Gone are the simple days of just “running in for a tube of toothpaste.” Miles of aisles of mind-numbing choices now stand between you and the simple days.

Today, toothpaste contains ingredients in a dizzying array of combinations to address tartar control, stain removal, breath freshening, cavity protection, gum health, gingivitis prevention, sensitivity reduction—all in the same tube—in gels, creams, and pastes, with flavors and stripes that have whiteners and brighteners, from bleaches to abrasives—and serious advertising dollars—challenging both your enamel and your common sense.

So, what do we really need? For a start, a mark of approval from the American Dental Association (ADA), says Richard Bebermeyer, DDS, MBA, A retired professor and former chairman of restorative dentistry and biomaterials at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry.

“The ADA uses committees made up of dentists and other scientists who evaluate all aspects of toothpaste and dentifrices [preparations for cleaning and polishing teeth], rank them and give approval to the best,” he says.

Donna Warren Morris, a registered dental hygienist and professor at the UTHealth School of Dentistry agrees. She recommends looking for the ADA’s Seal of Acceptance first and then considering your individual needs and preferences.

“It is important to know that ‘off-brand’ or ‘store-brand’ dental products and products manufactured in other countries may not have the same therapeutic results as those approved by the ADA and the US Food and Drug Administration (FDA),” she says. “All toothpastes made in the United States must be FDA-tested for safety and assurance that they are not too abrasive.”

What lurks inside

If you are one of the rare individuals wondering why you should bother with regular brushing, the answer is simple: brush your teeth “only if you want to keep them,” Bebermeyer says.

Each day plaque, which consists of bacteria and other debris, builds up on the teeth. Plaque bacteria produce acids which cause dental decay and deliver the one-two punch that leads to bad breath, tooth decay and gum disease.

“Dental decay is a simple process that many people do not understand,” Warren-Morris says. “It occurs when more calcium leaves the tooth than is replenished back into the tooth. Any form of acid, whether from foods such as soft drinks, or the plaque bacteria on the teeth leeches calcium from the teeth.”

Fluoride and calcium, the heroes

Calcium plays a vital role in tooth health—as does fluoride. Together they make a great team.

Fluoride is the most effective anti-cavity treatment today and one of the essential ingredients that should be in toothpaste.

“Both children and adults need fluoride in their toothpaste,” Bebermeyer emphasizes. “Fluoride found in saliva will absorb onto the surface of a tooth where tooth decay has begun to form and will remineralize the tooth. So you could say it hardens the teeth.”

To make fluoride even more effective at preventing cavities, calcium also should be present either as an ingredient in toothpaste or from the foods we eat.

“People tend to think that fluoride alone is responsible for preventing dental decay, but it [fluoride’s efficacy] is dependent on calcium availability,” Warren-Morris explains. “Fluoride prevents decay by chemically bonding to calcium, holding it in the tooth and attracting it from the mouth into the tooth to replace what was lost. The entire tooth can remineralize itself, taking in calcium from the diet or from toothpastes, as long as no cavity has already formed.”

Binds and bonds

Several years ago, an exciting development in toothpaste was the addition of copolymers that help fluoride and anti-plaque agents bind to the teeth for up to 12 hours. Copolymers provide long-acting protection, helping the fluoride decrease the rate at which bacteria [which live in dental plaque] can produce acid, Bebermeyer explains. Colgate Total® is one of many types of toothpaste on the market now that contain co-polymers.

Other relatively recent innovations in the dental- care world are products containing NovaMin, Recaldent and amorphous calcium phosphate (ACP), which help remineralize the tooth’s structure through delivery of calcium and phosphate.

Because saliva neutralizes acids and provides sources of calcium to the teeth for remineralization, these products are especially helpful for patients who have difficulty producing saliva or have other special needs, Warren-Morris explains.

“Many people are deficient in oral calcium reserves due to their diet, or perhaps they have insufficient saliva due to medications, systemic conditions or aging.”

These highly concentrated calcium products can be purchased through your dentist or at the UTHealth School of Dentistry Bookstore (713-486-4450) at a reduced cost. 

Some over-the-counter (OTC) chewing gums, mouth rinses and toothpastes contain calcium products as well, Warren-Morris says. Look at the ingredients and choose one with Recaldent or NovaMin, which contain ACP.

‘Pearly white’ in a tube?

Whitening toothpaste may help a little, Bebermeyer says, but there is no strong research that shows whitening toothpastes create any major dazzle.

Whitening toothpastes generally remove only the extrinsic or surface stains—those caused by tobacco, coffee, red wine, etc. “Intrinsic, through-and-through staining, such as tetracycline stains, require a dentist’s help,” Bebermeyer adds.

Warren-Morris adds that to whiten or bleach the teeth to any significant degree, the hydrogen or carbamide peroxide concentration has to be much higher than can be found in whitening toothpastes. However, Whitening toothpastes can often cause tooth sensitivity too, she says.

Easy does it

Most of the ADA-approved whitening toothpastes contain low-abrasive materials, whereas some off-brand toothpastes contain high-abrasive materials. “In general, it is not good to use highly abrasive toothpaste or a hard toothbrush for a long time because you can wear away tooth structures, particularly at the gum line,” Bebermeyer says.

