DentalBuzz: a jolt of current

trends, innovations, and quirks of dentistry

Candy that really fights cavities

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which tooth

Why do you get cavities? It’s not because your teeth are soft. Cavities happen in mouths where the environment is all jacked up. Too much acid, too many germs, an abundance of refined foods, too little saliva. Basically the little ecosystem in your mouth is out of whack.

How do you get it back in balance? You already know some things you can do: eat better, brush and floss better, drink water. Sometimes, though that’s not enough. What do you do between meals? Between brushing?

You change the mouth itself by changing what can grow in there.

One way is with licorice:

No, that doesn’t count, sorry. It has to be real, tar-black, sugarless licorice. Real licorice contains licorice extract (unfortunately, that’s the stuff that makes it taste way worse than Red Vines).  The way that licorice fights cavities is by changing the mouth environment so that the germs that cause cavities are inhibited.

These are licorice roots:LicoriceRoot

Licorice roots have been around ever since the original hunters and gatherers realized they were sweet-ish, quenched thirst, and tasted much better than most of the other twigs and sticks they used to dig around in their gums and teeth. Maybe they realized their teeth hurt less when they chewed on them, too. Licorice roots contain a compound called glycyrrhizin, which has been proven to reduce tooth decay. They’re cheap, natural, and abundant; you can even buy them here at this link on Amazon.com. But a word of caution: glycyrrhizin can be dangerous in excess amounts. Since licorice root is considered a natural herb, there’s no way for the FDA to regulate the dosage, and too much of it can cause heart arrhythmias, increase blood pressure, and reduce potassium levels.

If your response to black licorice and licorice roots are No, and Hell No, respectively, then how in the heck do you think you’re going to get kids to put licorice extract in their mouths?

Enter capitalism at its finest, folks.

Loloz1

When this company contacted me about a year ago, I was excited to eat free candy write a product review about something that may really help my patients prevent cavities. Remember what I was saying about licorice? Cavibloc™ is the proprietary formulation of licorice extract used in Loloz™ that you can read on their ingredient list here:

Lolozingredients

How this works

I’ve seen enough studies and listened to tons of lectures from smart people who know what they’re talking about to be convinced that the science is very strong behind using licorice extract in this way to prevent dental cavities. Here’s the biggest problem about it, though:  it doesn’t work if you don’t use it, duh. Follow the steps below to get started on this great cavity prevention regimen:

1. Overcome your objections. Just so you know, I’ve eaten practically a whole box of the berry flavored pops, given them to my kids and friends of my kids, and they taste good. Really good. No problem on the flavor at all. Also, it will cost about $90/year for three boxes. Those are the big obstacles. Everything after this is easy.

2. Buy your boxes at Amazon.com. Lookie, it even comes with Amazon Prime! Here are your flavor choices (and by the way, these are NOT affiliate links – I’m not making any money off of this, just in case you doubt my sincerity):

Loloz Berry Lollipops

Loloz Orange Lollipops

Loloz Lemon Lollipops

For people who aren’t into the whole “stick hanging out of your mouth” thing, there are candy lozenges, too:

Loloz Berry Candy

Loloz Orange Candy

Loloz Lemon Candy

3. Open up your box when it arrives.

Loloz2You’ll get 20 suckers per box… but maybe they’ll throw in a few for a bonus, with a note to let you know they didn’t count wrong. Maybe eat one of the extra ones as soon as you get them, to make sure you’re going to like them. Then…

4. Put them in the car. What? Following the recommended regimen is the most important part. It takes about 10 days of consecutive exposure time for licorice extract to disrupt the germs that cause cavities. And not just once per day. Two times per day for ten days. You’ll want to have one sucker in the morning, one in the evening. But how do you remember to have two per day? You and your kids (if you take them to school and/or work) are in your car at least twice per day. Maybe you don’t actually leave the lollipops in the car because they may get icky gooey on hot days. But you know what I mean. Discipline yourself to make sure you’re using them two times per day.

5. Repeat in 4 months. You’ll do this about three times per year for excellent cavity control, plus you get to feel good about eating candy. Whee! Over time, the bad bacteria will start creeping back in, but starting up another 10-day treatment in 3 to 4 months will help balance out the mouth environment once again.  People who get cavities easily need licorice root extract. It’s just that simple. If you’ve ever been given a prescription for high fluoride toothpaste, Loloz are for you.

