Oral health
For each one: how to use it, the best version, how to prepare it, what it does, and where it goes wrong.
HydroxyapatiteThe stuff your enamel is made of, as a toothpaste without fluoride. You choose it not because fluoride fails, but because fluoride builds up somewhere you would rather it did not.Read on
How to use it
As your daily toothpaste, twice a day, in place of your fluoride paste. Not alongside it and not alternating: then you know what neither of them is doing.
The best version
A paste that names hydroxyapatite as a main ingredient and gives a percentage. If it only says "with hydroxyapatite" and no number, you are buying a claim.
How to prepare it
Brush and spit, do not rinse. Rinsing washes the paste away before it has done anything, and that holds for fluoride just as much.
What it does
You give nothing up for it. In an eighteen-month double-blinded trial in adults, a fluoride-free hydroxyapatite paste was compared with a paste containing 1450 ppm sodium fluoride. In 89.3 percent of the hydroxyapatite group no new decay or filling appeared at all, against 87.4 percent in the fluoride group. That gap was small enough to call the paste not inferior.
The reason to want an alternative is where fluoride ends up. In eleven aged cadavers the pineal gland was measured, the gland that makes your melatonin: it held 297 mg of fluoride per kilo, against 0.5 mg per kilo in muscle from the same body. The fluoride in that gland tracked the calcium in it, and its fluoride to calcium ratio was higher than in bone.
Luke J. Fluoride deposition in the aged human pineal gland. Caries Research, 2001.
Watch out
That study shows it accumulates, not that you notice anything. No human study links calcification of the pineal gland to worse sleep or to less melatonin because of fluoride. This is a good reason to want an alternative and not proven harm.
Four of the authors of the toothpaste trial work for the company that makes the tested paste. That does not make the result untrue, and it does mean more than one independent trial is needed before this is settled.
It is one trial, in adults, over eighteen months. Fluoride has decades of research behind it. If you get a lot of decay or you are at raised risk, this is a conversation with your dentist rather than a choice in an aisle.
Oil pullingA spoonful of coconut oil pulled through your teeth. Against the rinse a dentist prescribes it held its own, and it does not stain.Read on
How to use it
A spoonful of coconut oil in your mouth, let it melt, pull it through and between your teeth for a few minutes, and spit it out. Then brush.
The best version
Virgin, cold pressed, unrefined coconut oil. There is nothing else to look for, and an expensive jar with a label on it does nothing extra in your mouth.
How to prepare it
Spit it into the bin and not the sink, because coconut oil sets as soon as it cools and your drain is cold.
What it does
Twenty-nine people rinsed for four days with coconut oil and four days with 0.2 percent chlorhexidine, with a washout in between. Plaque came back to the same degree, 1.67 against 1.61, and the coconut oil stained the teeth less: 0.21 against 0.47.
Watch out
This does not replace your toothbrush and it is not a treatment for gum disease. What was measured is plaque over four days in twenty-nine people.
Everything sold alongside it about pulling toxins out of your body is invented. What you spit out is oil with bacteria in it, and that is reason enough to do it.
XylitolA sweetener the bacteria cannot digest. The evidence is real, and it is weaker than the packaging suggests.Read on
How to use it
As gum or a lozenge after eating, or as xylitol in your toothpaste. Not as a sugar substitute in your coffee: that is not what it was tested for and not where the point is.
The best version
Gum with xylitol as the first ingredient and no other sweeteners alongside it. Or a fluoride toothpaste with xylitol in it, because that combination is what the best evidence is about.
How to prepare it
After eating, chew for a few minutes. The chewing itself does something too: it makes saliva, and saliva is your own rinse.
What it does
The clearest result in the Cochrane review is about toothpaste. A fluoride paste with 10 percent xylitol gave 13 percent less decay over two and a half to three years than the same paste without it, across 4216 children.
Watch out
Cochrane calls that evidence low quality itself, and it comes from two studies by the same authors in the same population. Of the 10 included studies with 5903 participants between them, one was at low risk of bias and seven were at high risk.
Riley P, et al. Cochrane Database of Systematic Reviews, 2015.
For lozenges, sucking tablets and wipes the evidence was too weak to say anything, and in adults there is only one study. The adverse effects reported were cramps, bloating, flatulence and loose stool.
Riley P, et al. Cochrane Database of Systematic Reviews, 2015.
Xylitol is toxic to dogs, even in small amounts. Do not leave your gum lying around.