Category: Erosion

Everything related to dental erosion.

Elmex Sensitive Professional Toothpaste Review

Dental Revelations1 Comment
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Elmex Sensitive Professional toothpaste

Elmex is a very old brand by GABA International AG (Switzerland). Gaba International AG is owned by Golgate-Palmolive of the United States. They brought out Elmex Sensitive Professional toothpaste which has added benefits to their Elmex Sensitive toothpaste.

I am always sceptical about new oral health care products and I make my judgement by testing the product myself and asking experiences of my patients. Lets find out what my professional opinion is about Elmex Sensitive Professional toothpaste. There will be an ingredient list at the end of this post.

The Selling Speech

The manufacturer promises scientifically proven immediate and long-lasting pain relief for sensitive teeth. It is quite bold promise, but the older Elmex toothpaste versions have always been relatively good toothpastes because they contain organic fluoride called amine fluoride. Amine fluoride has been considered to be superior to more commonly used inorganic fluorides in toothpastes – sodium fluoride and sodium monofluorophosphate. But having said that, it’s good to bear in mind that the type of fluoride makes very little or no difference to a relatively healthy mouth.

The suprising fact with the Elmex Sensitive Professional toothpaste is that it does not contain amine fluoride. It contains sodium monofluorophosphate 1450ppm which is the recommended level of fluoride for adults. Any less would be ineffective. I am not sure why they don’t use amine fluoride with this toothpaste. But I try not to get stuck to this detail because there is something else in this toothpaste that will make it a super star of the toothpastes.

That is Pro-Argin technology.

Pro-Argin Technology

Pro-Argin technology system contains arginine and calcium carbonate. Arginine is an amino acid naturally found in saliva.

Once the arginine and calcium carbonate bind to the surface of the tooth, they will start to attract calcium. Calcium is the mineral we loose from the surface of the tooth (demineralisation) when we eat something with carbohydrates or drink something with carbohydrates or drinks that are acidic. The saliva normally tries to fix the surface of the tooth by returning the calcium and neutralising the acids (remineralisation). But often our life style habits are too much for the saliva to handle and not enough calcium is returned to the surface of the tooth.

This will result in cavities, hypersensitivity and/or erosion. The hypersensitivity happens because the tiny channels (tubules) leading from the surface of the tooth to the nerve of the tooth, loose their mineral cap. Open tubules cause the nerve to react to the temperature changes and pressure. It reacts by pain. So using a toothpaste that comes to saliva’s aid in remineralisation process, is definitely a good thing. Together with saliva the Pro-Argin toothpaste can block the tubules again with a mineral cap.

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Pro-Argin technology in toothpastes blocks the open tubules and therefore reduces sensitivity.

The Design

Well, the design has not changed really and there is no need to. It is a trusted brand with quality toothpastes so no need for any hocus pocus to make it more appealing.

I love the environmental advice on the packaging. When people get these hints on the products they use regularly it will raise awareness. Maybe the environmentally-friendly habits will find their way into peoples everyday life. Let’s save the world by little deeds!

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The Testing

Over the years of being a dental professional I have noticed that people struggle sometimes when they run into toothpastes that have the same design for opening the tube as Elmex Sensitive Professional.

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How to open that tiny little lid that looks like a sprocket? The answer is in the cap.

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Just turn the cap upside down and it will fit on top of the tiny lid. By twisting the cap the tiny lid will come off effortlessly.

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The consistency of the toothpaste is more a gel than a paste which is perfect if you are using Philips Sonicare toothbrush. It’s not too runny which I appreciate (no toothpaste marks on the sink) but will very quickly transform into liquid when brushing.

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The closer look shows that it is rather smooth in texture. So to my mind this means two things. It’s not too abrasive and also it most likely does not contain microbeads. The RDA level which tells you how abrasive the toothpaste is, should be under 100 for safe use of toothpaste. Elmex Sensitive Professional toothpaste has RDA level of 65. Perfect!

To know if a toothpaste contains microbeads, the polyethylene is the ingredient to look for. No-one should buy a toothpaste that contains microbeads as those tiny little beads will pollute our oceans. Elmex Sensitive Professional toothpaste does not have polyethylene in the ingredient list (see at the end of this post).

