Tag: 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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Dental Erosion and Tea

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By Diliff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=6739706

As a dental professional I worry about growing phenomenon of dental erosion on patients teeth. Yesterday I saw 6 patients of which 5 of them had erosion on their teeth ranging from mild to very severe. There is not necessarily difference between different age groups any more. Dental erosion affects all the age groups and often it is due to ignorance – not knowing that something we do everyday basis is damaging our teeth. And damaging for good. With this post I hope to raise awareness of one very common habit many of us have that could damage the enamel of the tooth. That is drinking tea.

What is Erosion?

People often know what erosion means when it comes to for example coastal erosion (hence the photo of beautiful Seven Sisters, UK). But when I mention the word erosion to the patient, they often look perplexed.

Dental erosion is one type of tooth wear where tooth looses its structure due to chemical dissolution by acids. These erosive acids enter the mouth through two routes – from outside (food, drinks, medicine, supplements) or from inside of the individual (stomach acid due to gastric reflux or bulimia). The loss of the tooth structure is permanent. It won’t grow back. So the prevention of the dental erosion is the most important thing to do.

With this post I will not go into all the things that cause dental erosion as I have written it in my previous post How Diet Affects Your Teeth? But what I didn’t write on that post was something I didn’t know back then. You see, this profession is constant learning as long as you are receptive. I knew that fruit teas are acidic but what I did not know is that only two types of teas are safe to drink when it comes to tooth wear.

pH of Different Teas

There are plenty of studies about the pH levels of different teas. Just google words erosive potential of teas. When I did this I also run into some worrying sites like this one where incomplete advice is given to people. The effects on teeth is completely left out when talking about alkaline diet even though the mouth is one important part of your overall health.

What people following alkaline diet are thinking is that foods consumed will become alkaline in your body. But remember when acidic foods (lemon, lime, berries, apples etc) or drinks (e.g. herbal and fruity teas, carbonated drinks, juices) enter the mouth, they stay acidic. Lets take the lemon as an example. In the alkaline diet’s pH chart they state that lemon is very alkaline (pH 10). But when entering mouth, it is highly acidic (pH 2.0)

The same site advises people to drink hibiscus tea as alkaline tea. A revelation, also hibiscus is not alkaline when entering mouth. It is in fact the most acidic tea there can be (pH level <3.0). Any drink with pH level below 5,5 will cause erosion on enamel if consumed regularly.

It worries me that people actually follow these constricted advices blindly. I don’t blame them. Many people are clueless when it comes to matters of health. Everyone following alkaline diet should read this article to determine if there are enough health benefits of the alkaline diet to risk the health of the teeth. The only downfall of this article is that it is not writing about health risks of alkaline diet.

Erosion-Enhancers

The herbal and fruity teas are acidic but certain factors can make them even more erosive. These are exposure time and temperature of the drink.

Nowadays people carry their drinks with them in a travel mugs enabling them to sip it during e.g. commuting and perhaps some of it is left for them to drink when they reach their desk. If the drink is acidic tea it means prolonged exposure to acids and if repeated often, it will result in tooth erosion. If there is sugar or honey added to the drink it will be even more erosive and also cariogenic.

Also the hotter the drink is the more erosive it is. And these travel mugs keep the drink warm for a long period of time.

Warning Signs of Erosion

The first sign of dental erosion is normally sensitivity to cold or pressure (when brushing the teeth or touching the surface of the tooth with your finger nail. The latter us professional do not encourage to do). This should raise an alarm in your mind and you should go through your diet to find out if you are consuming something regularly that is too acidic to your teeth. You will find help from my post How Diet Affects Your Teeth. Remember that the best drink teeth-wise between the meals is tap water because it is alkaline.

Another sign of tooth wear is change in tooth colour. As the enamel gets permanently thinner, the yellower tooth structure the dentin under the enamel will start to show through. Your teeth will look yellower than before and no whitening done will change that as the whitening substance is not able to reach the dentin.

When the shape of your tooth is changing, the erosion is already severe. Thinning enamel will easily chip off making your teeth look less attractive than they used to be. Often people feel embarrassed about their teeth at this point.

So my message to you all is to prevent dental erosion! Think what you put in your mouth and how often you do that. Occasional acidic drink will not make any difference but when consumed often, it will cause problems.

Is Any Tea Safe to Drink?

Yes! The pH level of green tea and black tea are on the safe side. Black tea also contains fluoride which helps to prevent tooth erosion. But remember, they are only safe if no sugar (including honey) or lemon is added. Sugar will cause the pH level of the saliva to drop below 5,5 and lemon is very acidic like I mentioned already above.

Here are some studies for further reading

Erosive potential of herbal teas

International Journal of Science and Research (IJSR): Dental Erosion and Tea: A Systematic Review

BBC: “Sipping acidic fruit teas can wear away teeth, says study”

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