Children below six should use no more than a pea-sized amount on the brush. They should spit out and not swallow excess toothpaste after brushing. What is it in the innocent toothpaste that has invited such warnings?
Toothpaste is an aid to oral hygiene and helps prevent the formulation of particle build up in the mouth. Toothpaste, along with a toothbrush is necessary tools to eradicate plaque, gingivitis, mouth odour, as also a way of improving the aesthetic appeal of the mouth. Today’s formulations, herbal based or otherwise attempt to not just impart freshness in the breath, but also give the consumer a set of whiter and shinier teeth.
In the olden days, powdered alum, burnt bread, chalk, powdered herbs, especially mint and basil, salt, etc. were formulations that were used for cleaning teeth in the olden times. Some people also used crushed egg shells, bones and oyster shells. These were abrasive in nature and were massaged into the teeth with the help of a stick.
 Why should I be aware of this?
In a recent article in the Globe and Mail, Dr Hardy Lime-back, head of preventative dentistry at the University of Toronto's faculty of dentistry states: "We know for sure that kids who ingest more than the optimum amount [of fluoride] before the age of six will have fluorosis on their permanent teeth. 
There are more than 500 types of microorganisms in the mouth. The microorganisms feed on the food residues left in the mouth, thereby creating an acid. This acid, along with abrasive and harmful particles called the volatile sulphur molecules eat in to the tooth enamel producing cavities and bad odour.
Toothpaste along with a tooth brush physically cleans away food particles and thereby fights plaque. Some toothpastes chemically fight the formation of further plaque. The ingredients in these pastes contain natural Xylitol and artificial triclosan. Dental flossing helps in removing debris from the cracks between the teeth and also contributes to healthy teeth. The so called herbal alternatives have also not been found upto the mark. With studies showing that some of the chemicals used in toothpastes are mildly harmful, the Canadian Health authorities had issued a warning in its advisory, against the use of a toothpaste Neem Active, manufactured in India by a Kolkata based company, Calcutta Chemicals. The warning was in response to the alarming levels of DEG (Diethylene glycol) found in the toothpaste along with a high percentage of bacteria. DEG works as a sweeter since sugar cannot be used in toothpaste formulations.
In yet another warning of a similar kind, health officials in the USA have warned its citizens against the use of a toothpaste manufactured in China. The toothpaste was also found to have exceeded the permissible levels of DEG in its content. On grounds of health, especially for little children who often swallow the toothpaste, the Chinese toothpaste has been banned in the country. Health officials are more worried with the fact that the product is still being sold in small outlets and bargain stores.
 How does this affect me?
Studies have pointed out a number of ingredients in many brands of toothpastes which pose a health risk to children and those with poor immunity levels. Fever, abdominal pain, urinary tract infection, gastrointestinal problems are some of the problems that the health officials have listed as probable risks that may occur should the toothpaste be used.
This brings to light the fact that an innocuous health product as the toothpaste can also pose huge health risks. This is of concern more so because toothpaste, as a product, promotes oral health and hygiene. Hence it is imperative that we spend some time in choosing the right kind of toothpaste for ourselves, especially for our children who are the most vulnerable targets.
 Toothpaste and environment
The ingredient pyrophosphate used in toothpastes adds phosphate to the waterways. This along with triclosan another ingredient and a registered pesticide (used as an antibacterial and antifungal agent) can destroy fragile aquatic ecosystems. Potassium nitrate also harms the aquatic environment nasty, while parabens can disrupt the hormones in animals. The artificial flavors and sweeteners (more toxic chemicals) that cover up the taste of the other chemicals also add to the harm.
Though one little blob of toothpaste added to a stream does not kill the local frog population, but the problem is that millions of people use it daily.
The plastic toothpaste tubes end in a landfill each year and remain there for thousands of years.
 All about toothpaste
Toothpaste seems to improve every day. There are anti-cavity toothpastes, extra-whitening toothpastes, toothpastes with mouthwash, toothpastes for sensitive teeth, toothpastes with stripes, clear toothpaste, even liver flavored toothpaste for dogs.