The toothpaste stays on top of the toothbrush bristles without dripping but it slowly disperses between the bristles if you have time to wait for this. I emphasise that you don’t need to wait – I just wanted to see what happens.

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I brush my teeth for two minutes and I get slight burning feeling in my mouth. It’s not unpleasant though and most of the non-professionals would say that the feeling is fresh, not burning. I’m just very sensitive.

The representative of Elmex Sensitive Professional toothpaste advised to spit the toothpaste out after brushing but not to rinse. So I follow this advice. The teeth feel very clean despite the low RDA level. That always makes me satisfied with the toothpaste.

I carried on using the whole tube of toothpaste twice a day and I must simply say Wow! I have been suffering hypersensitivity for example if I eat ice cream. The hypersensitivity does not happen while I eat it but as soon as I have stopped I get this excruciating pain, nerve pain that lingers way too long. There’s been no way to relieve it other than by avoiding the ice cream.

But after using one tube of Elmex Sensitive Professional, the hypersensitivity is gone! So I guess the Pro-Argin technology really works.

There is also an advice on the tube to rub the toothpaste over the most sensitive areas with a finger. The rubbing should continue for 1 minute. The toothpaste can be left in place without rinsing. Remember that this advice is only applicable from the age 12.

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Would I Recommend

I would definitely recommend this toothpaste to anyone suffering from sensitive teeth or dental erosion. Or anyone who wants to prevent these two things. I have not had this good results with sensitive teeth than with Elmex Sensitive Professional. Also the Pro-Argin technology has tendency to resist acids from a diet that contain food of low pH which is why it helps to prevent dental erosion.

I’m just wondering why manufacturers want to add soap (sodium lauryl sulfate) to their toothpastes as for some individuals it can work as an irritant. Sodium lauryl sulfate is the foaming agent in the toothpaste. It may cause dry mouth and aphthous ulcers. Mind you, nothing is scientifically proven but it is widely recommended amongst dental professional that people suffering from aphthous ulcers should change their toothpaste to non-foaming toothpaste.

Always remember to check from the ingredients if a toothpaste contains soap. There are other ingredients that may produce foam so not all the foaming toothpastes contain soap.

This toothpaste can be used for children as well (if they accept the taste), but remember to use only pea-size amount for children under 6 years and to very young children who cannot spit out yet, use only smear of toothpaste.

The Ingredients

  1. Calcium Carbonate – a mild abrasive. Combined with arginine the alkaline conditions are created to the surface of the tooth which will encourage phosphate ions and calcium to deposit on to the dentin
  2. Aqua – a main carrier for all ingredients. Helps dissolve other soluble ingredients. Helps the mechanical process of cleaning teeth in mouthwashes
  3. Sorbitol – a sweetener, humectant and texturising agent
  4. Arginine – an amino acid, the good in the toothpaste
  5. Sodium Lauryl Sulfate – a soap and therefore the foaming agent. Can work as an irritant
  6. Sodium monofluorophosphate – the good in the toothpaste
  7. Aroma – a chemical compound which adds odours to dental products. The specific aroma is not specified by the manufacturer
  8. Cellulose gum – a thickening agent
  9. Sodium bicarbonate aka baking soda – a mild abrasive as an ingredient of a toothpaste. Do not use your own baking soda to brush your teeth as it will be very abrasive.
  10. Tetrasodium Pyrophosphate – an agent to remove calcium from saliva. Used normally in tartar control toothpastes but with Elmex Sensitive Professional toothpaste I believe it is used for attracting the calcium from the saliva to the surface of the teeth
  11. Titanium Dioxide – a colorant and thickening agent
  12. Benzyl Alcohol – a solvent and preservative. In rare cases, this ingredient can cause contact allergy.
  13. Sodium Saccharin – an artificial sweetener
  14. Xantham Gum – a thickening agent
  15. Limonene – a natural solvent that cleans. Also it flavours the product.

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Dental Erosion and Tea

Dental Erosion Risk Factors in Bullet Points

Dental Revelations5 Comments
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Eating fruits and berries frequently will put you at risk of dental erosion.

There has been so much discussion about dental erosion recently that I wanted to gather all the latest information in one post. I have been in dental profession for over 20 years and even I still learn new things about dental erosion. So read this post to see if you knew these things as well.

