1001 Uses For Dental Floss #61- Fluoride Toothpaste and Young Children

We’re back after a hiatus of a couple of years. Us smiling up at the top? No, that’s a mild form of dental fluorosis.


A recent report from the Centre for Disease Control and Prevention on the use of toothpaste and tooth-brushing patterns among children and adolescents (https://www.cdc.gov/mmwr/volumes/68/wr/mm6804a3.htm)suggests that young children are using and swallowing too much fluoridated toothpaste when brushing their teeth. They recommend that children under the age of 2 should use a non-fluoride toothpaste and those aged 3-6 should only use a pea-sized portion on their brushes.

Let’s dissect this advice down into its parts, or as they say these days, let’s unpack it. The prime idea here should be to do what is necessary, what is practical, and to not make compliance so difficult or complicated that it would turn some of us off from doing the right thing.

First of all, brushing is important. It should be done as soon as the teeth come into the mouth (about 6 months of age and later), preferably after each time a child eats (or drinks from the mom’s breast or a bottle), but since this is maybe impractical in some cases, like the middle of the night where mom is exhausted, do it at least once or twice a day. (Do it in the middle of the night too, if you can.) That way, bacteria won’t build up a layer thick enough to start retaining acid (from sugar breakdown by these germs) which will start to leach calcium from the tooth surface (and so cause tooth decay.)

Second, fluoride at proper levels has been shown over many years to be beneficial to tooth health, by changing the crystal structure of enamel so that the enamel is more resistant to acid. Fluoride has therefore been added to the water supply of many cities as a public health measure. Almost 200 million people in the U.S. and 300 million world-wide have fluoride added to their water supply.

Third, fluoride can enter tooth enamel in 2 ways, either when the teeth are still under the gums, and after they are already visible in the mouth. Before teeth come into the mouth, the enamel may still be forming and fluoride present in the bloodstream bathing these teeth increases the fluoride content as enamel is laid down as the outside layer of the teeth. After the teeth are already in the mouth, fluoride applied to the teeth strengthens the outer layer of enamel. Fluoride that moves from the blood into the saliva in the salivary glands also can contribute to this beneficial process.

Fourth, too much fluoride can cause white spots (see photo above) or lines on developing teeth (termed “fluorosis”), which are teeth which haven’t yet broken through the gums and entered the mouth. By the way, this growth of teeth from below the gums into the mouth is called “eruption”, sort of like a volcano erupts lava from underground onto the earth’s surface. I know, it’s a weird comparison but the term has been around for a long time, so what can you do?

If the concentration of fluoride your child is exposed to is significantly higher than 1.2 parts per million (ppm), fluorosis can result. If it is higher than that (the upper limit here is not well-defined), the enamel can be disrupted enough that surface defects, staining, and weakening of the enamel’s strength can happen. It’s therefore important that the fluoride concentration stays in the “Mama bear” zone (thanks, Goldilocks, for giving us this concept of just-rightness.) The two permanent upper front teeth, which are the most esthetically important teeth when we smile, have generally completed enamel formation between 15 to 24 months for boys, and between 21 and 30 months for girls, so fluorosis can happen to these teeth during this period.  Also, because we drink more when it’s hot, people living in a hot climate should probably have less fluoride added to their water, since they’ll drink more and absorb more fluoride, possibly producing fluorosis more easily.

Fifth, it’s clear that young children, if unsupervised, will not follow dental association guidelines (or listen to you, either.) Toothpaste, especially the fruit-flavoured children’s toothpastes, appeals to kids’ natural affinity for sweet flavours, so watch out.

Sixth, below the age of 6, children haven’t developed enough control over the swallowing reflex and the ability to spit to prevent swallowing of toothpaste. Some, if not most, will be swallowed. So, obviously, preparing the toothbrush with the right amount of fluoride toothpaste by a parent or supervising adult is very important. As for the right amount to put on the toothbrush, a very thin smear of toothpaste for kids below the age of 3, and a pea-sized blob, not more, is recommended after 3. The parent actively doing the brushing is really the best way to go.

So, finally, use of a non-fluoride toothpaste below the age of 3 is probably a good idea, and using a children’s fluoridated toothpaste, which has half the adult concentration of fluoride, from 3 to 6 years of age, is also recommended. And a parent should always be watching and helping young children brush their teeth. I hope all this is clear and convincing.

And don’t forget the dental floss (again, done by the parent), especially once the teeth next to each other are touching.


1001 Uses For Dental Floss #59- Fashion Toothpastes

A little late for the end-of-year holidays, but I can’t always be up-to-date on everything dental. Now toothpaste has joined so many other products as worthy of a fashion article. In Vogue Magazine, an article of 8 toothpaste products deemed worthy of being considered as gifts (and why not throw in some floss) was in the December 20 issue, just in time for those last-minute head-scratchers trying to come up with the ultimate unusual and impressive article for the gift stocking. They come in a variety of flavours, including:

1. David’s Natural Toothpaste, touted as being fluoride-free (actually not a good thing, in my professional opinion) and sulphate-free (I don’t know what the value of this is, but I’m not a chemist or public health person.

