Q. I see so many toothpaste and mouthwash products on store shelves. Do any of them really protect me against gum disease?
A. Brushing and flossing, plus getting regular cleanings, are critical to preventing gingivitis, an early stage of gum disease linked to bacteria in the mouth that can cause red, swollen, and bleeding gums.
The toothpaste that you buy should contain fluoride, which helps prevent cavities by several mechanisms, including remineralizing tooth enamel so it can be more resistant to the acid produced by decay-causing bacteria. Toothpastes with higher fluoride concentrations are also available by prescription from your dentist, if needed.
Newer toothpastes on drug store shelves contain an ingredient called stannous fluoride, which can help reduce plaque (the soft, sticky film on your teeth that can lead to cavities and gum disease). Some brands with this ingredient include: Crest ProHealth Advanced Extra Gum Protection, Crest ProHealth Clinical Plaque Control, and Parodontax. But stannous fluoride has the potential to stain teeth, so those products also contain scrubbing and whitening ingredients.
Triclosan, an antimicrobial agent in Colgate Total, has been found to be particularly effective against plaque, but it has also been linked to hormonal changes in animals and may be contributing to the development of antibiotic resistance.
According to the American Dental Association, at least part of the anti-plaque effect comes simply from the mechanical action of brushing and the cleaning power of toothpastes that contain mild abrasives.
What about mouthwash?
Likewise, some mouthwashes contain ingredients that kill bacteria, inhibit plaque formation, and thus help protect against gingivitis. If you have periodontal disease, your dentist may prescribe a rinse with chlorhexidine (such as Peridex or Perioguard), which is most effective against plaque.
“I don’t recommend using chlorhexidine long term, however,” cautions Mazen Natour, D.M.D., a Manhattan-based prosthodontist and a clinical professor at New York University College of Dentistry. “We typically prescribe chlorhexidine mouth rinses for one week prior to dental implant surgery and two weeks after. If you use them for longer than that, you may stain your teeth permanently.” Chlorhexidine can also temporarily impair tastebuds.
If you have a lot of plaque buildup or gum inflammation between cleanings, your dentist may recommend an over-the-counter rinse. Crest Pro-Health Multiprotection CPC Antigingivitis/Antiplaque Mouthwash and Colgate Total Gum Health both contain cetylpyridinium chloride 0.075 percent, a safe alternative to chlorhexidine.
The bottom line
Whether you choose to use over-the-counter products to try and prevent gingivitis or not — and Natour says those OTC products can be used on a regular basis — the game changes if your gums should bleed. In that case, you should always see a dentist as soon as possible.
“Bleeding gums indicate you have inflammation in your mouth, and it may not be because of gingivitis,” he says. “It could be caused by periodontitis [gum infection]. By using a toothpaste or a rinse instead of seeing a dentist, the problem could become more severe.” In fact, you could lose a tooth, he warns.