RDA Value in Toothpastes – Any Relevance?

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Gum & Enamel Repair Original Toothpaste

I promised in my post Oral-B Gum & Enamel Repair Original Toothpaste Review that if I find out the RDA level of this toothpaste I will announce it. Well I found it out recently, sort of. And this occurrence sort of made me annoyed once again. So I’m going to pour it out now.

I saw a representative from Oral-b recently. She was going to ask about our experiences of the Gum & Enamel Repair Original Toothpaste. I told mine and to my pleasant surprise she suggested we would fill an adverse reaction report. So we did. She said she had never heard anyone’s tongue getting numb from their toothpaste.

My most important question to ask from the rep was the magic RDA value of this toothpaste. I was dreading it as the reps are quite sensitive about the whole subject of RDA value. They know that it is thought widely amongst the dental professionals that the higher the RDA value is the more abrasive it the toothpaste is. So the manufacturers want to keep it a secret.

What Is RDA?

To explain it very simple way, the RDA is the grittiness of the toothpaste. If it is too high, it can cause tooth wear. But to explain RDA more elegantly, here is a quote by ADA (American Dental Association):

To help quantify the abrasivity of dentifrices, the ADA along with various academic, industry and government agencies established a standardized scale called Relative Dentin Abrasivity (RDA). This scale assigns dentifrices an abrasivity value, relative to a standard reference abrasive that is arbitrarily given an RDA value of 100.

All dentifrices at or below 2.5 times the reference value, or 250 RDA, are considered safe and effective. In fact, clinical evidence supports that lifetime use of proper brushing technique with a toothbrush and toothpaste at an RDA of 250 or less produces limited wear to dentin and virtually no wear to enamel.

ADA (American Dental Association)

So what this quote is saying is that most of the toothpastes are safe. Mind you, FDA (U.S. Food & Drug Administration) has set the safe limit of RDA to 200. But internationally it is the RDA 250 or below that is recognised as safe to use. I did a research and found out that many dental sites (both english and my native language) state that the highest safe RDA level has been set too high. It should be 100 or less.

Here is a link to one of the dental sites with a very good chart about abrasiveness levels in different toothpastes.

The Big Question

Ok, back to seeing the rep. I gathered all my courage and asked the big question.

Err, what is the RDA level of this toothpaste?

Oh boy, he looks annoyed. He asks if he has ever shown us a video about RDA. No, he hasn’t. He took his tablet out and put the video rolling. It was about RDA level of the toothpaste made by Oral-b. In the video they were demonstrating that it doesn’t matter what the RDA level is as long as it is below 250.

He looked victorious when the video ended. I asked again.

So, what is the RDA level of this toothpaste?

He said with a sigh that the RDA level of the Gum & Enamel Repair Original Toothpaste is somewhere between 100-200.  So this is what I meant when I found out the RDA level of this toothpaste, sort of.

Conclusion

It is good to remember that not only the toothpaste’s RDA level determines how much you will get tooth wear. If you brush your teeth straight after breakfast, with a hard toothbrush and with too vigorous technique (applying too much pressure), it has very little meaning what the RDA level of the toothpaste is.

You might be interested in these posts as well:

Testing Oral-b Smart Phone Holder, Take 1
Testing Oral-b Smart Phone Holder, Take 2
Oral-B Gum & Enamel Repair Original Toothpaste Review

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Oral-B Gum & Enamel Repair Original Toothpaste Review

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Oral-G Gum & Enamel Repair Original toothpaste

Today I am going to review a toothpaste for the first time ever. It is a toothpaste that was given to me by a representative of Oral-b. It is called Oral-b Gum & Enamel Repair Original toothpaste and it is Oral-b’s newest toothpaste.

Here’s the manufacturer’s selling speech about the toothpaste on their website:

  • It defends against acid erosion and helps to repair enamel
  • It provides antibacterial action to help rejuvenate gums
  • For sensitive teeth – clinically proven
  • Oral-B Gum & Repair Original toothpaste comes with a mild flavour and a smooth texture

The Design

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The design of the packaging looks simplified and minimalistic which I very much like. This is welcome change from their previous toothpastes’ outlook that had too much information in a small space.