I will update this post every time I learn something new that will cause dental erosion. I would be grateful if you could collaborate by commenting this post in case I have missed some risk factors.

The Risk Factors

  • diet that does not contain dairy products
  • vegetarian diet even if dairy products are used
  • consumption of acidic beverages, especially when consumed between the meals (including all juices, sugar-free drinks, sparkling water, any drink with flavouring, alcohol and bubbles. As an example the pH of Coca-Cola is 2,5 = highly acidic)
  • vitamin supplements in a form of a drink (including fizzy tablets)
  • use of sport drinks
  • dehydration
  • dehydration + sport drinks = increased risk
  • drinking tea apart from green tea and black tea
  • consumption of erosive foods, increased risk if consuming erosive foods/drinks over 3 times per day (e.g. fruits, berries, vinegar, pickled food, herbal tea, cola, sparkling water, juice, flavoured water)
  • eating sour candy
  • frequent consumption of alcohol
  • use of smokeless tobacco
  • frequent use of salad dressings
  • gastro-esophagel reflux disease (GERD)
  • gastro-esophagel reflux disease combined with a use of a mouth guard (read this to find out how to protect your teeth if you use mouth guard)
  • eating disorder (anorexia, bulimia)
  • frequent vomiting (e.g. when pregnant)
  • eating fruits between the meals (when fruits are eaten as a part of a meal = no risk)
  • eating indian food frequently (indian spices, especially panipuri masala, are acidic)
  • swishing acidic drink in mouth before swallowing
  • sipping an acidic drink (e.g. herbal tea, cola, sparkling water, juice, flavoured water) over a long period of time
  • brushing teeth after eating
  • brushing teeth after drinking acidic drinks like wine, juice, sparkling water
  • dry mouth (saliva protects the teeth, neutralises the acids)
  • drinking herbal tea very hot (high temperature increases the erosive potential of a drink)
  • consumption of pickled foods
  • medication that dry the mouth as a side-effect (e.g. antihistamines, antidepressants)
  • use of oral moisturizers with pH below 6.7 (see a table pH levels of commonly used oral moisturizers and dry mouth treatment products here)
  • acidic mouthwashes e.g. Listerine Total Care rinse pH = 3.57
  • anti-tartar toothpastes that has chelating agents – chelators bind or trap other chemicals such as calcium = they effectively remove calcium also from teeth.
  • use of non-fluoride toothpaste
  • liquid breakfast (including smoothies). There’s no saliva in mouth in the morning = nothing to neutralise acids. Chewable breakfast would make the saliva flow again after sleeping.
  • certain illnesses that affect the saliva flow (e.g. Sjögren’s syndrome)
  • drinking fruit juices instead of eating the real fruit – fruit juice has been proven to cause erosion 10 times more than the same fruit chewed.
  • chewing gum with liquid center including sugar-free chewing gums (also xylitol). The liquid inside the chewing gum is acidic.
  • sugar-free candy, especially fruit-flavoured ones (they contain high levels of food acid, particularly citric and phosphoric acid)
  • dry mouth + sugar-free fruit-flavoured candy to stimulate saliva flow = increased risk of erosion
  • asthma medication, especially if brushing after corticosteroids (e.g. Flixotide evohaler)

Edit 27.1.2019

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GC Tooth Mousse Review and Advice for Use

GC Tooth Mousse Review and Advice for Use

Dental Revelations23 Comments

It is time for my second review. This time it is the GC Tooth Mousse. I have been using this product on my patients and myself for several years and I am going to tell you how I choose the patients whose teeth will get application of Tooth Mousse and why many patients also get advice to use Tooth Mousse at home.

There will be instructions on how to use the Tooth Mousse at home and in surgery.

What Is Tooth Mousse?

Gc Tooth Mousse review by Dental Revelations

Mousse? Not really. The name is slightly misleading as it is more like a gel. But I guess strawberry flavoured mousse brings positive associations in people’s minds. Almost like a delicious dessert. It does taste pleasant though. There are 5 different flavours: the featured strawberry, vanilla, melon, mint and tutti-frutti.

Let’s see first what the manufacturer’s selling speech is:

When Tooth Mousse is applied to tooth surfaces, the CPP-ACP molecule binds to biofilm, plaque, bacteria, hydroxyapatite and surrounding soft tissue.

