White,Whiter, Whitest

 The oral hygiene aisle at the grocery store, a place where cartoon characters, superheroes and flavorful fun merge into must-have mayhem, is rivaled only by the cereal aisle. Metallic rectangular boxes contain the assurance of toothpaste offering a Hollywood smile. Bottled potions of red, orange, blue and green pledge to freshen breath and break-up strong marriages between plaque and enamel. Cynics stroll between the shelves questioning if these products are for the eyes rather than the teeth. Titillated consumers of commercialism suffering from show-me-something-shiny syndrome fill their carts with fancy-packaged promises.

Healthy critical thinking is called for, of course, but most dentists agree that if swanky tubes and rainbow colored toothbrushes increase enthusiasm for personal hygiene, then get giddy over them. Sure, those battery-powered toothbrushes with the whirring heads that entice children seem a silly waste of money to their parents. But guess what? Electric toothbrushes really work, even for adults, who invest in the upscale models. They are especially practical for people with limited manual dexterity. “Used properly,” says Dr. Christopher W. Cutler, professor and chair of the department of periodontics at Georgia Health Sciences University College of Dental Medicine, “an electric toothbrush will do a better job than a manual toothbrush.”

He adds, “Most consumers pick a toothbrush based on the appearance,”  thus, the huge variety of colors, grips and bristle configuration. Buy whatever brush charms you as long as it has soft bristles and fits your mouth comfortably (adults should not use pediatric-sized toothbrushes nor should children use toothbrushes sized for adults). Other than that, everything else is superfluous because the most important thing about a toothbrush is what you do with it once it’s in your mouth. Time and technique equal effectiveness. Many electric toothbrushes have built-in timers. Two to three minutes two to three times a day using the Modified Bass Technique (learn how at www.savemysmile.com) will interrupt the growth of bacteria that cause tooth decay.

Though most people use more toothpaste than necessary, the fluoride in it is not harmful in such a small amount and is an essential element in the fight against tooth decay. Don’t forego it by buying a fluoride-free toothpaste. Beyond that, select a toothpaste that meets your particular needs. Suffering from sensitivity to hot or cold foods and drinks? Pick a paste that addresses that. Your dentist remarks that you have heavy tartar build-up between visits? Use a tartar control paste.  

Want whiter teeth? Well, consider this. Toothpastes claiming to whiten teeth do not have bleaching agents in them. They whiten by using abrasives, or grit, to polish away stains from the surface of the teeth, says Dr. Cutler. Abrasives such as sodium bicarbonate not only polish the teeth, but they also neutralize the mouth’s pH. Reducing acidity decreases the probability of developing cavities. On the other hand, Dr. Cutler warns, “Sometimes these products work against each other.” Whitening toothpastes may increase tooth sensitivity. And beware the product that claims to do it all. These big sellers have recently hit the market, but Dr. Cutler advises, “It’s very difficult for a product to be really good at something when it’s trying to do everything.” A better course of action is to prioritize your dental hygiene needs, then work on them one at a time, targeting each issue with a toothpaste formulated to address it.

If flossing isn’t part of your brushing routine, find a way to fit it in, literally. Maybe you don’t floss because you have difficulty slipping the strand between your teeth without shredding it. Shred-free floss is one answer. Flosses with Teflon, making them slide easier between teeth with close connectivity, are another. Floss threaders enable those with dental work like bridges and braces to get between teeth. Floss handles facilitate comfortable reach to the back of the mouth. But will floss whiten between your teeth? Probably not, says Dr. Cutler, who recommends dental tape to his patients. The greater surface area improves removal of food particles and plaque beneath the gum line and 360 degrees around each tooth. Floss is a tool. Avoid getting sucked in by guarantees of periphery benefits, like whiter teeth.