The tube is still easy to open, but there is small change in the lid. It used to be made of metal which at least in my opinion is better recycling-wise than plastic. Small detail but still. Can’t help this image of whales’ intestines full of plastic popping in my mind. But then again the whole tube is plastic.

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The Testing

Staying on the environmental subject. The plastic and the whales. There has been lots of talk over microbeads that are found in many consumer products. Even in toothpastes. These microbeads will eventually find their way into the sea and cause problems to the oceans as persistent pollutant. The representative who gave me this Gum & Enamel Repair Original toothpaste sample promised that there are no microbeads in it. The ingredient to look for is polyethylene when you want to make sure there is none of them. I found no polyethylene in the ingredients list (see at the end of this post). Great.

The texture of the toothpaste looks smooth as they promised but when you take closer look, it is not that smooth after all and the fear of microbeads is getting stronger again.

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The texture of the Gum & Enamel Repair Original toothpaste

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Closer look of the toothpaste reveals tiny beads.

The tiny granules are clearly visible but these could be actually hydrated silica (abrasive), not microbeads.

Ok, time to add toothpaste to my toothbrush. Like with Oral-b Pro-Expert toothpaste, this new one is also quite runny and can be messy if you are not quick enough. Once I had applied toothpaste to my toothbrush I was in a rush to take a photo before it dripped on to the table.

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I use my beloved Philips Sonicare

and with this brush the runny texture is actually better than the ones that are stiffer pastes. But I can see that the sink in the bathroom will have toothpaste marks here and there. Also, note to myself – do not let husband use this toothpaste as he brushes his teeth after he has put his suit on. Silly man.

So lets put the toothpaste in my mouth. It does begin to formulate foam which means there is soap in the toothpaste. Not the best option for somebody with sensitive soft tissues or dry mouth. Soap aka sodium lauryl sulfate can make the mouth dry and also it has been linked to canker sores aka aphthous ulcers (although nothing is scientifically proven and oh boy don’t I hear it from the rep e-v-e-r-y time).

Very soon I begin to feel burning sensation on first third of the tongue (the tip of the tongue), both top and bottom of the tongue. Also the tongue feels slightly numb. This carries on all through the brushing and after spitting the toothpaste out. Now, I do advise my patients not to rinse after brushing but the burning sensation is so strong that I must rinse lightly. Once I did that and bit my teeth together, I could feel biting on some grit. This made me think about the abrasiveness of the toothpaste. It is new toothpaste so the RDA value (Relative Dentine Abrasivity) was impossible to find. I will add the RDA value as soon I find it out.

Ten minutes after brushing the burning can still be felt. Also I feel that the layer of skin inside my lips is peeling off. This has been “a feature” with Oral-b Pro-Expert toothpastes and the reps have said it’s absolutely normal and will diminish when using the toothpaste for longer period of time. My colleague asked the rep if this new Gum & Enamel Repair Original toothpaste does the same. I must say that I cannot remember the rep’s exact answer but I think she said this toothpaste should cause less of the peeling of the mucosa. Well it doesn’t. At least with me. If anything I think the peeling of the mucosa is quicker than with Pro-Expert toothpaste.

Twenty minutes after brushing I can still feel the burning feeling slightly. I guess some people will associate this burning feeling with effectiveness of the toothpaste. The more it burns, the more effective it is. As a dental professional I must say that this is not true. No toothpaste should feel uncomfortable to use.

Would I Recommend?

To be honest, most likely I will not recommend this toothpaste to anyone. Not after I took a closer look at the ingredients. One ingredient has been nominated as Allergen of the Year for 2018 by American Contact Dermatitis Society. This ingredient is called propylene glycol.

The list of ingredients is long and to my mind the longer the list is the more side-effects there will be. My favourite toothpaste that I recommend to my patients a lot has only eight ingredients (aqua, crystalline sorbitol, hydrated silica, crystalline xylitol, PEG, anhydrous natural betaine, cellulose gum, sodium fluoride (1500 ppm F), sorbate). Oral-b Gum & Enamel Repair Original toothpaste has nineteen! Three of these ingredients can have adverse reactions to one’s health – propylene glycol, CI 77891 and sodium lauryl sulfate.

