You won’t find these toothpastes in your local grocery store, because of the high amount of fluoride
ve never minded going to the dentist. This probably has a lot to do with the fact that I’ve never really had a dentist tell me anything other than “your teeth look great, see you next year.” Or, at least, I’d never had a dentist tell me anything other than that before this month.
After a lengthier-than-wise hiatus (we’re talking years), I made an appointment to see a new dentist in my neighborhood in Brooklyn. I sat in the exam chair for what felt like an eternity — probably about 30 minutes — waiting. I stepped out of the exam room to get my teeth X-rayed and when I returned the building manager bustled in to check a leaking pipe. An assistant came in and used the phone to order new toothbrushes for the office while loudly discussing the order with the person doing my intake survey. When the dentist finally appeared, he snapped at the assistant. This is all to say that by the time the dentist looked at my scans and told me I had developed a bunch of cavities, I was feeling pretty rattled.
Rattled enough that when he suggested I immediately start using a prescription, high-fluoride toothpaste priced around $25 for 3.4 fluid ounces, I nodded and handed over my debit card. “Just add it to my tab,” I joked, as I was shown the projections for what filling and sealing my teeth would cost.
And then I got home, took a breath, looked at the toothpaste, and started to wonder if I actually needed the pricey bottle I’d just paid for. A healthy number of questions is never a bad thing when it comes to your health and I’d be lying if I didn’t also have a story from The Atlantic about a scammer dentist rattling around in my brain. (My unnamed dentist, to be clear, was not a scammer so much as just a terse person on a busy Monday morning.)
When he suggested I immediately start using a prescription toothpaste, I nodded and handed over my debit card. “Just add it to my tab,” I joked.
I mentioned it to my girlfriend who also uses a prescription toothpaste each night. “Oh yeah, it’s $30 for a tube and it only comes in a gross fruit flavor,” she told me. Which confused me since mine was a little cheaper and minty. (Mine’s Colgate PreviDent 5000 Booster Plus, if you want to get specific.) I started googling. Which was a terrible idea because I soon found myself down a rabbit hole of what to do if you poison yourself from swallowing too much fluoride, but without any answers to my original question.
To be very clear, there’s a lot of misinformation out there if you start poking around forums and YouTube videos peddling pseudoscience. You can poison yourself by consuming too much fluoride, but you’d need to eat a lot of toothpaste. Way more than you swallow in the course of brushing your teeth. The National Capital Poison Center says even for children, it’s no big deal to accidentally ingest a little over the counter toothpaste while you brush.
So, instead, I talked to some professionals.
“Prescription fluoride toothpastes have a higher concentration of fluoride than other toothpastes and are formulated in a way that allows it to be more easily released in the mouth,” Marc Schlenoff, vice president of clinical development at dentistry startup Tend told me. “Several of these prescription toothpastes also contain a higher concentration of potassium nitrate, an active ingredient in many sensitivity toothpastes.”
He said he’d prescribed prescription toothpaste hundreds of times and described the results as “universally positive.” “While the prescription aspect can be cumbersome and they are not always covered by insurance companies, these products are very helpful,” he said. By the numbers, my over-the-counter tube of Crest contains .243% sodium fluoride, while my new tube has over four times that figure, at 1.1%.
Armed with Schlenoff’s info, I also reached out to Kailee Williams, a dentist who works out of a community dental center in Maine. (She is also, I should disclose, a friend from college who I knew wouldn’t laugh at my possibly very dumb questions.) The first thing she told me was that if I lived in Europe or Canada, I could get my new toothpaste over the counter. “The FDA requires a prescription for it here,” she explained. Williams told me to think of my new toothpaste less as a replacement for toothpaste — my dentist had likewise instructed me to use it only at night — but as a preventative tool.
But what exactly does it do? Between Williams and Scientific American, I now understand that as our teeth decay they are losing minerals, which is what causes cavities. Applying fluoride to those cavities — a process known as “remineralization” — helps your teeth to grow enamel crystals more efficiently and at a faster rate. This, in turn, can help keep your teeth from getting worse and prevent them from sustaining future damage.
Buying pricier toothpaste is ultimately way cheaper than dental work. “A lot of people have the starts of decay between their teeth which can be ticking time bombs. With good flossing habits and regular fluoride exposure those could stay small and never need a filling,” Williams said. “If you’re just brushing and don’t change those habits those could easily get larger and once one of them becomes big enough to need a filling the neighboring one tends to not be that far behind. If I see anything between teeth that is new, even if it wasn’t something I would treat, I prescribe fluoride toothpaste.”
I asked her about fluoride’s bad reputation online. I’d received treatments as a kid and never thought twice about them, but, like many things science has repeatedly proven, there are plenty of people on the internet claiming the benefits are bunk, or even dangerous. “Fluoride, in general, is a battle we fight all the time. It is something that has decades of junk science claiming a number of crazy health risks, but it has been studied extensively by clinicians. Every professional dental association and medical association agrees it’s among the best preventative tools out there,” Williams said.
So it looks like I’ll be sticking with the prescription. I’ll also be on the market for a friendlier dentist.
*Original article online at https://elemental.medium.com/25-prescription-toothpaste-is-not-a-sham-3205a1d50b10