So you may be asking yourself, why no one else is talking about this, why there might not be a lot of Amazon reviews on Loloz, it must not be any good, right? No, that’s not it. The company made a big push a year ago to get the word out, but marketing these days is a tricky thing for new companies. I am confident that the product is spot-on, and I’m here to reinforce again to you that balancing your mouth environment is one of the most important things you can do to prevent cavities. There are other ways to reduce tooth decay, but right now Loloz are your best bet for obtaining a proven, long-term, dose-controlled antimicrobial effect against decay-causing bacteria. And if you’re a dentist or hygienist who is thinking about recommending this to your patients, remember:

COMPLIANCE IS EVERYTHING!

…She says, with a delicious, sugar-free Loloz lollipop in her mouth.

 

 

trishlollyTrish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She has a very, very bad sweet tooth and doesn’t take money from companies like Loloz because she’s afraid they would give her a lifetime supply of sugarless candy which would be no fun because, hey, if it’s good for you, the days of living dangerously from sugar highs just go phhhht. gone.

 

 Resources and References:

International Journal of Pharma and Bio Sciences, January 2015. “Assessing the effectiveness of liquorice root extract lollopop in reducing the S. mutans count in saliva in children aged 6-12 yrs – a pilot study.” http://www.ijpbs.net/cms/php/upload/4020_pdf.pdf

European Academy of Pediatric Dentistry, December 2010. “Clinical reduction of S. mutans in pre-school children using a novel liquorice root extract lollipop: a pilot study.” http://www.ncbi.nlm.nih.gov/pubmed/21108917

Medscape, January 2012. “Licorice Root May Cut Cavities, Gum Disease.” http://www.medscape.com/viewarticle/756532

John C. Comisi, DDS, MAGD, April 2013. “Employing a whole-patient approach to the lifelong struggle of caries management.” http://www.dentalaegis.com/id/2013/04/oral-disease-the-battle-for-balance

British Dental Journal, December 2009. “Liquorice Alert.” http://www.nature.com/bdj/journal/v207/n11/full/sj.bdj.2009.1090.html

Toothpaste can do more harm than good

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wrongTP

The next time a patient innocently asks me, “What’s the best toothpaste to use?” I’m going to unleash a whole Chunky Soup can of “You Want The Truth? You CAN’T HANDLE THE TRUTH!!!” Gosh, that’s such an overused movie quote. Sorry about that, but still.

If you’re a dental professional, isn’t this the most annoying question you get, day after day? Do you even care which toothpaste your patients use?

No. You don’t. Asking a dentist what toothpaste to use is like asking your physician which bar of soap or body scrub you should use to clean your skin. Your dentist and dental hygienist have never seen a tube of toothpaste that singlehandedly improves the health of all patients in their practice, and the reason is simple:

Toothpaste is a cosmetic.

We brush our teeth so that out mouths no longer taste like… mouth. Mouth tastes gross, right? It tastes like putrefied skin. It tastes like tongue cheese. It tastes like Cream of Barf.

On the other hand, toothpaste has been exquisitely designed to bring you a brisk rush of York Peppermint Patty, or Triple Cinnamon Heaven, or whatever flavor that drives those tubes off of the shelves in the confusing dental aisle of your local supermarket or drugstore.

yuckpaste

Toothpaste definitely tastes better than Cream of Barf. And that’s why you use it. Not because it’s good for you. You use toothpaste because it tastes good, and because it makes you accept your mouth as part of your face again.

From a marketing perspective, all of the other things that are in your toothpaste are in there to give it additional perceived value. So let’s deconstruct these ingredients, shall we?

cavprotecttooth

1. Fluoride.

This was probably the first additive to toothpaste that brought it under the jurisdiction of the Food & Drug Administration and made toothpaste part drug, part cosmetic. Over time, a fluoride toothpaste can improve the strength of teeth, but the fluoride itself does nothing to make teeth cleaner. Some people are scared of fluoride so they don’t use it. Their choice. Professionally speaking, I know that the benefits of a fluoride additive far outweigh the risks.

2. Foam.

Sodium Lauryl Sulfate is soap. Soap has a creamy, thick texture that American tongues especially like and equate to the feeling of cleanliness. There’s not enough surfactant, though, in toothpaste foam to break up the goo that grows on your teeth. If these bubbles scrubbed, you’d better believe that they would also scrub your delicate gum tissues into a bloody pulp.

