Toothpaste Selection 101

April 1, 2009
You have just completed a hygiene exam when the patient asks two common questions — “What toothpaste do you recommend?” and ...

by Anastasia L. Turchetta, RDH

For more on this topic, go to and search using the following key words: hygiene exam, professional toothpaste, over-the -ounter toothpaste, oral health, patient compliance, tartar control, Anastasia L. Turchetta.

You have just completed a hygiene exam when the patient asks two common questions — “What toothpaste do you recommend?” and “Have you heard of brand X?” Have you asked your patients which toothpaste they use, and compared it to which toothpaste would benefit their current state of oral health?

You may be surprised to learn that most people's choice of toothpaste is based on taste or cost, not oral condition. Although many hygienists' toothpaste recommendations can be found over the counter (OTC), some patients may benefit from a professionally dispensed toothpaste based on their current oral health condition.

Taking into account that most practices receive many toothpaste samples, which they offer to patients, the constant challenge for you and your team is identifying product ingredients, recognizing their purpose, and effectively passing that knowledge on to patients. “Toothpaste Selection 101” will review over-the-counter and professionally applied toothpaste categories that will help your patients maintain optimum oral health. You should discuss patient compliance and prepare your entire team to talk about the differences with confidence.

You may have noticed that OTC toothpastes have increased counter space. Take a walk down the aisle and you will scratch your head in disbelief. Let's begin with the basics. Your patients will recognize toothpaste buzzwords such as anti-cavity, anti-gingivitis, tartar control, sensitivity, oral malodor, whitening, enamel building/remineralization, and dry mouth. Here are the key ingredients:

Anti-cavity toothpastes will likely have sodium fluoride or sodium monofluorophosphate at 1,000 to 1,450 ppm for adults. Children's doses should be 500 to 1,000 ppm. Stannous fluoride also provides anti-cavity benefits; however, it is not the most common ingredient found in OTC toothpastes.

Anti-gingivitis pastes may have a combination of ingredients that are both bactericidal and bacteriostatic. Stannous fluoride, triclosan, cetylpyrindium chloride, chlorine dioxide, and zinc all play a role in reducing or eliminating bacteria associated with gingivitis.

For tartar control, look for tetrasodium pyrophosphate. It may or may not be included as an ingredient in either anti-cavity or anti-gingivitis pastes. Some of your patients may be sensitive to this particular ingredient.

Most pastes targeted for sensitivity will have potassium nitrate. Stannous fluoride and NovMin® also have a positive effect on sensitivity.

Ingredients in pastes for oral malodor vary and include zinc, essential oils, CPC, chlorine dioxide, and xylitol. Many whitening pastes have the added benefit of anti-cavity, anti-gingivitis, and tartar control plus hydrogen peroxide or sodium carbonate peroxide.

OTC remineralization pastes have a combination of amorphous calcium phosphate (ACP) and fluoride. Patients may be a bit confused regarding the importance of this category when choosing a paste for their family.

Sodium lauryl sulfate (SLS) is an ingredient that requires attention. Some patient may be sensitive to this foaming agent.

Most OTC pastes are user-friendly, meaning that patient compliance is not an unrealistic expectation. Sensitive pastes pose the most concern, as instructions are generally for the product to be used for two consecutive weeks before desired results are noticed.

Many pastes now incorporate xylitol. This natural sugar is a great benefit for patients with caries, periodontal disease, and dry mouth.

By separating and describing the purpose for each OTC paste category, you may feel better prepared about which paste would best benefit each patient.

Professionally dispensed pastes have similar categories. The concentration of particular ingredients, such as sodium and stannous fluoride, Recaldent™ (CPP-ACP), NovaMin® and SensiStat®, varies to help maintain optimum oral health. Patient compliance with each of these specific product guidelines is essential for desired results.

Matching patients' current state of oral health to their medical health is where your work begins. Start with medical health.