-Delivers Recaldent™ Casein Phosphopeptide – Amorphous Calcium Phosphate
-Inhibits enamel demineralisation and induces remineralisation
-Reduces hypersensitivity by obturating open dentinal tubules
-Prevents initial caries forming thanks to the anti-cariogenic properties
-Reverses white spot lesions
-The delicious flavours stimulate saliva flow for an enhanced effectiveness of CPP-ACP

Source

Many difficult to understand words I think. And this letter combination CPP-ACP, what the heck is that? If you are a common consumer, you probably are not 100% sure what you just read. I will try to tell the same in more simplified way.

What Is the Secret in Tooth Mousse?

It is the milk. Well part of it.

It is known that milk is beneficial to dental health due to its calcium and other derivatives. Tooth Mousse contains plenty of calcium complex of CPP-ACP (see below where this abbreviation comes from), commercially named as Recaldent, which is the ideal delivery system for calcium and phosphate ions that are naturally available in milk.

Recaldent is derived from the milk protein, casein hence the protective effect to the teeth.

Research has shown that this activity is due to a part of the casein protein called Casein Phosphopeptide (or CPP), which carries calcium and phosphate ions in the form of Amorphous Calcium Phosphate (or ACP).

Source

GC Tooth Mousse does not contain fluoride but there is a product called GC Tooth Mousse Plus that contains fluoride (900ppm).

Who Benefits of Using Tooth Mousse?

On top of my list are definitely the patients with signs of dental erosion. But these people fall into two different categories – to the ones whose dental erosion is active and progressing and to the ones whose dental erosion has stopped progressing and no reason from diet or health, that would cause erosion, can be found.

The former group will always (with three exception, will tell you about it later) get an application of Tooth Mousse in my surgery. People who belong to this group are often vegetarians, vegans and people suffering from gastric reflux – they are the ones who suffer from the dental erosion the most. And especially people who have gastric reflux and grind/clench their teeth at night – if they use night guard, then even more so as the saliva that protects the teeth is present in very small amounts in mouth at night and this small amount of saliva is not able to reach the top teeth that are covered by the night guard.

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Mouth guard. Read about them here.

The problem is that even though the saliva is not able to reach the top teeth, the stomach acid is because it travels on the surface of the tongue. The tongue rests often against the roof of the mouth and the stomach acid has access under the night guard. And stomach acid is very acidic – its pH is between 1,5-3,5.

To these patients I also advise to buy Tooth Mousse to be used at home. And once they have used it regularly I often see that the enamel has restored its shine again. Of course you cannot grow the lost enamel back by using this product but Tooth Mousse will make the remaining enamel stronger to the effects of acids.

The dental erosion is not the only reason for the application of the Tooth Mousse. I will apply Tooth Mousse to the patients

  • that suffer from dry mouth (xerostomia)
  • who have high risk of caries
  • who have hypersensitivity

Also I apply Tooth Mousse after scaling and root planing, after bleaching and after removal of orthodontic brackets to prevent sensitivity after treatment.

The Exceptions?

I do not apply the Tooth Mousse to people

  1. who are allergic to milk protein as the Recaldent is derived from the milk protein, casein.
  2. who are allergic to hydroxybenzoates.
  3. who are strict vegans as everything entering the mouth should be plant-based.

How to Apply Tooth Mousse at Home?

It is very easy to apply Tooth Mousse at home. If you are a night guard user, continue reading further to find out how to use it with night guard at night.

Follow these simple steps:

  1. Brush your teeth and clean in between the teeth thoroughly.
  2. Wash your hands and apply pea size amount to the back of your hand. Then apply another same sized amount next to the first one (see photo). Now you have one dosage for your upper teeth and one for your lower teeth. This is the minimum dosage.
  3. Use a clean finger or a cotton swab/bud (see the photo) so spread Tooth Mousse all over you teeth (see photo).
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  4. Leave the Tooth Mousse undisturbed for at least 3 minutes (go and watch the telly to make the time pass quicker – it doesn’t matter if the Tooth Mousse stays undisturbed in your mouth for longer. The longer it stays, the better).
  5. Once 3 minutes has passed, move your tongue over your teeth to spread the mousse everywhere in your mouth, including the soft tissues. You can swish the mixture of saliva and Tooth Mousse around your mouth. Try to keep the liquid in your mouth for 2 minutes and then spit out the liquid. There is also an option not to spit out – just spread the mousse with your tongue all over you mouth and that’s it. Leave it there. If doubting – jump to
    Is It Necessary to Spit It Out?
  6. Do not eat, drink or rinse for 30 minutes.