Also the fact that I got this burning feeling in my mouth tells me this toothpaste is not suitable for most of the people. Remember that it should not feel unpleasant to use a toothpaste. Certainly it should not hurt. So change if it does.

The Ingredients

Here are the ingredients of the Oral-B Gum & Enamel Repair Original toothpaste and short explanation of what they are (by clicking the link you will find more information):

  1. Glycerin – an organic compound most commonly from animal fat and vegetable oil
  2. Hydrated Silica – abrasive
  3. Sodium Hexametaphosphate – anti-stains and anti-tartar
  4. PEG-6 – an emulsifier and foaming agent
  5. Propylene Glycol – the American Contact Dermatitis Society’s Allergen of the Year for 2018. An emollient and emulsifier.
  6. Aqua – the main carrier for all ingredients. Helps dissolve other soluble ingredients. Helps the mechanical process of cleaning teeth in mouthwashes
  7. Zinc Lactate – such a difficult ingredient to find any information solely on zinc lactate. Lots of information on zinc but there must be difference in different types of zinc? If anyone finds trustworthy site with information on zinc lactate, please drop me a line.
  8. Sodium Gluconate – to sequester calcium and helps to prevent gingivitis
  9. CI 77891 – titanium dioxide (nanoparticles). A thickening agent and colourant.
  10. Sodium Lauryl Sulfate – soap, the foaming agent. Can work as an irritant.
  11. Silica – a mild abrasive to clean teeth.
  12. Aroma – a chemical compound which adds odours to dental products.
  13. Sodium Saccharin – an artificial sweetener
  14. Carrageenan – an extract from a red seaweed. Binds and gels all the ingredients together
  15. Trisodium Phosphate – stain remover and de-greaser
  16. Stannous Fluoride – the good in the toothpaste
  17. Stannous Chloride – antibacterial
  18. Xanthan Gum – a thickening agent
  19. Sodium Fluoride – the good in the toothpaste

If you are interested in other common ingredients in toothpastes, click here.

Edit 21.6.2018

Want to know what the rep told me about the RDA level of the Oral-B Gum & Enamel Repair Original toothpaste? Click here to find out.

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RDA Value in Toothpastes – Any Relevance?
Hands up Who Knew That Zinc in Toothpaste Can Cause Dry Mouth?
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Testing Oral-b Smart Phone Holder, Take 2

Testing Oral-b Smart Phone Holder, Take 2

 

Oral-b smart phone holder should be attached to the mirror

 

“Whoomp (there it is)” was ringing in my head when I was thinking about the title for this post. But I decided to use the same title as on my previous post for you to be able to follow the subject.

So there it is! The smart phone holder attached to the mirror. And so well it is attached that it feels like it is glued to the mirror. When I tried to pull it off to test how well it is attached, the mirror almost came off.

Conclusion

The smart phone holder should be attached to the mirror to avoid your smart phone plunging towards the floor.

Irrelevant to the usability of the apparatus, I must say that as an aesthete I think the holder is too bulky. But hey that’s just me.


You might be interested in these posts as well:

Testing Oral-b Smart Phone Holder, Take 1
Oral-B Gum & Enamel Repair Original Toothpaste Review
RDA Value in Toothpastes – Any Relevance?

Can You Trust the Recommendations given to You by a Dental Professional?

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Too Many Options

Floss, tape or ribbon? Soft, medium or hard brush? Manual or electric? Fluoride or herbal toothpaste? Whitening, double-action, triple-action or all-in-one? Mouthwash or not?

These questions are endless in the mind of a common consumer. So no wonder they rely on the advice of a dental professional. Why wouldn’t they? Us professionals have the latest information and studies. We have tested the products ourselves. We have seen them in use amongst patients with good results before recommending them.

Not.

As some of us might have, most of us haven’t. Let me tell you how a product gets recommended.

Annual Dental Show Case

Every year dental professionals gather at dental show cases where manufacturers of dental equipments and oral health care products have set up impressive stands to lure dentists, hygienists and nurses to discuss about the new products.

A revelation:

Most of these professionals are not interested in what types of root canal files they have invented or the qualities of the new toothpaste.

What they are interested in (while acting as if they are listening the representative) is:

Are there any freebies?