3. Abrasive particles.

Most toothpastes use hydrated silica as the grit that polishes teeth. You’re probably most familiar with it as the clear beady stuff in the “Do Not Eat” packets. Depending on the size and shape of the particles, silica is the whitening ingredient in most whitening toothpastes. But whitening toothpaste cannot get your teeth any whiter than a professional dental cleaning, because it only cleans the surface. Two weeks to a whiter smile? How about 30 minutes with your hygienist? It’s much more efficient and less harsh.

4. Desensitizers.

Teeth that are sensitive to hot, cold, sweets, or a combination can benefit from the addition of potassium nitrate or stannous fluoride to a toothpaste. This is more of a palliative treatment, when the pain is the problem. Good old Time will usually make teeth feel better, too, unless the pain is coming from a cavity. Yeah, I’m talking to you, the person who is trying to heal the hole in their tooth with Sensodyne.

5. Tartar control.

It burns! It burns! If your toothpaste has a particular biting flavor, it might contain tetrasodium pyrophosphate, an ingredient that is supposed to keep calcium phosphate salts (tartar, or calculus) from fossilizing on the back of your lower front teeth. A little tartar on your teeth doesn’t harm you unless it gets really thick and you can no longer keep it clean. One problem with tartar control toothpastes is that in order for the active ingredient to work, it has to be dissolved in a stronger detergent than usual, which can affect people that are sensitive to a high pH.

6. Triclosan.

This antimicrobial is supposed to reduce infections between the gum and tooth. However, if you just keep the germs off of your teeth in the first place it’s pretty much a waste of an extra ingredient. Its safety has been questioned but, like fluoride, the bulk of the scientific research easily demonstrates that the addition of triclosan in toothpaste does much more good than harm.

Why toothpaste can be bad for you.

Let’s just say it’s not the toothpaste’s fault. It’s yours. The toothpaste is just the co-dependent enabler. You’re the one with the problem.

Remember, toothpaste is a cosmetic, first and foremost. It doesn’t clean your teeth by itself. Just in case you think I’m making this up I’ve included clinical studies in the references at the end of this article that show how ineffective toothpaste really is.

peasized

• You’re using too much.

Don’t be so suggestible! Toothpaste ads show you how to use up the tube more quickly. Just use 1/3 as much, the size of a pea. It will still taste good, I promise! And too much foam can make you lose track of where your teeth actually are located.

• You’re not taking enough time.

At least two minutes. Any less and you’re missing spots. Just ’cause it tastes better doesn’t mean you did a good job.

• You’re not paying attention.

I’ve seen people brush the same four spots for two minutes and miss the other 60% of their mouth.brushguide The toothbrush needs to touch every crevice of every tooth, not just where it lands when you go into autopilot and start thinking about what you’re going to wear that day. It’s the toothbrush friction that cleans your teeth, not the cleaning product. Plaque is a growth, like the pink or grey mildew that grows around the edges of your shower. You’ve gotta rub it off to get it off. No tooth cleaning liquid, paste, creme, gel, or powder is going to make as much of a difference as your attention to detail will.

The solution.

Use what you like. It’s that simple. If it tastes good and feels clean to you, you’ll use it more often, brush longer, feel better, be healthier.

You can use baking soda, or coconut oil, or your favorite toothpaste, or even just plain water. The key is to have a good technique and to brush often. A music video makes this demonstration a little more fun than your usual lecture at the dental office, although, in my opinion you really still need to feel what it is like to MASH THE BRISTLES OF A SOFT TOOTHBRUSH INTO YOUR GUMS:

 

A little more serious video from my pal Dr. Mark Burhenne where he demonstrates how to be careful with your toothbrush bristles:

Final word.

♬ It’s all about that Bass, ’bout that Bass, no bubbles. ♬ Heh, dentistry in-joke there.

Seriously, though, the bottom line is that your paste will mask brushing technique issues, so don’t put so much faith in the power of toothpaste.

Also you may have heard that some toothpastes contain decorative plastic that can get swallowed. Yeah, that was a DentalBuzz report I wrote that went viral earlier this year. And while I can’t claim total victory on that front, at least the company in question has promised that the plastic will no longer be added to their toothpaste lines very soon due to the overwhelming amount of letters, emails, and phone calls that they received as a result of people reading that article and making a difference.

But now I’m tired of talking about toothpaste.

Next topic?

