste includes some sort of ingredient that mechanically removes plaque and buildup on the teeth. However, highly abrasive toothpastes can actually be damaging to enamel and cause erosion of tooth structure. In other words, toothpaste, when used incorrectly, can cause a lot more harm than good. (See our other blog post, “Teeth sensitivity even though you brush a lot?”)
Please see the ADA’s (American Dental Association) RDA (Relative Dentin Abrasivity) chart to see how abrasive each toothpaste can be.
Where there is evidence of loss of tooth structure or “abfractions”, I recommend that you brush with water only, baking soda or a low abrasive toothpaste and that you use an electric toothbrush. Many of my patients have seen a significant improvement in overall sensitivity when switching to brushing with just baking soda and water.
So the truth about toothpaste? We don’t need it! If you desire the minty taste of toothpaste, use a very small amount on your tongue and rinse it out or use an alcohol-free mouthwash. Above all, remember to brush for 2 minutes on top, 2 minutes on bottom and floss!
If you are interested in more information, reach out to our office and I will be happy to discuss this with you further at your next visit.