In my local pharmacy, there are 20 different types of toothpaste available, spread over five shelves. It used to be that I’d simply choose between just white or stripey, but now products that promise gum repair, clinical whitening and 24-hour protection jostle for space – often with eye-watering price tags of up to £16.
“There’s been an explosion in different types of toothpaste in the UK in recent years,” confirms Nicola Innes, professor of paediatric dentistry, honorary consultant and head of Cardiff Dental School.
Advances in oral research over the past few decades have allowed manufacturers to add in extra ingredients to tackle common dental problems like sensitivity, discolouration and gum disease. Meanwhile, consumers are desperate to seek out the toothpaste that will keep their pearly whites in tip-top condition amid a crisis in dentistry.
Just four in 10 adults in England have seen their dentist in the past two years. A lack of dentists providing NHS care (creating “dental deserts” across the country) and the cost to see one privately (where check-ups cost £75, on average) have been blamed for Britain’s declining oral health, making it more important than ever that your toothpaste is working hard to protect your teeth.
But how can we pick the best paste while avoiding paying a premium purely for some clever marketing? Here, the experts help to decode them.
The pros and cons of cheap toothpaste
Best for: All-round cleaning and protection against tooth decay
Fluoride is the most important ingredient in toothpaste. While the physical action of brushing removes plaque, preventing gum disease, fluoride is a natural mineral that makes the enamel (the outer layer of your teeth) stronger and more resistant to decay, explains Karen Coates, a registered dental nurse and Oral Health Foundation spokesman.
“As long as the toothpaste contains the optimum level of fluoride, it will offer protection against dental decay and help to strengthen the enamel,” no matter how cheap it is, she says. The ideal level of fluoride is 1,350 to 1,500ppm (parts per million) for everyone except under-threes, who only need 1,000ppm, Coates says.
There are toothpastes available for £1 that contain 1,450ppm fluoride, meaning that it’s simple to look after your teeth on a budget. You can check the level of fluoride in your toothpaste on the ingredients list and it is usually written on the packaging as ppmF.
However, cheap toothpastes usually don’t contain extra ingredients to tackle common problems like sensitivity or discolouration.
Dentist recommendation
When it comes to picking a cheap toothpaste, “the main feature to look for is the fluoride”, confirms Dr Joe Bansal, a dentist at London Smiling.
He recommends Aquafresh Complete Care Whitening (£1.30, 1,450ppm fluoride) and Oral-B Complete Plus Extra White Toothpaste (£1.25, 1,450ppm fluoride).
Does whitening toothpaste work?
Best for: Improving the appearance of stains caused by tea, coffee or red wine
No matter how grand the promise is of whitening toothpaste, it will not make the natural colour of your teeth any whiter, says Coates. “At best, they may help to remove staining from tea, coffee, red wine and smoking,” she says.
This is because the legal limit for over-the-counter tooth whitening products in the UK is 0.01 hydrogen peroxide, which is not enough to alter the natural hue of teeth, Coates notes.
A whitening toothpaste will clean teeth as well as other toothpastes, providing it has enough fluoride in it but the downside is that it can give people “unrealistic expectations”, she says.
Whitening toothpastes may also remove some of the tooth enamel over time because most of them work by removing stains through abrasiveness, Innes explains.
Additionally, some whitening toothpastes contain sodium lauryl sulphate (SLS).“This is the foaming agent in toothpaste and some people, especially those with a dry mouth or some other oral conditions, may find that this ingredient can make their mouth sore,” Coates says.
“If you do find that your toothpaste is causing irritation, it may be worth finding a toothpaste that does not contain SLS.” Check the back of the packet to see if a toothpaste contains this ingredient.
Ultimately, if you want whiter teeth, it’s best to ask your dentist whether it’s possible to use whitening toothpaste without causing damage and what other treatments might be available.
Dentist recommendation
“Whitening toothpastes are designed to gently lift the surfaces stains present on the outer surfaces of the teeth rather than actually whitening the teeth as a professional whitening kit would do from the dentist,” Bansal explains. He recommends Arm and Hammer Advance White Pro (£3.49, 1,450ppm fluoride).
“Their pastes contain baking soda for a super clean feeling afterwards,” he says. “The advance white pro version has micropolisher technology for added whiter teeth.”
Is luxury toothpaste worth the cash?
Best for: A thorough clean – but abrasive ingredients could damage teeth over time
Pricey toothpastes promise a brighter, healthier and more radiant smile but the high-end packaging is often a marketing ploy, Innes says. However, they may contain some extra ingredients compared with a bog standard tube.
“The reason they may be more expensive is that they contain abrasives in them, like silicates or calcium carbonates that are designed to actually clean the teeth, rather than just relying on the bristles on your toothbrush,” she says.
“But abrasives can cause damage to the teeth too, eventually. We do find people with tooth wear from overzealous brushing with abrasive toothpastes.”
Some pricey toothpastes may contain chemicals that are like hydroxyapatite – a really hard substance that your teeth are made out of. “They may be called things like bio repair or bio fill,” Innes says. The idea is that hydroxyapatites are used to repair tiny microscopic holes in the teeth, instead of fluoride which fills them in. “Lab studies show that these toothpastes can fill in some of the enamel to a little extent,” she says. “It doesn’t look like it’s more effective than fluoride.”