I’m bringing pyorrhea back.

 

 

Trish Walraven RDH, BSDH is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She brushes her teeth every morning and night with a major-label toothpaste because she likes the way it makes her mouth taste but at lunch you never know. Sometimes it will be with a dry toothbrush, or dipped in her leftover coffee, one time she even brushed with a starlight peppermint out of desperation.

 

 

Resources:

PubMed.Gov: Role of dentifrice in plaque removal: a clinical trial.

PubMed.Gov: Clinical studies to determine the effectiveness of a whitening toothpaste at reducing stain

 PubMed.Gov: Factors contributing to adverse soft tissue reactions due to the use of tartar control toothpastes.

Vicky Flint RDH: The Truth about Toothpaste

DearDoctor.com: Toothpaste-What’s in it?

Trisha O’Hehir RDH: Dry Brushing -The Toothpaste Secret

 

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*dentist not included (with clear aligners)

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This post is from the time when SmileDirectClub first began its marketing campaign, from the standpoint of a general dentist’s practice, and the feelings of whether or not online-ordered cosmetic aligners would be taking away market share for dentists.  The reviews are posted below the article, from those who have used the product or who have questions about it.

phototeeth

If you’re not an orthodontist, but you straighten teeth in your dental practice, I’ve got a fistfight just waiting for you. Where? Thankfully someone else went through the trouble of making this cute little scroll-ey infographic, so I’ll just post it here and save myself the trouble, and the punches.

SmileCareClub Wants to Disrupt Dentists- Crowdfunding Insider (no longer available)

(sorry, looks like the infographic wasn’t sanctioned by Smile Care Club… anyways, here’s another link on IndieGogo)

A full set of dental aligners, just like the Invisalign® ones, for a third of the cost or less, can you simply order them online? With no visit to a dental office? Heck, why not? I mean, all you have to do is worm two pieces of putty together and then squish them onto your teeth for an impression, mail them to the lab, upload a few photos from your smartphone, and wait for your trays to magically appear at your doorstep.

What is it with blue boxes? Is blue, like, a confident color or something? See how the SmileCareClub box compares to an aligner box from our office:

alignerboxes

And then there’s the involvement of the aligner-providing dentist. The ClinCheck inclusion is a facade, a joke? You mean to tell me that the lab could do all of this via 3D imaging and just cut the middleman dentists out of the deal?

Not completely. You’ve got interproximal reductions that still need to be managed in some cases, and the SmileDirectClub is looking for suckers Endorsed Local Providers to saw those big fat teeth into submission. And who the heck knows whatever happened to attachments? I personally had Invisalign attachments placed a decade ago, and cannot imagine what my results would have been without them.

Orthodontists are probably chuckling to themselves. They saw this coming with all of the cosmetic tooth straightening programs being marketed to general dentists over the last decade.

It makes the whole teeth whitening mall kiosk issue seem petty, now, doesn’t it?

SmileCareClub doesn’t appear to have a single dentist on its management team, but they employ a few, I guess, to keep it legal, I guess. It’s really hard to tell. This aligner system is also sold on the Sharper Image website, in case you want to forward a link to any patients who look at you sideways and curse under their breath when you tell them what their in-office aligner treatment is going to cost. Sharper Image– that’s legit, right? Maybe you didn’t realize that the original Sharper Image went bankrupt. Interestingly, the brand name was bought by the same VCs that, guess what?- own SmileDirectClub.

Orthodontists, are you feeling disrupted yet?

I didn’t think so.

A blogger since 1997, Trish Walraven, RDH, BSDH is a practicing dental hygienist and marketing manager for an indie dental software development company. Her mission with DentalBuzz is to offer a fresh podium of discourse for those involved in dentistry and to expose fun in our professional lives.

 

 

Update: SmileCare Club is now called SmileDirectClub, which you can see at SmileDirectClub.com. The cost is $1500, and if you Buy Today!, they’ll include GloScience gel (interestingly enough, here’s what DentalBuzz had to say about GloScience in 2011).

Aug 2016 Update: Invisalign has announced that they are building aligners for Smile Direct Club. See the notice in the comments below. The similarity of the boxes now makes sense!

2017 Update: Invisalign now owns a 19% interest in SmileDirectClub. But that kind of backing will cost you $350 more, which now brings the cost of aligner therapy to $1850.