A modern toothpaste has many things to do. It must have abrasives to scour off bacterial films. It must have fluorides to harden the teeth against decay. It must have a strong enough flavor to hide the bad tastes of decaying bits of previous meals, and the awful taste of some of the other ingredients, such as detergents and phosphates.
Toothpaste must have thickeners to stay on the toothbrush, and squeeze out of the tube. It must have detergents to remove fatty films, and water softeners to make the detergents work better, and sweeteners, preferably non-nutritive, so bacteria are not encouraged.
 Ingredients in toothpaste
- Fluorides are the most recognized toothpaste ingredient in toothpastes. They work better in combination with surfactants, which help the remineralization process. These surfactants (detergents) also help clean the teeth, and provide a foam that helps to carry away debris. Moreover, lauryl sulfates have significant anti-bacterial properties, and they can penetrate and dissolve plaque. However, lauryl sulfates can irritate oral membranes. Allantoin is sometimes added to relieve the irritation caused by detergents, alkalies, and acids.
- Tetrasodium pyrophosphate (TSPP), a sequestering agent removes calcium and magnesium from the saliva, so they cannot deposit on teeth as insoluble deposits called tartar, (calcified plaque). In this respect it acts as a water-softening agent. It cannot remove tartar that already exists. TSPP is slightly alkaline, and has a bitter taste, requiring additional flavorings to mask it. Also, additional detergents must be added to keep it in solution. All of these factors can irritate oral membranes and cause sensitivity.
- Polymers such as the acrylic PVM/MA copolymer are added to prevent bacteria from breaking down pyrophosphates.
- Sodium bicarbonate (baking soda) is added for taste and mouth feel. It combines with acids to release carbon dioxide gas, adding to the foam produced by brushing. It is a mild abrasive. It may reduce the numbers of acid loving bacteria in the mouth, although this effect lasts only as long as the mouth stays alkaline.
- Sodium carbonate peroxide is added to "peroxide" toothpastes as a whitener. It breaks down into sodium carbonate (washing soda) and hydrogen peroxide. The hydrogen peroxide bleaches the teeth, and kills germs.
- Sweeteners such as sodium saccharin are added for taste. Other flavors are usually strong essential oils in the mint family.
- The anti-bacterial agent Triclosan is added to kill plaque-forming microbes.
- Various gums are used to thicken the paste, but also to retain moisture, so the toothpaste does not dry out if the top is not replaced.
- In white pastes, titanium dioxide is used to make the paste opaque and white.
 What can I do about it?
 Useful tips
- Young children under five should never swallow toothpaste and should be supervised by an adult when brushing;
- Keep toothpaste out of the reach of small children;
- For children under six, use only a small pea-size dab of toothpaste;
- Children under two should brush with only a thin smear of toothpaste;
- Only children at high risk of getting cavities (including those in Third World countries who do not receive any fluoride whatsoever) need fluoride supplements, even those living in non-fluoridated areas.
 Herbal toothpastes
Herbal concoctions include herbs such as fennel, mint, tea tree, clove, cinnamon, green cardamom, neem, majuphal, babool, ashok, bakool, jastimadhu, coriander, ginger, eucalyptus, lemon, spearmint, etc. The herbal concoctions are all based on ayurvedic and yunani recipes and are known to be effective minus the many side-effects. Some of known brands available in India are Babool, Herbodent, Meswak, Colgate Herbal, Neem, and Himalaya Herbal.
 Natural methods of oral hygiene
Since a long time Indians, especially in rural India, use the twigs of the neem tree to brush their teeth. Neem is known to have highly anti-bacterial properties. Also the easy availability of the neem twig, or ‘Datuun’ as it is commonly called, is another reason behind its popularity. The twig is chewed and the juices are excreted by the teeth, the bristled tips act as a tooth brush and is used to gently brush away plaque or other build up. It is a known and powerful resort for those who wish to have better oral hygeine, though not at the cost of their health. This low-priced twig is a much preffered option for most of India's rural population.