What health ailment would be a risk factor for periodontal disease, caries, dry mouth, or oral malodor? What medications may contribute to dry mouth, oral malodor, and caries? What nutritional choices benefit or harm the oral environment as well as medical health?

Next, evaluate past and present oral-health conditions to reveal potential patterns of compliance and conditions. Keep in mind that recent advancements in professionally dispensed pastes may not have been available before.

For instance, has the patient ever had periodontal therapy? If so, is there recession? Are those areas sensitive or prone to caries? Is the patient caries status high, moderate, or low risk? Has the patient undergone orthodontic treatment? How much decalcification is documented? What does the patient's soft tissue look like? What is the quantity and quality of salivary output? What is its pH?

Finally, discuss lifestyle and oral hygiene regimen with patients. Lifestyle choices affecting oral health are smoking, drinking alcohol or carbonated beverages, certain chewing gum or mints, acidic food selections, and environment. Obstacles to a good oral hygiene regimen include dexterity, intervals between brushing, and oral hygiene product use.

Now your job is to decide whether this condition is controllable with an OTC paste or a professionally dispensed paste.

If finding time for thorough communication regarding use is a challenge, it's a good idea to train the entire team. They should know your current preference — over-the-counter or professionally dispensed pastes. Schedule “lunch-'n'-learns” with several different company reps who can provide you with evidence-based information, correct application technique, and postapplication guidelines. Samples may be offered so you can gain insight about what your patients experience.

Once you receive your degree in “pasteology,” ask your team to write down the questions that patients ask them. Decide on a universal answer for each question. This is imperative. Your patients must hear the same answer from each team member to avoid confusion.

Some common questions for OTC pastes are:

“Isn't it just a fad?”
“Does it really work?”
“What does it taste like?”
“Can children use it?”
“When will I see results?”
“How much does it cost?”

Professional paste questions to prepare for are:

“How do I use it?”
“How often do I have to brush with it?”
“What if I swallow it?”
“Can children use it?”
“Why is it $25?”
“Will my insurance cover it?”
“How long will this tube last?”
“How long will I have to use this special paste?”
“Can I still use my whitening paste?”
“What if I don't like the taste?”
“Why don't you offer this product so I don't have to make a trip to the pharmacy?”

Who would have thought that toothpaste choices would expand so rapidly? It's no wonder that our patients are overwhelmed or that they purchase products that are not optimal for their oral health needs. Your patients' paste selection isn't based on their oral health-care needs. Instead, it is frequently based on cost, taste, or product size.

Educate yourself and your team on the various categories, their active ingredients, and the protocols necessary to achieve the desired results. Understand why patients may compromise compliance with your recommended paste selection.

Create your own Q and A with your team in an effort to deliver a universal message pertaining to paste recommendation. This preparation will save time in explaining the protocol. Diagnosing your patients' state of oral health, comparing it to their medical history, and discussing their accountability for product compliance is your professional responsibility. It is a waste not to know your pastes.

Anastasia L. Turchetta, RDH, is a national and international speaker, author, and coach. Her seminars empower and educate in a lively, team-centered, patient-focused atmosphere. She maintains memberships with NSA, SCN, ADHA, and ADA. She is a feature author in Conversations of Health and Wellness, and creator/author of “Just a Cleaning?”— an interactive assisted hygiene guide which contains a unique collaboration of both her 20 years of clinical hygiene experience and her coaching format. She may be contacted at

Five factors that determine patient compliance

  1. What is the length of time for efficacy of the product? Some pastes must remain in the mouth for three minutes.
  2. What is the application method of the product? Will the patient be able to benefit from a customized tray?
  3. What is the post application regimen for this product? Will your patient be able to be liquid-free for 30 minutes following use of the paste?
  4. How will the product efficacy measure when combined with other oral hygiene products? Different selections of mouth rinses may be counterproductive.
  5. Is your patient willing to change his or her lifestyle habits or oral regimen to comply?

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