September 2019 Update:

Smile Direct Club just had their IPO, and now the founders are billionaires. It’s all about disruption of the status quo, apparently, because if you can afford $80/month instead of $150/month (the cost to see a real orthodontist) you should Do Orthodontics Yourself. Smile Direct Club have no more than 250 dentists that “check” the cases. That’s one dentist per 3000 patients (750,000 people served so far)! Bottom Line? If you think of teeth as ornaments, not functional body parts, then that’s on you if they rot out or you can’t chew with them afterwards. Story here: https://www.bloomberg.com/news/articles/2019-09-13/smiledirectclub-s-ipo-creates-a-pair-of-30-year-old-billionaires

Phocal fluoride disks

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What in the phôc is Phocal? The name is oh-so-clever, the way it changes up the F-sound, pinpoints the precision of its delivery mechanism, adds in a little calcium and acid/base interplay there. Plus, the little disks sorta kinda look like contact lenses. Phocal – the latest in fluoride therapy.

phocal-discs
Phocal disks were brought to market last year, but I just discovered them a few days ago at Hygienetown, one of my favorite online dental hangouts, where they were met with a vague sort of shrug and a huh? Which got me to wondering, why in the world aren’t these things getting more press, more attention, more rave reviews?

Of course! It’s because they haven’t been DentalBuzzed yet.

The few articles that I’ve read about Phocal so far are as exciting as your average WHAT’S NEW IN DENTISTRY dreck. DentalBuzz is here to change that, to present to you all the facts about Phocal Therapy in an entertaining, yet insightful package designed to bring the maximum exposure possible to a product that will sink or swim on its own merit in the end.

Problem #1: Incipient interproximal lesions

If you’re not in dentistry you probably don’t know what these are. Let’s just call them future “Cha-Ching!” You know when dentists take radiographic images inside your mouth with x-rays? They’re looking for cavities between your teeth, where sugar and decaying bacteria ferment into acids that dissolve the surface of enamel into a mass of tiny swiss-cheese chalky goo.

incipient
When an interproximal lesion has gone too far, expect your dentist to drill it, fill it, and bill it (sorry for such a stale joke!). But Phocal disks promise to change all that. These cute little frisbees are designed to be inserted between your teeth (interproximal) before they’ve decayed, at the first sign of a beginning (incipient) cavity, to minimize the damage done to your teeth, as well as to your bank account.

Problem #2: Isocaps

Even many dentists have forgotten what an isocap is, so that’s why I’m going to explain them to you and why a Phocal disk inhibits their formation. Essentially an isocap is a bubble created between two flat surfaces that prevents liquids from wicking into it. Isocaps have to do with capillary action and surface tension.

Isocap1
Most fluoride delivery systems rely on a liquid to get the tooth-strengthening bits to soak deep into dental structure. If you’ve got a bunch of isocap bubbles between your teeth you can see how there’s no way that you’ll get a liquid-based fluoride to wick into the space where it may be needed most.

The Solution: Jam Some Stuff Between Your Teeth

If you can’t penetrate an isocap, well then, just obliterate it, take it out of existence, displace it. Whatever it takes, just put something ELSE there. Fluoride has been proven in many studies to increase the remineralization of a tooth that has begun to weaken, which is why fluoride is the active ingredient in the Phocal disks.

I’d explain how this whole process works, the options available, and even the studies that show how Ah-May-Zing this new fluoride therapy is except that someone at Collident paid a production company to make this perky animated video that does the job for me pretty well. Yes, you DO have three minutes to watch it. And there’s no voice-over, so feel free to turn off your sound before you click the arrow to start it up.

 

The Obstacles: Price, Chair Time and FDA Approval

What…you were expecting that these disk are THE answer to cavities between our teeth, forever and ever, end of discussion? If they were perfect we’d all have them in our mouths right now. For one thing, they’re not cheap: a box of 20 Phocal disks cost the dentist around $125 – that’s over $6 for each insertion. And because they are “technique sensitive” (read: only an experienced professional can place them) you’ve also got to deal with the dental office overhead fees. As far as the FDA approval goes, as of the time of this publication it appears that the Food and Drug Administration says that the Phocal Disc is unapproved, stating “this drug has not been found by the FDA to be safe and effective, and this labeling has not been approved by the FDA.”

