toothpaste oozing from tube

The Great Toothpaste Debate Continues: Fluoride? Xylitol? Probiotics?

toothpaste oozing from tubeYou hear fluoride touted as the best way to prevent decay. Then you run into studies like the one published this spring in the Journal of Dental Research.

For it, the dental health of 1248 caries-free children was monitored for three years. Half of the kids got fluoride varnish regularly applied. They also got toothbrushes, fluoride toothpaste, and “standardized, evidence-based prevention advice.” The other half got advice only.

This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression.

Other research suggests that including xylitol with fluoride could reduce caries more. After all, xylitol is known to keep S. mutans at bay – one of the main pathogens involved in tooth decay. It also seems to inhibit demineralization.

But the quality of evidence in that literature review was pretty low, with a high risk of bias.

So what happens if you throw probiotics into the mix?

The idea behind oral probiotics is to promote a healthy balance of microbes in your mouth. There are a lot of them – billions – even in the cleanest mouth, representing hundreds of different species. Some of these are harmful, leading to tooth decay and gum disease. Others keep those bad guys in check (among their many other functions).

Probiotics help the good guys thrive. And so far, the research has been quite promising.

A new study in Oral Health & Preventive Dentistry set out to compare a xylitol-plus-probiotic paste with a xylitol-only paste and a conventional fluoride paste. Four dozen teens were randomly split into three groups, each with a different product. They were taught how to brush effectively and were told to brush twice daily, two minutes each time, for six weeks.

At the end of the test period, all groups showed better plaque control. But only the probiotic and fluoride paste groups showed “statistically significant” improvement in gum health. And all told,

PerioBiotic toothpaste was found to be better than Xyliwhite and Colgate Max Fresh toothpastes at reducing plaque and gingival scores,

although the differences between the probiotic and fluoride pastes were not found to be statistically significant.

But before you rush out and buy a probiotic paste, there’s one other thing you might like to know. When it comes to removing plaque, as we’ve noted before, the toothpaste you choose may not matter much – a point made by a systematic review published last year in the Journal of Clinical Periodontology.

Evaluating data from 10 studies that met their criteria, the authors found that brushing without a toothpaste was just as effective than brushing with one. In fact, most “comparisons did not show an additional effect of dentifrice use.”

The cumulative evidence for this systematic review demonstrates that there is moderate certainty that toothbrushing with a dentifrice does not provide an added effect for the mechanical removal of dental plaque.

Regardless of the paste that you choose – or if you choose no paste at all – the main thing is to keep up your hygiene, a crucial matter when it comes to keeping a healthy microbial balance in your mouth.

Image by Janmi S, via Flickr