Yes, I have seen highly paid dentists with their Louis Vuittons to run after freebies like they had no money to buy them. They sit in free 45 minute lecture sponsored by one of the leading oral hygiene product manufacturer to receive the latest model of an electric toothbrush which they already have. This new one they will either sell or give as a Christmas gift to a relative. They go from stand to stand to pick toothpaste, floss, chewing gum, sweets and reluctantly accept advertisement leaflets which will go straight into the bin when they reach home.

The most generous representatives are the ones whose product end up recommended the most.

Why?

Because they send boxes and boxes of free samples to the practices. Let’s say a dental practice receives 6 boxes of toothpaste samples, those handy travel sized ones, you know? Each box has 100 samples. So 600 tubes of toothpaste to give away. Will all of these be given to the patients? Nope.

300 of them will confiscated by the staff of the dental practice for personal use
200 of them the staff will give to the relatives and friends

And finally the rest will go to a small bowl on the side of the desk in the surgery and these samples are given one by one to a patient who has deserved it. Some might even hide them in a drawer to avoid being forced to give them to a patient that annoyed them (because it’s not good manners to say no if the patient asks for samples).

Salesmen of the Manufacturers

The leading oral hygiene manufacturers have salesmen who visit regularly the dental practices to promote their products. They are warmly welcomed to the practices but often only if they visit whilst the practice is having a lunch break. The reason for this is:

  • The practice does not want to lose any profitable surgery hours.
  • All dental professionals know they will bring something to go with a coffee. A cake, sweets, a swiss roll. They had better or the salesman will be faced with a grumpy audience.

When the dental professionals are happily sipping away their coffee or tea with the cake, the salesman goes through the new products. There might be a question or two but what everyone is thinking while the salesman talks is:

Are there any freebies?

We often meet quite aggressive salesmen who will defend their product to the death. Honestly, what happened to customer is always right? If you are actually listening to the salesman when he is telling you about all the impartial studies of how their pulsating electric toothbrush is better than a manual toothbrush and especially better than their competitor’s sonic toothbrush (their study actually says sonic toothbrush is as crap as the manual toothbrush – whaaaat?) you are urged to raise your hand to get a say.

You want to tell the salesman, that you are actually using the sonic toothbrush and that you have recommended it to the patients with poor oral hygiene and the results are great. If you are wise, you don’t say anything and carry on recommending the product you know is the best. But if you cannot keep quiet, you will soon learn to do so next time. The salesman starts to talk to you as if you are retarded or malpracticing when recommending something their study has shown to be ineffective.

Impartial study my arse (beg pardon my French).

Anyway, the salesman gives everyone toothpaste and promises to send samples later on. Boxes of samples. And they will. And you already know what happens then.

I must say that it amazes me how some of the dental professionals are stubbornly stuck on recommending the same electric toothbrush they are using themselves and have never tried another one. Or they might have tried it once (let’s say this leading sonic toothbrush) with incorrect technique and judge it by that. They refuse to see the good results that are clear with the patients who are using this sonic toothbrush. Where is professionalism in this?

Personalities and Professions Clash inside the Practice

The dentist is the ultimate Master of the Universe (by Universe I mean a dental practice) and if the Master has ordered certain toothbrushes, certain toothpaste, floss and interdental brushes to be sold in the practice, then the rest need to comply. Of course there will be some rebellion inside the closed surgery doors. But it needs to be done so that one does not get exposed as there will be consequences. So one must occasionally recommend the products the Master has chosen.

For some reason unknown to the writer the patients seem to consider the dentists as God. What the dentist says overwrites everything another dental professional has said, including oral hygiene recommendations. The hygienist cannot be right if the dentist said something else.

This leads me into temptation to step out of the subject for a little while as I remembered something that has puzzled me for ages and I think I might get an answer through this blog. Here it goes… Patients consider the dentists as God and bring gifts (wine, chocolate, flowers etc) to them when the treatment is done and the nurses, hygienists and the rest hardworking supportive staff get nothing. Gifts TO THE DENTIST who makes gazillion amount of money compared to the supporting staff! Why o why? Dear patients, please use comment box to enlighten me in this matter!

Back to the subject.

Later on in this blog I will be writing more about the personalities and how it affects dental practice and the treatment given to the patient. But having mentioned it on the heading already I will write shortly here as well.