Does this mean, then, that Phocal disks are doomed to obscurity and demise? Not necessarily. Dentists have no problem purchasing a box from the usual channels, but they may not be aware that this therapy exists in the first place, because there are all these flashy things in dentistry that many dentists prefer to spend their time learning about besides prevention. Besides, there’s more money to be made by fixing decayed teeth versus trying to preserve demineralized ones. That’s why the 5th dentist never recommends sugarless gum to his patients who chew gum (!). Cavities keep dentists profitable.

Which is why it’s now YOUR job to ask for Phocal disk therapy the next time your dentist wants to “watch” a spot between your teeth. And that is because watching is a very, very unhealthy type of voyeurism in the dental world.

References:
University of Michigan: Capillary Action around Dental Structures
National Library of Medicine: http://dailymed.nlm.nih.gov/dailymed/Phocalfluoride

Crest toothpaste embeds plastic in our gums

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This is polyethylene:

bottlesandbags

Did you know that polyethylene is the most common plastic in the world? It is used primarily for containers and packaging, such as these bottles and plastic grocery bags, and has been a concern for the environment because polyethylene lasts practically forever and isn’t biodegradable. It only breaks down into smaller and smaller particles until you can’t see it anymore. That’s why a couple of states are trying to ban it in body scrubs and dental products.

This is also polyethylene:
PeasizedTPaste

Well, not all of it. Most of it is toothpaste. But do you see those blue specks? That’s plastic. This is the suggested pea-sized amount that you should use when you brush your teeth. Yes, there is plastic in this toothpaste.

Want to see how many pieces of plastic are in this exact sample?

PasteSmear

Not that I’m counting the bits but that seriously looks like A LOT of plastic… err…high density polyethylene. That’s what plastic trash cans are made from! If you throw away the box like most people do, the ingredients aren’t actually listed on the tube (sneaky, sneaky, Procter & Gamble!) However, I was able to track down the box here at this link. We’re not talking about polyethylene glycol, which is soluble in water. This stuff won’t dissolve in water, or even acetone or alcohol for that matter. How do I know it won’t dissolve? Because I put on my little scientist hat and tested it.

Like many of you, we often let our daughter pick out her own toothpaste at the store. She liked the tween vibe of this particular product so much that she chose it twice, but eventually the squeezed-out tubes ended up in the back of her toothpaste drawer.

Crestforme

When I first got wind that plastic was in some toothpastes, it was kind of exciting to realize that we had some on hand! And a bit concerning, because, after all, this is in my own home, used by my own child. Able to confirm that, sure enough, there was polyethylene in this toothpaste, I squirted out a pea-sized sample, mixed it up with some water, strained out the undissolved particles and let them dry on a paper towel. Oh, and I used a hair dryer to speed things up because I’m impatient. Then I shook approximately half of the sample into each of two pyrex bowls and added some household solvents:

acetonealcohol

They didn’t dissolve in the acetone, (nail polish remover) or in the alcohol either. I even left the samples in the solutions overnight, then re-hydrated them. No change in the particles.

specks1polyethylenefinger

So it has been established here that polyethylene will not dissolve in the mouth, or even in household products. It is an inert substance, which means that it doesn’t change at all. You know, that’s pretty good in some ways, because at least it’s probably not morphing into big blobs of plastic evil cancer bait.

Here’s where the story gets scary, though.

You see, I’m not just a concerned mom. I’m also a dental hygienist. And I’m seeing these same bits of blue plastic stuck in my patients’ mouths almost every day.

Around our teeth we have these little channels in our gums, sort of like the cuticles around our fingernails. The gum channel is called a sulcus, and it’s where diseases like gingivitis get their start. A healthy sulcus is no deeper than about 3 millimeters, so when you have hundreds of pieces of plastic being scrubbed into your gums each day that are even smaller than a millimeter, many of them are getting trapped:

plasticingums

The thing about a sulcus is that it’s vulnerable. Your dental hygienist spends most of their time cleaning every sulcus in your mouth, because if the band of tissue around your tooth isn’t healthy, then you’re not healthy. You can start to see why having bits of plastic in your sulcus may be a real problem, sort of like when popcorn hulls find their way into these same areas. Ouch, right?

Like I said, I’ve been seeing these blue particles flush out of patients’ gums for several months now. So has the co-hygienist in our office. So have many dental hygienists throughout the United States and Canada who have consulted with each other and realized that we have a major concern on our hands.

