Think of toothpaste as an adjunct.
Toothpaste that's been formulated with xylitol can play a role in helping a person to reach their needed daily dosing. But, as we discuss below, it probably doesn't provide create as great an exposure as other types of products.
This general assumption is confirmed by the work of Lif Holgerson (2006). This study compared subjects following their use of xylitol-sweetened chewing gum, tablets, candy, mouth rinse, and toothpaste. It was found that toothpaste produced the lowest overall oral exposure.
In defense of the use of toothpaste, however, Jannesson (2002) found that over a six month time frame using just a 10% toothpaste did reduce the levels of cavity-forming bacteria in test subjects' saliva and plaque.
Look for toothpaste products that have a xylitol content of 25% or more.
Our search for quality products.
We performed a web search as a way of identifying some of the different brands xylitol toothpastes that a consumer will find available. The stated amount on these products ranged from a high of 36% (Squiggle's Enamel Saver Toothpaste) down to 10%. We also encountered a number of products that did not document a specific content level.
How a toothpaste's content is calculated.
In regards to toothpaste labeling, xylitol percentages are calculated on a "by weight" basis. Using just a little bit of math, it's easy to figure out that a four-ounce tube of toothpaste that has a 10% concentration will contain about .4 ounces of xylitol. This is on the order of 11 grams. Of course, the important question isn't how much xylitol is in the toothpaste tube but rather how much dosing you get with each brushing.
Calculating what your per-brushing exposure is.
Figuring this out isn't quite so easy, primarily because the amount of toothpaste each person uses varies. When fluoride toothpaste is used, the dental community has always suggested that a pea-sized dab of toothpaste is sufficient (much less than most advertisements typically show). Depending on what your impression is in regard to the size of a pea, this amount might run on the order of .4 to maybe .8 grams of toothpaste. For the sake of argument, let's consider the larger amount.
If a person uses the toothpaste that has the highest percentage of xylitol that we found (36%), then with each brushing they might receive a xylitol exposure on the order of .3 grams. That's not a whole lot. And you're going to need other sources in order to meet your optimal daily xylitol requirement. But as mentioned above, just using xylitol toothpaste alone has been shown to provide some benefit.
The toothpaste products we found.
Let us get this rant off our chest first.
We find it somewhat insulting that some companies make a xylitol claim for their toothpaste but do not back it up by stating a percent concentration. Many times this lack of documentation is related to the fact that the product contains such a small amount of xylitol that the company doesn't want a consumer to be able to make an easy comparison with other products.
Our opinion is that companies that clearly state their toothpaste's xylitol content should be rewarded by way of consumers purchasing their products, the others should be avoided. That's because customers need adequate information about the products they buy, so they can make an informed decision regarding their use.
Here's a listing of toothpaste products that we found available via our web search. We display this information here simply to demonstrate the different levels of content that we found being offered.
This list is not all-inclusive. There very well may be other products on the market that do have high concentrations of xylitol but either we did not find them or could not document their exact level. If you know of any well documented products, please leave a comment below.
|Toothpaste Brand||Xylitol Content|
|Squigle Enamel Saver Toothpaste||36%|
|Epic Fluoride & Xylitol Toothpaste||31%|
|Branam All-Natural Toothpaste||30%|
|Branam Baby and Toddler Tooth Gel||30%|
|NOW Xyliwhite Toothpaste (Gel)||25%|
|Dr. Collins All White Toothpaste||25%|
|Xlear Spry Cinnamon Toothpaste||25%|
|CariFree CTx3 Gel||25%|
|CariFree CTx4 Gel (contains fluoride)||25%|
|Natural Dentist Health Teeth & Gums Toothpaste||10%|
How to estimate the relative xylitol content of toothpastes.
During our research, we took the time to compare the stated xylitol content of each toothpaste with its list of ingredients.
Example #1: A toothpaste with expected high xylitol content.
With xylitol listed first, this toothpaste should make a good choice.
As you probably already know, the items found in an ingredient list are stated in decreasing order. This suggests that those toothpastes with comparatively higher xylitol content will be those where xylitol is listed closer to the beginning of the list.
This is exactly what we found. The majority of the higher-concentration products (25 to 36%) showed xylitol (or water and then xylitol) first. (Like in Example #1.)
Example #2: A toothpaste with expected moderate xylitol content.
The lower positioning of xylitol in this paste's list suggests that it contains a comparatively lower concentration of it.
In comparison, and as expected, the lower-concentration toothpaste (10%) we found had xylitol listed further down the line.
(Like shown in Example #2.)
Example #3: A toothpaste with expected low xylitol content.
The fact that xylitol is listed low in this list, and well below sorbitol (another sweetener), suggests that this toothpaste makes a worse choice than our other examples.
This last example illustrates what might be considered to be a low-quality product.
Imagine a toothpaste product that states it has xylitol in it, yet its packaging contains no numeric documentation of this fact. Then, when you look at the ingredient list, you see something like in Example #3.
Notice that xylitol is way down in the list. And even worse, it's preceded by another sweetener (sorbitol).
As the pages of our site discuss, the usual reason sorbitol is used in a product, instead of just 100% xylitol, is related to the fact that it is less expensive. The scenario we describe here would suggest that this manufacturer is not serious about making a quality xylitol product.
A word of caution.
Both xylitol and fluoride use can help to prevent cavities. And since each works via a different mechanism, when used appropriately, a person can benefit from both. Toward this goal, some manufacturers include both in the formulation of their toothpaste.
Parents of children need to be aware of the fact that the ingestion of excessive levels of fluoride can lead to dental fluorosis (children often swallow toothpaste rather than spit it out). The most common outcome of this condition displays itself as spotchy-white areas on a child's permanent teeth.
Take note of what you buy. And if the xylitol toothpaste you choose contains fluoride too, you'll need to ask your dentist for guidance in determining when its use is appropriate for your child.