The number of different toothpastes available is staggering. Visit Boots or Superdrug’s websites and you’re faced with well over 100 options promising everything from whitening to enamel repair, deep cleaning, germ protection, tartar control and sensitivity relief. How do you choose the right one for you? To find out, we asked three leading dental health experts, with a wealth of toothpaste knowledge, to assess the ingredients typically found in toothpastes that target sensitivity, whitening, and enamel repair to get to the root of whether they are worth it. They examined research provided by the manufacturers, and wider clinical research, to help you decide whether to pay a premium for types of toothpaste, such as those for sensitive teeth. While it’s true that some claims do stand up to scrutiny, others may be more down to interpretation. And bear in mind that many claims may be based on the inclusion of one key ingredient – fluoride, which can be found in even the cheapest toothpaste. Want to invest in a decent electric toothbrush? Read our electric toothbrush reviews first.

The importance of fluoride

Brushing with fluoride toothpaste remains the best thing you can do to maintain your dental health, according to experts.  Fluoride infiltrates the enamel’s surface and reaches areas that brushing can’t – providing you brush for around two minutes – making the tooth surface harder (remineralizing) and more resistant to attack by sugar-loving bacteria. To maximize its benefit, spit but don’t rinse your mouth with water after you finish brushing. The gold standard of research reviews, Cochrane, found that the use of fluoride in toothpaste leads to less tooth decay. The stronger the concentration, the more decay is prevented.

What to look for when buying toothpaste

Check the fluoride concentration. Look for the parts per million of fluoride (ppmF). Less than 1,000ppmF is a low concentration and offers limited or no protection against decay. 1,450ppmF is generally used in over-the-counter UK toothpaste and is recommended by our experts. But children’s formulas can contain lower levels.   Think about your needs. Many people – especially those who brush well – don’t need extra active ingredients apart from fluoride.  If you have specific concerns around things such as whitening, sensitivity, or enamel wear, see our ingredients guide (below) to understand the claims made about a particular toothpaste, and whether the evidence supports them.   Check the pack size. A toothpaste that looks cheap can be pricey when you calculate the price per 100ml compared with rivals.

Whitening toothpastes

Whitening toothpaste are on shakier ground when it comes to whether they live up to their claims or not. There are two types of staining that affect the ‘whiteness’ of your teeth:  Intrinsic staining happens inside your teeth and can be caused by trauma, certain medical treatment or excessive childhood fluoride consumption (but this is rare in the UK). Teeth also yellow as we age, due to thinning enamel. The only way to remove intrinsic staining is bleaching through dentist-administered professional products (using hydrogen peroxide). Extrinsic staining is typically caused by smoking, or drinking tea, coffee or red wine. It responds well to brushing with whitening toothpaste, which contains ingredients to help remove stains, but won’t change the underlying colour of your teeth.  So as long as you don’t have expectations that a whitening toothpaste will change the underlying colour of your tooth enamel, there may be value in buying a toothpaste which makes whitening claims, as it could contain stain-removing ingredients that a standard paste won’t have. Here’s a rundown of the evidence behind typical ingredients found in whitening toothpastes:

Hydrogen peroxide The UK legal limit allows a concentration of 0.1% in a toothpaste, compared with 6% in a professional whitening treatment, so any toothpaste containing this is unlikely to have much effect on underlying enamel colour. Optic brighteners Another method for whitening is the use of a film that coats the teeth to provide an optic whitening effect. Blue covarine is a typical optic brightening ingredient. These might have an immediate effect, but won’t last as saliva washes away most paste quite rapidly.  Sodium bicarbonate Sodium bicarbonate is an effective stain remover with mild abrasive action. It also has some anti-bacterial properties. It’s a favourite for ‘natural’ toothpastes, for example Arm & Hammer uses it across its range. Charcoal  Charcoal whitening toothpaste has seen a huge rise in popularity, despite the Oral Health Foundation and our experts agreeing there’s not enough evidence to support claims around its whitening effect.  Charcoal, in some higher strength formulations, can also be too abrasive, which could wear down tooth enamel over time.

Furthermore some charcoal toothpastes are also fluoride-free, which our experts would not recommend.