2. Lebon Cinnamon-Mint flavour

3. Jarvis Jasmine Mint

4. Theodent Kids, which has a chocolate flavour

5. Couto Pasta Dentifrica

6. Acca Cappa

7. Boka Mint Natural Toothpaste

They all look fancy and flavourful, and may make you feel good about taking care of your teeth, so check them out. Not an endorsement, though, just thought this was interesting. I haven’t looked into the prices or availability, though.

So, brush your teeth every day and floss them too. Again, floss your teeth.
But like one of my dentistry teachers once told his patients, only floss the teeth you want to keep. I case you have favourites.

To see the original Vogue article, go to:


1001 Uses For Dental Floss #47- Plastic Beads In Toothpaste (What?!)

My daughter Rebecca found this article about tiny plastic beads in certain varieties of Crest toothpaste, apparently put there by the manufacturer to give the toothpaste its blue colour. As some of us may know, there is great controversy in the inclusion of plastic beads as an abrasive in some “invigorating” body wash soaps, supposedly as a scrub enhancement or exfoliating agent. They wash down the drain and into large bodies of water like the Great Lakes and our oceans.

These beads, made of the polyethylene, have been found in the bodies of plankton, tiny sea creatures which are an important part of the marine food chain, and have been adversely affected by them, as they may block their digestive tracts, causing them to starve to death. These little animals are eaten by larger creatures, such as fish, and the beads progressively work their way up the food chain. The plastic also has the sponge-like property of soaking up pollutants like motor oil and pesticides. On the positive side, polyethylene doesn’t contain bisphenyl A, so it seems to be safe from that standpoint (that is, it doesn’t contain this hormonal disruptor.)

Although the plastic beads in this brand of toothpaste are much smaller and so may be less of a threat to the aquatic ecosystem, we don’t really know how harmful they may be. What we do know is that in people, these tiny plastic bits have been found in the gingival crevice, the narrow space between the gum and the tooth, and are difficult if not impossible to dislodge. This happened to my daughter.

Although regulators from the U.S. Food and Drug Administration have approved the use of these plastic beads, as there is no real evidence that they’re dangerous to health, no comment has been received from the Environmental Protection Agency, I guess because no one asked. On the other hand, they have no  health benefits. Many dentists, though, are questioning the possible effects of the beads retained below the gum, as they fear that they may form a surface which harbours oral bacteria, and so may endanger the health of the gums.  So far, no scientific inquiries have been carried out to test this possibility, which means that the effect is unknown, not that it is nonexistent. I don’t tend to be alarmist, but these plastics don’t  break down naturally, and they’re not biodegradable.

The use of these beads has been banned in Illinois.

Crest put out a statement recently that it has begun phasing out microbeads from its products, a process that will be completed by March 2016. A spokesman for the company told the Washington Post that the decision was made “months ago” in response to “changing consumer and dental professional preferences.” One questions why it should take so long to do this, but with no urgent threat to public health, economic considerations seem to be taking precedence.

“While the ingredient in question is completely safe, approved for use in foods by the FDA, and part of an enjoyable brushing experience for millions of consumers with no issues, we understand there is a growing preference for us to remove this ingredient. So we will.” the company said in a statement. “We currently have products without microbeads for those who would prefer them. We have begun removing microbeads from the rest of our toothpastes, and the majority of our product volume will be microbead-free within six months.”

The American Dental Association, which endorses some Crest products, stands behind the beads, citing a lack of clinical evidence questioning their safety. The ADA has not revoked their approval of these products, citing a lack of scientific evidence against them.
The ADA’ s statement is: “The American Dental Association’s (ADA) Council on Scientific Affairs, on an ongoing basis, monitors and evaluates the safety of all ADA Seal-Accepted products. If the council’s evaluation determines sufficient scientific evidence exists that an ADA Seal-Accepted product poses a health risk, the council has the authority to withdraw the Seal from that product. At this time, clinically relevant dental health studies do not indicate that the Seal should be removed from toothpastes that contain polyethylene microbeads.”

Anyway, remember to floss. Floss contains no microbes. So far.

This article is based on one by Abby Philip found in the Washington Post, dated September 14, 2014.


1001 Uses For Dental Floss #13- Paranoia


It was almost inevitable. Evil people have used water bottles filled with inflammable (or flammable, if you prefer) liquids, carbonized their underwear, and burnt their shoes on commercial aircraft, generally with embarrassing and painful results for the would-be bad guy. Recently, according to a CNN report, the U.S. government warned that sinister toothpaste tubes were a possible way of damaging aircraft flying to the Winter Olympic Games in Sochi, Russia. This would be funny if it wasn’t so scary. And the picture? – not what you imagine. My question is: Edward Snowden, can Sarah Palin see you flossing from her back porch?

1001 Uses For Dental Floss #2– Radium Toothpaste

http-inlinethumb23.webshots.com-43798-2706452680102347975S600x600Q85During World War II, a German company, Auergesellschaft of Berlin, marketed a radioactive toothpaste, Doramad. On the back of the toothpaste tube it was stated that, ‘radioactive radiation increases the defenses of teeth and gums… cells are loaded with new life energy, the destroying effect of bacteria is hindered… it gently polishes the dental enamel and turns it white and shiny.’ The description failed to mention that the radiation could cause mutations and cancer in the mouths of the users and, when swallowed, many other organs of the body. The popularity of this toothpaste is unknown, likely because Germans were more concerned with surviving the war and “following orders” at the time.