Warren-Morris also observes that certain ingredients in whitening toothpastes can lead to tooth sensitivity or allergic reactions in some people.

If you have porcelain veneers, steer clear of abrasives since they can scratch the surfaces—like rubbing sand against a porcelain tea cup. “Since brighteners are more abrasive than ‘regular’ toothpastes, those with porcelain or even composite [tooth-colored] restorations should probably avoid them,” Bebermeyer warns.

Other bleaching products such as strips and bleaching trays are not advised for persons with certain types of cosmetic dentistry or dental decay. Bleaching chemicals do not lighten veneers or composites and can actually harm them.

The best policy when it comes to brightening your smile is to check with your dentist before you use any bleaching product.

“You hurt my fillings.”

If you are one of those over-zealous scrubbers who in the past used a wire-hard toothbrush to scour away tooth grime (and tooth enamel and gum tissue), you might benefit from desensitizing toothpaste.

People whose teeth are sensitive when brushed should consult a dentist, Bebermeyer says. Sensitive teeth usually indicate other problems, such as gums pulling away from the teeth, decay on the root surfaces, or even a bite or occlusion problem.

“Certainly it doesn’t hurt people to pick up one of the desensitizing toothpastes,” Bebermeyer says. “Many people can experience relief from hypersensitivity within days of using desensitizing toothpaste,” Warren-Morris adds.

Typically, these products are low abrasion and have ingredients that help to relieve pain. “There is not strong evidence for major pain relief,” Bebermeyer notes, but desensitizing pastes do seem to help some people, particularly those with exposed roots or gum disease.

Instant relief from tooth sensitivity can be obtained from the application of fluoride varnish from a dental professional, Warren-Morris says. “The varnish reduces hypersensitivity via the fluoride as well as the resin ingredient it contains.”

The tartar-control blues

In some rare cases, toothpastes have created problems. Sodium pyrophosphate (the primary ingredient in tartar-control toothpastes) has been linked to a minor gum problem, sloughing, in which the top layer of skin on the gums peels like sunburned skin.

“Like whitening toothpaste ingredients, pyrophosphates can cause hypersensitivity in many people, especially those with gum recession,” Warren-Morris explains. “I have sensitive teeth and cannot use toothpaste with any whitening or tartar-control ingredients.”

Dermatologists also are reporting an increase in visits for dermatitis (irritation of the skin) around the mouth that is caused from toothpastes containing anti-tartar chemicals.

“If your mouth is getting sensitive or you’re seeing that your gums are red or sloughing, then check in with your dentist,” Bebermeyer advises.

Bad breath: cure or cover-up?

Countless toothpastes on the market now contain mouthwash. Think you’re getting a two-for-one benefit to freshen your breath and your teeth when you use them? Not so much, experts say.

“Cosmetic breath fresheners in most toothpastes and mouth rinses just cover odors temporarily,” Warren-Morris says but adds, “However, some products containing chlorine dioxide or essential oils actually reduce odor and bacteria, and there are clinical studies to demonstrate this.”

And when dealing with bad breath, remember that sometimes it’s a sign of a serious condition. It’s one thing to try to cancel out the garlic you exhale after spaghetti marinara or freshen classic morning breath from time to time. If you have a chronic breath problem, you need professional help. “People with chronic bad breath should see their dentist to determine if the odor is from periodontal disease (gum disease), dental decay, dry mouth or some other cause,” Warren-Morris says.

Tiny Teeth

Even an infant’s teeth need care. “Parents should begin cleaning the very first tooth to erupt in their baby’s mouth,” Warren-Morris says. “This is easily done without toothpaste using a soft clean washcloth prior to washing the baby’s face.”

When your child’s back teeth appear, it’s time to clean the teeth with a soft-bristled toothbrush. It takes time to learn to spit the toothpaste out and not swallow it. Be sure to use only a tiny amount of fluoridated toothpaste to prevent your child from ingesting too much paste.

“The little ones tend to swallow the toothpaste, since their swallowing reflex is not mature,” Warren-Morris explains, adding that there are toothpastes with half the amount of fluoride content designed for babies and children under 6. “If regular toothpaste is used with children under 6, use just a tiny “pea-sized” portion—not like the toothpaste commercials that show a long ribbon of paste! Or use one that’s nonfluoridated.”

Brush your child’s teeth twice a day—once in the morning and once before bed. It’s surprising to note, Warren-Morris says, that children generally need help with brushing their teeth until the ages of 8 or 9.

In 25 (okay, 60) words or less

Here’s oral hygiene in a nutshell: Proper daily care should clean the mouth adequately. Simply brush two to three times each day—within 20 minutes after eating if possible—and floss daily. Use a soft toothbrush and apply a pea-sized dot of toothpaste, any brand approved by the ADA. (Look for the ADA Seal of Acceptance on the tube of toothpaste.) And don’t forget those check-ups to keep problems from occurring—or at least to catch them early.

This article, which has been updated, originally appeared on HealthLEADER, an online wellness magazine produced by The University of Texas Health Science Center at Houston (UTHealth). Visit HealthLEADER for more articles on a broad array of health and wellness topics.