This is what an actual polyethylene speck looks like when it’s embedded within the sulcus, under the gumline:

gingival specks

I am not saying that polyethylene is causing gum problems. I’d be jumping too soon to that conclusion without scientific proof.  But what I am saying definitively is that plastic is in your toothpaste, and that some of it is left behind even after you’re finished brushing and rinsing with it.

Do you want plastic in your toothpaste? So far the only mention of polyethylene on the Official Crest website at this link is that it is added to your paste for color, not as an aid in helping to clean your teeth or to disperse important anti-plaque or anti-cavity ingredients. [Note: as of 9/3/14 Crest took down the link about polyethylene, but I saved a copy of it here in case this ever happened.]

In other words, according to Crest:

Polyethylene plastic is in your toothpaste for decorative purposes only.

This is unacceptable not only to me, but to many, many hygienists nationwide. We are informing our patients. We are doing research separately and comparing notes. And until Procter & Gamble gives us a better reason as to why there is plastic in your toothpaste, we would like you to consider discontinuing the use of these products.

Here are some of the brands (click each to see their ingredient list and labeling) that we currently are aware of which contain polyethylene:

What you can do

At this point, it’s probably best if you leave your flaming torches back in the barn. We’re not going after witches or Frankenstein here; you’re using your power as a consumer to send a message that you do NOT want plastic in your toothpaste. Heck, you might even be worrying about what may happen if you or your children swallow some of it.

1. If you’ve already purchased one of these toothpastes you can take it back to the retailer where you bought it, make sure that the manufacturer knows why you’re returning it, and ask for a refund.

2. Lodge a Crest consumer complaint at (800) 959-6586 and report an adverse health effect, namely, that you’re concerned that plastic pieces may be getting trapped in your mouth.

3. Click here to send an email to Procter & Gamble, the makers of Crest.

4. Share this! Let your friends and family know that you are also concerned about the plastic in their toothpaste by clicking on your favorite social media link below and getting the word out.

Response to criticism

Procter & Gamble’s current party line? “We will discontinue our use of PE micro plastic beads in skin exfoliating personal care products and toothpastes as soon as alternatives are qualified.”

And your response then may be, “I will discontinue MY use of Crest toothpaste until there are no more decorative microplastics entering my mouth.”

 

Trish Walraven RDH, BS is a mom and practicing dental hygienist in the suburbs of Dallas, Texas. She is also the co-creator of BlueNote Communicator, the top selling intra-office computer messaging system for dental and medical offices.

 

References and acknowledgements

Plastic Trades Industry: http://www.plasticsindustry.org/AboutPlastics
US National Library of Medicine: http://dailymed.nlm.nih.gov/crest
HygieneTown: http://www.hygienetown.com/blue-dots-in-patients-mouths

And a HUGE thank you goes out to my friend and colleague Erika B. Feltham, RDH for bringing this problem to our attention and for her extensive research. Erika is dedicated to providing the best possible care for her patients. She has been active in the dental profession for over 30 years, is a recipient of the 2008 American Dental Hygiene Association/Johnson and Johnson Hygiene Hero Award, the 2010 RDH Sunstar Americas (GUM Dental)Award of Distinction, lectures extensively about the harmful effects of sour candies, energy and sports drinks, and along with her San Diego component, she is responsible for presenting the resolution on sour candy labeling at the 2009 CDHA House of Delegates.

Update on 9/10/14:

As requested, here’s a quick video I made today that demonstrates polyethylene microbeads becoming embedded after brushing. This is for real; I didn’t poke the plastic in my gums (although I may have brushed a little more rough than normal!).

Update on 9/20/14:

This story got picked up nationally over the past week, with these notable entries:

The American Dental Association issued this press release regarding the safety of plastic in toothpaste and whether or not to remove the ADA Seal of Approval on Crest products.

FDA says that plastic is not approved as a food additive: NBC National News – Today Show

Interview in Phoenix, AZ  mentioning the influence of DentalBuzz on Procter & Gamble:

 

Trish’s interview on Good Morning America:

http://abcnews.go.com/video/embed?id=25560562

 

Brian Williams on NBC:

http://player.theplatform.com/p/2E2eJC/nbcNewsOffsite?guid=nn_09_bwi_toothpaste_140917

 

A concise writeup at the Washington Post

 

And a final word on why we shouldn’t even be so preoccupied with toothpaste in the first place:

http://www.dentalbuzz.com/2014/12/30/toothpaste-can-do-more-harm-than-good/

 

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