Natural And Conventional Toothpastes: Is One More Effective Than The Other?

The Sudanese used purple nutsedge more than 2000 years ago; a bitter-tasting weed with antibacterial properties that rewarded them remarkably sound teeth. Many people throughout Southeast Asia and in the Middle East use twigs from the arak tree (known as miswak) to clean their teeth. It has a high concentration of fluoride and contains other antimicrobial components that help prevent tooth decay, and produces reasonably effective whitening. Some cultures still use twigs from aromatic trees that freshen the mouth as has been done for thousands of years. Recorded use of these chew sticks goes back to ancient Babylonia in 3500BC; the Chinese, along with ginseng and herbal pastes, were using them almost two thousand years before that.

Studies over the last decade conclude that chew sticks have a similar cleaning result to a conventional toothbrush. The frayed end of the twig is dampened with water (or rosewater) and rubbed against the teeth. The stick, however, can’t effectively clean between teeth, and if it’s not properly manoeuvred and controlled, gum damage and abraded enamel can follow.

Other cultures, for traditional or religious reasons, use fingers to rub substances onto their teeth; walnut tree bark for example is used in some Muslim countries. Medicinal plants like tulsi and amla (Indian gooseberry) have held a continued role in good oral hygiene.

Certainly the Ayurvedic practice of oil pulling (using coconut, sesame, sunflower or olive oil) is believed to remove harmful bacteria and toxins; recent clinical studies have found it can help to reduce gum inflammation.

That mouthwash is a modern-day phenomenon is a misconception: Chinese texts from 2700 BC evidence mouth rinses; and southeast Asians have for centuries used combinations of cranberry juice, tulsi, ginger and guava. Notably, these have been scientifically proven to be as effective as chlorohexidine – the prominent ingredient of dentist-recommended mouthwashes recommended.

However, not all traditional methods can be similarly endorsed. Betel and areca nuts for example – commonly used in Southeast Asia – actually stain teeth and gums, and are associated with an increased risk of oral cancer.

There’s no way Mrs Marsh would be dipping her chalk into that one…

Throughout history mixtures have been used containing some type of fine grit. From powdered ox hooves, burnt eggshells and pumice to brick powder, ash, mud, and salt. There’s the tradition of charcoal, and that’s been making a comeback over the last few years – whether in activated powder form, as an inclusion in homemade toothpastes or as an infusion in manufactured toothpaste brands. Some claim its effectiveness in binding harmful bacteria, while others – particularly the American Dental Association – maintain its abrasive property damages tooth enamel.

The importance of good oral health was well known in Europe by the 1400s. Having white teeth and fresh breath was more fashionable than implicit, but oral hygiene was most certainly practiced. With a diet low in sugar and high in calcium, the Pythonesque view of blackened and rotting medieval teeth is a furphy – many herb, ash, and salt preparations are known to have been used. (Presumably in the hopeful avoidance of a trip to the barber for some incredibly barbaric treatments and extractions.)

Along with gunpowder, paper, printing and the compass, it was the Chinese who created a brush for teeth cleaning that is most like the one we use today – the handle was either of bone or bamboo, and boar hair was used for bristles. Taken to Europe during the 17th century, it remained largely unchanged until 1938. Dupont de Nemours (later the DuPont Company) marketed Doctor West’s Miracle Toothbrush – the first nylon fibre dental brush: much sturdier and more hygienic than its animal hair predecessor.

And with a better brush, came better toothpaste.

From the 1800s, dental pastes had included soap and chalk. It wasn’t until research in the 1940s by biochemist and dentist Joseph Muhler, and chemist William Nebergall showed that sodium fluoride ions made tooth enamel harder and more resistant. Thus the idea of fluoride in toothpaste gained support.

Sodium fluoride protects against cavities; stannous fluoride is an anti-bacterial agent. Clinical trials proved that these chemical compounds assisted protection against tooth decay, gingivitis, plaque and tooth sensitivity.

In 1956, Crest toothpaste was introduced, and by 1960 it was the first toothpaste recognised by the American Dental Association to be effective against tooth decay.

In sixty years, the global toothpaste market has grown in worth to $US17.75 billion – with a projection of $US21.99 billion by 2027. Curiously, not only has the coronavirus disrupted the global supply chain, it seems COVID-19 sufferers have a higher risk of oral issues and disease.

For most of us, the toothpaste we purchase is automatic. Occasionally we may be tempted by some special price, or a budget worthy 2-for-1, but for the most part we stick to one brand for whatever reason we (or our family) have already decided.