Other than neem twigs, people have also used Tulsi (Basil) powder, babool bark and dried orange peel powder -- all of which have proven to be excellent tooth cleansers. Here is a great recipe for making an effective tooth cleanser at home.
Tulsi (Basil) leaves powder-2 tbsp Neem leaves powder-2 tbsp Saindhav salt-2 tbsp Jatamansi-2 tbsp Ashes of almond shells – 2 tbsp Roasted betelnut powder – 2 tbsp Cardamom (Elaichi) powder- 2 tsp
Grind all these to a slightly coarse powder. Use it to brush your teeth in the morning and at night. This is supposed to help with disorders of teeth, including pyhorrhea.
Here's a herbal remedy for toothache -- apply a paste of one teaspoon of cinnamon powder and five teaspoons of honey on the gums. Tea tree oil and clove oil, applied 3 times a day are also very effective remedies.
 You also need to know
Common oral ailments
- Bad Breath - Food particles that remain in the mouth decay and lead to bacterial growth. This leads to particle fermentation leading to bad breath. Smoking, intake of tobacco, improper cleaning of dentures all are leading causes of bad breath. Under severe conditions, bad breath may lead to a decay of the gums.
- Gingivitis - decay of the gums, formed due to a series of bacterial growth. Over time it causes loosening of the gum grip over the tooth. It is characterized by bleeding of the gums while brushing. This leads to gaps in the gums and subsequent loosening of the teeth. Usually common in the aged, this is also known as periodontisis.
- Discolouration of the teeth - This occurs due to reasons ranging from heredity, age, consumption of alcohol, tea, coffee, antibiotics such as tetracycline to poor oral hygiene or an excessive use of fluoride.
- Plaque - A thin, colourless sticky substance that can be seen coating the teeth. It occurs due to improper brushing of the teeth and subsequent build up of bacteria.
- Tooth Cavities - Holes in the teeth caused by improper diet and build up of plaque are clinically called cavities. They indicate the genesis of a host of tooth related diseases. Very common among children due to their high intake of chocolate and other sweet substances.
 Taking care of one's teeth
The best way to cast aside worries on this front would be to brush daily, at least two times a day. Rinsing after every meal is also highly recommended as is eating the right kinds of food and having lots of water daily. Many peole do not wash their tongues. This is one of the most common mistakes that people make as build up of bacteria also happens on the tongue. Brushing stimulates the gums. However care must be taken to ensure it is done properly i.e at least for a full 2 to 3 minutes. The angle of the tooth brush should be at 45 degrees and teeth must be brushed in slow circular motions.
Fluoride, in a small amount does go a long way in the prevention of cavities. Hence it must be resorted to once in a while.
- Toothpaste usage
- The "right amount" of toothpaste is the size of a pea.
- Even if you want the benefits of whiteners and flouride, it probably isn't necessary to use it more than once a day.
- It is probably better to use all-natural products from the health food section, and to follow the rule: If you cannot pronounce an ingredient, you probably do not want it in your mouth.
- Dentists across the world advise that fluoridated toothpaste should be introduced only when a child is 2-3 years of age. Even after that parents should supervise brushing.
- Toothpaste is an abrasive paste. The abrasive, Dicalcium phosphate dihydrate and makes up about a fifth of a tube of toothpaste.
- Some toothpastes contain Diethylene Glycol, a chemical used in antifreeze compounds. Swallowing such toothpaste may cause fever, infections of urinary tract and gastrointestinal problems.
- Dental plaque buildup and gum disease have also been linked to pneumonia, especially in people breathing with the help of ventilators. When the ventilator pushes air into the patient's lungs, it may also push in harmful bacteria from the plaque. Researchers have found that cleaning patients' mouths with toothpaste or mouthwash is a simple way of preventing respirator-induced pneumonia.
- A Parent's Guide to Children's Dental Health
- FDAs Findings about Foreign Toothpaste Brands
- Diethylene Glycol Found in Toothpastes
- History of Toothpaste
- All About Toothpastes
- Ingredients -- Toothpaste