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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Eeny Meeny Miny Moe – Which Type of Tooth Wear?

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There are four types of tooth wear that we diagnose from patients’ mouths. Erosion, abrasion (I’m sorry for a missing link – I did not agree with any of the images of abrasion), abfraction and attrition. The easiest ones from these to diagnose are the erosion and attrition. You can’t go wrong with them. But it is completely different case with abfraction and abrasion. I run into this very often with my patients.

When a dentist or a hygienist sees tooth wear on the neck of the tooth they diagnose it by default as abrasion caused by too vigorous brushing. They recommend softer toothbrush and this silly brushing technique called Bass (it is so silly that I think I am going to dedicate one post entirely to this technique).

This normally leads into a situation where patient begins to be too careful with the brushing because she doesn’t want to cause further damage to the teeth. That’s when the plaque starts to build up to the gum line, gum gets inflamed because of the plaque and the patient begins to notice bleeding when brushing. Now she’s even more careful with the brushing as in her mind bleeding means she’s doing something wrong – brushing too hard like the dentist said she is.

But what if the dentist/hygienist misdiagnosed the tooth wear? What if the correct diagnosis was the abfraction?

Tooth wear – What to Check?

When you see a tooth wear that you are tempted to diagnose as abrasion, stop for a moment before you proceed giving advice on brushing. Instead do the following:

1. Check if there is mobility on the teeth affected by tooth wear

2. Check if there are interferences on side movements and protrusion

3. Check if there are shiny facets on occluding surfaces

If you get positive answer to even one question the chances for the tooth wear to be abfraction are great. And in this case telling patient that the tooth wear is caused by her brushing can be damaging in many ways:

  1. It is hard to convince a patient that they are not actually brushing too hard and that they have not damaged their teeth by it. I have my ways of convincing the patient but life would be soooo much easier if I didn’t have to.
  2. The dentin will decay very easily (as I’m sure you know) and plaque accumulating and staying there undisturbed for longer period of time because of too careful brushing will very quickly cause decay. And we all know how these fillings in the cervical area are pain in the butt. Somehow they always seem to have overhangs or they come off when scaling. Sound familiar?
  3. The teeth where the surface of the root (dentin) has been exposed by receding gums will get sensitive if the plaque builds up.
  4. If the tooth is mobile and has already bone loss the plaque building up to the gum line and inflaming the gum can be disastrous. Please memorize that

MOBILITY + PLAQUE = RAPID BONE LOSS

The Cause for Abfraction Needs to Be Dealt With

When a tooth interferes with full closure, it will trigger deflective interferences6-8 and cause any of the 7 signs and symptoms of occlusal disease such as hypersensitivity, abfractions, mobility, excessive wear or fractures, and muscle or temporomandibular (TM) pain.

There is no consensus amongst the dental professionals over the right approach to occlusion. Is this the reason why signs of interferences on occlusion are ignored or unchecked and the tooth wear is so easily made as patient’s fault?

The quote above is from an article The Three Golden Rules of Occlusion in dentistrytoday.com and you can read a full article here.

But by Whom?

To be honest – and like I have expressed in my previous post – I would not let just anyone touch my occlusion. I would love if the dentists would refer patients to the specialist in prosthodontics and stomatognathic physiology because they have the best knowledge and skills to treat the occlusion. And that’s something every patient is entitled to.

Guilt Is a Heavy Load to Carry

I have often noticed that patient feel unnecessarily guilty over damaging their teeth. They feel guilty and desperate over the fact that the damage done by brushing is irreversible. And that they are not sure if their brushing technique is still damaging their teeth hence too careful brushing to make sure they are not.

I believe that guilt does not lead us forward in life, it does not bring anything positive into our lives. Therefore I always try to relieve my patient’s guilt whenever it is possible.

In the case of tooth wear and some dental professionals way of putting the blame on patients’ brushing technique I always have the same conversation with a patient. It goes like this.

Me: Have you been told that you brush too hard?
Patient: Yes I have.
Me: I thought you might have. You see when a patient is told this, she starts to be too careful and then the plaque starts to build up and there is actually plaque in the gum line of your teeth. (I take a mirror and show the plaque to the patient)
Patient: Eww..
Me: I personally try not to tell patients that they are brushing too hard because this leads to too careful brushing which will cause more problems like decaying and gingivitis. Instead I interview the patients about how they brush their teeth and correct it if necessary. You see the tooth wear can be caused by other things than just vigorous brushing… 

Prior to this conversation – in the beginning of the treatment – I have interviewed the patient and asked about her oral hygiene habits. Which brush she uses? How often? How often does she replace the brush head/brush? How does the brush head look like before replacing it? Spread or still like new apart from colour fading? This is why I can continue the above conversation like this.

Me: In your case I doubt it that the tooth wear is caused by your brushing but I will just in case show you the right technique. I will first just check couple of things…

And then I check the mobility, the interferences and the occluding surfaces. I feel great satisfaction when the teeth affected by tooth wear have mobility on the side movements. I am on the right path!

The patient is visibly relieved when they can stop worrying about their brushing. Well who wouldn’t be! There is enough to worry about in life even without worry over brushing.


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Don’t Let Just Anyone Touch Your Occlusion