Some people need a little extra umph, beyond floss. Oral irrigators, devices that mechanically deliver a stream of pulsating water, offer an additional way to flush bacteria and food particles from spaces between and around teeth. If you’re brushing and flossing as instructed by your dentist and still developing gingivitis and gum disease, then an oral irrigator is a great investment says Dr. Cutler. When choosing one, check for the capability of adjusting for pressure. Buying irrigation solutions is not crucial. Water works just as well.

According to Dr. Cutler, most people who brush and floss regularly do not necessarily need to use mouthwash too. Though most consumers associate mouth rinses with efforts to waylay bad breath, for people who suffer from dry mouth or gingivitis or who have acidic saliva, mouth rinse used twice a day can help prevent cavities and ameliorate gum disease. “Teeth retain calcium better if you have adequate saliva and the pH of your saliva is not acidic,” says Dr. Cutler.  Fluoride-containing mouthwashes can replace tooth-hardening minerals. Take a few minutes to study labels. Choose a mouthwash with fluoride and one that is anti-bacterial and alcohol-free.

Along with fresh breath, guarantees of white teeth appeal to consumers. Over-the-counter teeth whitening kits work depending on the type of staining. Some surface stains are easily removed with toothpaste infused with abrasives to essentially “sand” off the stains. Whitening kits, as opposed to whitening toothpastes, apply bleaching agents to the teeth, which can result in even better results. But these whitening systems have limitations. Intrinsic stains that occurred while teeth were developing, stained veneers and stained crowns will not whiten with OTC bleaches. And most of these products only result in a couple of shades of improvement. If more dramatic whitening is desired, consumers should see a dentist. Furthermore, over-the-counter whitening kits may increase tooth sensitivity because as the bleaches oxidize stains, they de-mineralize the teeth if used too often. It is imperative to follow directions and not abuse these products. In general apply treatments in intervals at least six months apart and avoid these products altogether if you have a lot of crowns and fillings (particularly white fillings), tooth sensitivity or dry mouth. Children under age 17, according to Dr. Cutler, should not use teeth whiteners either.

Dr. Cutler also stresses that tooth-whitening kiosks in the mall are not an adequate alternative. Attendants, while dressed to look like clinicians, are not certified clinicians or technicians at all. There are no regulations on these businesses. Again, see your dentist if over-the-counter products aren’t right for you.

Most of all, guard against falling victim to your own fear or vanity. Despite what you may read on the Internet, using fluoridated toothpaste and mouth rinse and drinking fluoridated water as part of an appropriate dental hygiene regimen will not lead to fluoride toxicity. Fluoride is a critical component of oral health products. It strengthens the enamel of the tooth and makes it resistant to decay. “Fluoride for sure is one of the 10 most important public health advances in the 20th century,” says Dr. Cutler. As well, the other ingredients do not pose a threat to consumer health when these products are used as directed.

Consumers who opt for products with alternative ingredients to fluoride may risk future problems. Dr. Cutler warns, “Patients have to be pro-active in looking for evidence in the literature and not just reading blogs on the Internet.” Research whether these alternative ingredients have been proven effective in double-blind scientific studies. The American Dental Association Seal of Approval indicates that the claims of products bearing it have been scientifically tested and that the products’ safety and efficacy are proven.

In addition to worry over what’s in the products we use, a lot of people have concern about what’s on the dental tools, primarily toothbrushes. The potential for germs strikes at the hearts of Americans, who spend their hard-earned money on any variety of preventative measures. Toothbrush sanitizers speak to those fears. Yet, indeed, they are worthless. “There’s really no reason to try to sanitize your toothbrush,” says Dr. Cutler. And those lozenges and gums that tout whitening properties probably aren’t worth the money either. Think how many mints or sticks of gum it would take to get any noticeable change in stains.

Despite products wrapped in colorful, attention-grabbing packages that stimulate our senses and motivate us to purchase, there are just a few basic weapons necessary to guard your mouth and, ultimately, your overall health. The three most important tools in a person’s oral health arsenal are a good toothbrush, a fluoride toothpaste and dental floss, plus proper technique and common sense. Protect your teeth. Protect your body. Protect your wallet.