Tooth Mousse with night guard (especially if you suffer from gastric reflux):

  1. Brush your teeth and clean between the teeth (or vise versa, it doesn’t make much difference which way around you do it).
  2. Clean the night guard by using manual toothbrush for it. Do not use toothpaste for the night guard.
  3. Apply small amounts of Tooth Mousse inside the night guard (see photo) and place it in your mouth.
  4. Sleep tight, don’t let the bed bugs bite.
  5. In the morning, brush the night guard with manual toothbrush and rinse with water. Brush your teeth as well.

How to Apply Tooth Mousse in the Surgery?

Demonstrative photo.

If there is lots of saliva in the surfaces of the teeth I dry the surfaces with a cotton roll. The enamel does not need to be absolutely dry so do not use pressurised air.

For the application I often use Monject syringe with a black dispensing tip (19 gauge) but it can be applied also with a cotton roll – just remember the aseptic technique. Pea size amount per arch is the minimum amount for the application.

Now after the applications there are two ways to do proceed. I pretty much always ask the patients to ignore the Tooth Mousse for couple of minutes and then to move the tongue over the teeth to spread the gel also to the soft tissues. And that’s all. Very simple to apply. But always remember to instruct the patient not to drink, eat or rinse for half an hour after the application.

Another option is to repeat the above but after the patient has spread the gel around the mouth you can advice her to wait for couple of minutes before spitting out all the extra saliva and Tooth Mousse. Advise patient not to eat, drink or rinse the mouth for half an hour.

Personally I stick to not spitting out.

Is It Necessary to Spit It Out? Oh, the Confusion!

Now personally I find it confusing that two different ways to do it is advised by the manufacturer. Why not stick to advising to leave the Tooth Mousse in mouth if there is no reason to spit it out?

In their leaflet where Tooth Mousse is introduced, they advice to leave the Tooth Mousse in mouth without spitting:

For at-home use: when your patients apply Tooth Mousse and MI Paste Plus immediately before going to bed, they should leave it on their teeth to slowly dissolve overnight.

But in their instructions for use (IFU) that is found inside the package the advise given is the opposite:

4. Expectorate thoroughly and if possible avoid rinsing. Any GC Tooth Mousse remaining on the surface can be left to gradually dissipate overnight. Do not eat or drink for 30 minutes following application.

To make it even more confusing, on their FAQs leaflet they leave it up to the consumer whether to spit out or not. This what the manufacturer answers to the customer’s question Do I need to wash it off?

This is a matter of preference. For the maximum benefit, leave it on the teeth as long as possible. The minimum recommended application time is three minutes. You can then rinse the mouth or simply wipe any remaining crème from the teeth.

And to the question Is it safe to swallow?

Yes. The main ingredient of GC Tooth Mousse® is derived from milk casein and, like milk and cheese, is edible. GC Tooth Mousse® should not be used by people with milk protein allergies or sensitivity to benzoate preservatives.

If it does not really matter whether to rinse or not to rinse but it would be beneficial to leave the Tooth Mousse in mouth as long as possible, I repeat – why not stick to advising Do not spit?

Would I Recommend This Product?

Hell, yeah.

I have noticed numerous times that sensitivity after scaling and root planing is almost non-existent every time I have applied Tooth Mousse after treatment.

Also the enamel restores its shine after patient suffering from dental erosion has used Tooth Mousse regularly. Of course I must say that one part of this process is the fact that many people change their lifestyle habits once they understand that the enamel does not grow back once it’s gone. There is natural defence in everyone’s mouth and that is saliva. As long as there is not too much for the saliva to handle in daily basis (e.g. sour drinks, snacking), it can keep the enamel healthy.

It is comforting to know that there is something that the patients suffering from the gastric reflux can use at night to protect their teeth from the stomach acid. Gastric reflux is a nasty thing to have and very often patients do not even know they are suffering from it but that is completely another story. I might write a short post about it soon.

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