In terms of marketing and advertising, dominant brands exploit science and technology to portray unique or specialised ingredients. For the most part, there is scant difference between any product in the same market segment. In 2018, the Advertising Standards Agency banned a Colgate dental product for making misleading claims: the company’s fifth in seven years.

As the long-term global leader in toothpaste sales, it can afford to take these risks.

Quite frankly, all toothpastes are effective. It’s the ingredients that become debatable – in terms of the health of both humans, and the environment. Triclosan and Sodium Laurel Sulphate are hugely controversial: the manufacturing process of SLS results in 1,4-dioxane – a known animal carcinogen, a likely human carcinogen, a suspected toxin to both renal and respiratory systems, and a verified groundwater contaminant.

Even the use of fluoride is contentious. It’s been added to the water of many countries for more than 75 years because most oral health advocates believe it strengthens enamel and helps prevent tooth decay. In stark contrast are claims it is responsible for joint pain, porous bones, declining sperm production and motility, dementia, gastrointestinal distress, premature puberty, immunity dysfunction, cancer, and lowering the IQ of children.

Interestingly, non-fluoridated nations like Luxembourg, Belgium and Denmark have better dental health than the US – where 73% of its population has fluoridated water. Germany, Finland, the Netherlands, Switzerland, Sweden and Japan all tried, and then abandoned fluoridation years later.

Each reported no rise in tooth decay.

In 2015, the Cochrane – with a fiercely guarded reputation for impartiality and scrupulousness – waded into the debate.

The team found 4,677 fluoridation studies. All but 155 of them (20 that focused on tooth decay; 135 that centred on dental fluorosis) failed to meet the two criteria it had set: there needed to be two large groups of subjects – the intervention group (fluoride), the control group (without), and each had to have been examined at least twice.

It found that every one of the tooth decay studies, and all but a handful of the fluorosis reports, were deemed “at high risk of bias”. Fundamentally, it’s impossible to evaluate large groups of comparable people in which one is not drinking fluoridated water, or brushing their teeth. Measuring sugar consumption, socioeconomic status, and other confounders is too complex a task. Did dental health improve from the ’60s and ’70s due to water fluoridation? Or was the result of fluoride toothpaste? How much impact did increased affluence have in more regular visits to the dentist?

These questions are too complex for absolute and judicious answers.

The Cochrane reported that water fluoridation evidence was sparse, and what little there was implied that cavities are reduced in children; but that the results are based predominantly on old studies prior to 1975 “that may not be applicable today.”

It found “insufficient evidence” to determine whether fluoridation is effective for adults.

Ultimately, the Cochrane neither supports nor derides fluoridation; it simply requests more research. There’s no argument that fluoridation doesn’t work; the question is whether it remains the moral, financial, resourceful and sustainable way forward.

In terms of toothpastes, the Cochrane concludes that a fluoride concentration of 1500 ppm is beneficial. (Typically toothpastes contain between 1000 and 1500 ppm.) Evidence regarding the usefulness of xylitol as an oral health aid was of too low a quality to discern its value in regard to preventing tooth decay in infants, older children or adults.

The toothpaste tube, which have been around since 1898 (and, by the way, influenced NASA in terms of food delivery) is basically an environmental catastrophe. Being made from a number of different plastics, and sometimes with a metal laminate, they’re not recyclable and end up as landfill – 1.5 billion of them every year, with each one taking five centuries to degrade.

More than that, according to Dutch NGO Plastic Soup Foundation, nearly half of all toothpastes contain microplastics: those minute, indestructible plastic polymers we spit down the sink for them to wash up in the food chain.

Ostensibly, where toothpaste is concerned you’re damned if you do, dentally damaged if you don’t.

Herbal, organic and natural toothpastes essentially address just the ingredients, emphasising plant extracts, compounds and substances of a non-synthetic category. Generally – although not entirely – they subscribe to policies of ethicality in terms of eschewing toxic chemicals, animal testing, protecting animal rights and promoting product sustainability.

The hard line really, is that for all these things to be a reality rather than an influencer’s high or a Tik Tok token, we have to be making our own in reusable glass jars. The supply chain that globally criss-crosses oceans and countries to deliver that minty freshness in neatly squeezable tubes comes at a cost that far exceeds the price. Toothpaste has to be more about ethics than aesthetics. It has to be about conscience, not convenience.

You might want to brush up on that.

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