When a dental professional has a big ego it sometimes runs over the best interest of the patient. Lets say a dental hygienist recommended you a yellow interdental brush and she spent time and effort to get you to learn the technique by showing how to use it and by checking that you understood how and why to use it. You leave the practice happy because you learned a new skill to improve your oral hygiene.

Then you see a dentist the next week and he thinks the interdental brush is rubbish (as you lost a filling made by him when using the interdental brush) and advices you to use floss on your heavily filled teeth with wide gaps. He just casually says this without showing the technique. You try the floss as you have many times previously and it gets stuck, breaks and is difficult to use between the back teeth. You give up and stick to the toothbrush only.

Who wins? Nobody. Especially not the patient. And to be honest, you would be wasting your money anyway as the floss is not the right tool for you.

A revelation:

The dentist is not in the area of the best knowledge when it comes to recommending the oral hygiene products. They are far better drilling and filling the teeth. And doing all sorts of other nasty (from patient’s perspective) things that requires higher and longer academic education than hygienist’s.

Old Habits Die Hard

“I have always recommended floss and it’s been fine”

Oh, dear. Lets start from the basics of oral hygiene.

Patients are all different, our teeth and bones are different shapes. They have teeth that have no fillings, some fillings or mouth full of fillings and other restorations (crowns, bridges, implants). Some restorations are well made, some not. Patients have different motoric skills.

So you cannot recommend something out of custom.

To find out the best product to recommend to the individual patient, we should always use disclosing liquid (the one that dyes the plaque red/blue). If not used, it is impossible to tell what works and what doesn’t. You would be surprised to find out how ineffective the common floss or tape is. I do recommend floss every once in a while but only 3 certain types of certain brands (you will find out from here which they are, plus correct technique for the sonic toothbrush).

How It Should Be Done

This chapter is especially useful for the dental professionals but the patients benefit of reading this as well. You know you are in good hands when a dentist or hygienist is as thorough as I describe.

This is a short version of upcoming post about what recommendations should be based on.  It is last on the list because there are not many dental professionals who are this thorough.

The most important thing is to interview the patients about their current oral hygiene habits and reasons behind them. E.g. if the patient is not cleaning between the teeth, ask why? without sounding or being judgemental. Laziness, ignorance, stress, depression, difficult life situation, too hard… there are as many reasons as there are patients.

The next you need to find out where the problem areas are in patient’s mouth and decide the right tool for the patient to use. Test it, show it to the patient and let the patient try. Remember to say, it won’t be an easy ride at first even if looks easy when I do it.

Tell the patient where she can find them and where they are the cheapest to buy (do your research).

Give leash and don’t be overenthusiastic. By this I mean you should encourage patient even if there has been only small improvement, but also same time encourage to do better next time. Change the tool if it’s not working. Small steps!

In my experience it takes 12-18 months on average until you get it right if the patient is responsive. So don’t give up after the first visit.

Also worth remembering

  • the products sold in the practices are not necessarily the best ones like electric toothbrushes of certain makes and models. They are normally just the owner’s way of making more money on the counter. Use the products recommended by an experienced hygienist.
  • some of the products might even be a health risk like mouthwash which contains alcohol (now this is an issue that divides dental professionals. Some agree with me, some don’t. I will be writing about this later on in this blog).
  • some of the products might not be suitable for you like toothpaste containing soap if your mouth is sensitive (sodium lauryl sulfate).
  • some dental professionals are not revising and open to a new information and studies about dental products. They stick to the old knowledge despite the fact that the new information is indisputable. This happens especially if the new information is delivered by the lower rank colleague in the practice.
  • fillings, when well-made, do not come out with any oral hygiene product. The fault is always in the filling and in it’s maker if the filling is relatively new.

Conclusion

It was a long post, hopefully you made through it. To sum up all 2000+ words, only two words come to my mind that defines us dental professionals these days. Greed and pride. Two out of seven of deadly sins.

But there is hope.


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Oral-B Gum & Enamel Repair Original Toothpaste Review

New Natural Remedy (Fluoride-Free) for Decay

Hands up Who Knew That Zinc in Toothpaste Can Cause Dry Mouth?

Do You Recommend Toothpick?

Should You Use a Mouthwash?