“Again, look at the fluoride level of the toothpaste,” Coates urges. “Do not be tempted to use a non-fluoride toothpaste, as you will not be getting the protection against tooth decay.”
Dentist recommendation:
Bansal recommends Curaprox (£11 to £18, 1,450ppm fluoride), which is “a well renowned brand amongst dentists, gum specialist and hygiene therapists”. Its products “are SLS free and contain fluoride”, he adds.
When to use a toothpaste for sensitive teeth
Best for: Easing discomfort caused by hot, cold, sweet or sour food and drinks
Teeth sensitivity is caused by bacteria in the mouth making acid which attacks the tooth’s surface, creating micro holes that go down to the nerve, causing sensitivity and pain, Innes explains.
Teeth sensitivity to cold, like ice in drinks, can also be caused when the root of the tooth becomes exposed, which gives a pathway to the nerve, resulting in sensitivity and pain, she continues. If you have these symptoms, it’s important to see your dentist, in case it’s tooth decay causing the pain.
“Sensitive toothpastes include either potassium nitrate or stannous fluoride, which work by forming crystals in the tooth to block holes,” Innes says. While these ingredients don’t fill the holes permanently, twice-a-day use is sufficient to ease symptoms.
“This means you need to use a de-sensitising toothpaste continuously for the effect to last,” Coates notes. “If you stop using it, the sensitivity comes back.”
To slow the erosion of enamel, which will worsen sensitivity, choose a toothpaste with low relative dentin abrasivity (RDA) which is classed as 0 to 70, she recommends. Toothpastes with an RDA of 70 to 100 are considered medium abrasive and suitable for daily use, while a rating of more than 100 is highly abrasive and may not be best to use daily, Coates says.
Dentist recommendation
“Sensodyne Rapid Relief (£5.30, 1,450ppm fluoride) is a long-standing dentist recommendation for fast result for patients with sensitive teeth,” Bansal says.
“With two different types of fluoride, it quickly creates a barrier over the sensitive areas of the teeth for both short-acting and long-lasting results to help with sensitive teeth.”
Does ‘eco toothpaste’ work?
Best for: The eco-conscious – but there’s no research on their effectiveness against decay and gum disease
Eco and alternative toothpastes, which may state “organic” on the packaging, often don’t contain fluoride. They can include ingredients like coconut and peppermint oil.
“Many of these toothpastes are non-fluoride,” Coates notes. “We do not recommend using a toothpaste that does not use the optimum level of fluoride.”
“If a toothpaste is ‘eco’ because of the packaging, that would be brilliant. But if it’s ‘eco’ because it’s avoiding fluoride then it will be less effective at protecting your teeth from decay,” Innes says.
Dentist recommendation
Parla toothpaste tablets are eco because they are zero-waste, Bansal notes. Unlike standard toothpaste tubes, which can be tricky to recycle, the tablets come in a glass jar and refills come in recyclable packaging.
“They are used slightly differently to paste in that you have to chew the tablet for five seconds or so and then proceed to brush your teeth with a wet brush to enhance the effect,” he says. However, there is little research into how effective toothpastes tablets are.
What’s the point of tooth powder?
Best for: There’s no research on the effectiveness of powder toothpastes
Powder toothpastes contain many of the same ingredients as regular toothpastes but tend to leave out thickeners and humectants (moisture-retaining ingredients that help keep toothpaste from drying out). They’re not as available in stores but there are dozens online.
However, they may not be the best for our teeth. “Some powder toothpaste can be more abrasive [than standard toothpaste] and if used regularly could lead to enamel erosion,” Coates warns.
They may also be a breeding ground for bacteria. “If you’re dipping your toothbrush repeatedly into a powder, it may not be very hygienic,” Innes notes.
Dentist recommendation
“I wouldn’t recommend tooth powders,” Bansal says. They are harder to use in the correct doses, unlike toothpaste (which should be a pea-sized amount) and toothpaste tablets, he says. “They may not be best thing to have in a shared household, as this could lead to cross-contamination of brushes and powder,” Bansal adds.
Should I use an anti-bacterial or anti-tartar toothpaste?
Best for: Reducing tartar build-up and combating gum disease
Anti-bacterial and anti-tartar toothpastes contain ingredients, such as chlorhexidine, to help combat gum disease, including swollen, bleeding gums and bad breath, Coates explains.
“These are especially useful for anyone who experiences these symptoms or has been diagnosed with gum disease by their dentist or hygienist,” she says.
However, chlorhexidine can also stain the teeth which causes problems with appearance, Innes notes.
Dentist recommendation
Bansal recommends Colgate Total original toothpaste, which is anti-bacterial (£2.50, 1,450ppm). “This range prides itself on being the jack of all trades of toothpastes with a range of active ingredients to give it long-lasting bacterial protection, plaque and tartar reduction, gum health and sensitivity relief,” he says.
Expert verdict
“I would advise people to use the toothpaste that has 1,350 to 1,500ppm fluoride, is within their budget and that they like the taste of,” Innes says. “The most important thing is for the toothpaste to be used twice a day for two minutes.”
“Any toothpaste that contains the optimum level of fluoride for protection against tooth decay in children and adults and is low-abrasive to prevent enamel erosion,” Coates adds.