Buying a tube of natural toothpaste these days is a lot more complex than simply deciding between peppermint and cinnamon. Many customers stand perplexed before the oral care shelves trying to decide what's best—and in some cases what's what—among the array of products. By brushing up on common oral health concerns and product ingredients, retailers can help these customers determine what they need—and keep them coming back for more.

Oral Health
Periodontal disease, or gum disease, the main cause of tooth loss in adults, is an infection caused by bacteria that accumulate between the teeth and gums and affect both the gums and bone supporting the teeth. Gingivitis, the mildest form of the disease, causes tender, red gums that swell and bleed easily. Untreated gingivitis can advance to periodontal disease when plaque spreads below the gum line. Bacterial toxins irritate the gums and trigger a chronic inflammatory response leading to tissue and bone destruction. Gums then separate from the teeth and infections form in these pockets.

And oral infections don't necessarily stop at the mouth—periodontal bacteria can enter the bloodstream and travel beyond the mouth to major organs and begin new infections, according to the American Academy of Periodontology. This may contribute to heart disease and increase the risk of stroke, among other health risks. Genetics influences a person's predisposition to periodontal disease, but hormonal changes, stress and smoking are also risk factors.

Tooth decay is the second major oral health concern. It occurs when tooth enamel is destroyed by the acids produced by bacteria that live in the mouth and thrive on sugars and starches left on the teeth between meals or remain there because of ineffective cleaning.

Tools Of The Trade
Experts agree that a thorough brushing and flossing routine is the key to healthy teeth and gums.

"If you disorganize the plaque within a 24-hour period, you'll keep the incidence of tooth decay and periodontal disease to a pretty minimal level," says Dick Thom, D.D.S., N.D., of Natural Choices Health Clinic in Beaverton, Ore. He recommends that oral care routine tools should include a toothbrush, stimulator toothbrush (also called a sulcus brush), tongue cleaner and floss. A stimulator toothbrush has two rows of bristles and is typically used without toothpaste to massage the gums, which Thom says improves blood and lymphatic circulation, thereby removing waste products.

Toothbrush designs vary widely from the I-forgot-to-pack-my-toothbrush $2-specials to various ergonomically designed brushes, those with unique flexing capabilities and brushes with bristle differentiations only marketers can appreciate. Dentists agree that the right toothbrush is the one that gets used.

Kutztown, Pa.-based Radius Corp. offers toothbrushes with a wide head full of fine nylon bristles, and handles with thumb grips designed for right- or left-handed brushers. The handles—made of cellulose propionate, a wood-based natural plastic, 93 percent of which is derived from sustainable-yield forests in North Carolina—are wide and place the bristles at the American Dental Association-approved 45-degree angle with teeth.

Recycline Inc. of Somerville, Mass., is the only company to offer toothbrushes and tongue scrapers made from recycled plastics. The company's partnership with Stonyfield Farm of Londonderry, N.H., secures a reliable quantity and quality of plastic yogurt cups to make the 100 percent-recycled handles. (In a year and a half, more than 500,000 yogurt cups were turned into toothbrushes and tongue scrapers, says Matt Rogers, Recycline's sales and marketing manager.) All the brushes have extra-soft, virgin-nylon bristles.

When it comes to flosses and rinses, there is no shortage of choice. Infused flosses feature essential oils and enzymes that can help eliminate plaque, reduce tooth decay and freshen breath. Anti-inflammatory and antibacterial herbs, such as echinacea, goldenseal and tea tree, enhance mouth rinses. You may also see soothing aloe vera and astringent witch hazel in some rinses. Products with alcohol can be harsh and damage sensitive mouth tissues. Tom's of Maine offers a nonalcoholic rinse with witch hazel as an astringent. "Some of the alcohol mouthwashes on the market can be a pretty unpleasant experience for some people," says Kathleen Taggersell, corporate relationship development and communications team leader.

Toothpaste preference is a personal decision, and consumers are likely to be driven by flavor, texture and ingredient lineup. Many paste choices feature nonabrasive vegetable fibers or powders, such as peelu or bamboo, instead of sand, bone or chalk. Other common mild abrasive and cleansing ingredients include baking soda, silica and sea salts.

Congers, N.Y.-based Weleda offers a sea salt toothpaste. Christine Mack, the company's creative director, says, "The sea salt is going to work as far as polishing the teeth, and it is going to [promote salivation] and that's what actually cleans between the teeth and the gums."

In addition to fluoride, sodium lauryl sulfate is another toothpaste hot button. Researchers have shown that this foaming agent can damage sensitive mouth tissues. Mack says Weleda products don't contain sodium lauryl sulfate. "That is certainly something you shouldn't be swallowing," she says. "And the mouth is [extremely] absorbent of everything." She says the "from coconut oil" disclaimer used by many naturals manufacturers that use sodium lauryl sulfate is misleading. "It's not pure coconut oil; it's a chemical derived from that," she says.

Many natural toothpastes are saccharine- and sugar-free. Look for more pastes and rinses to include xylitol, a birch-derived sweetener that doesn't cause cavities. Essential oils and herbs do double duty by providing flavor as well as astringent, antibacterial and soothing effects. Weleda's blend includes spearmint, peppermint, licorice and fennel, Mack says.

Although mainstream marketers promote breath-freshening toothpastes, researchers have shown that 90 percent of bad breath is caused by bacteria on the tongue. Instead of using toothbrushes for this task, many dentists recommend scrapers and brushes to remove these bacteria from the tongue's crevices. These tools are less likely to trigger the gag reflex, and they're specifically designed to clean tongues, not teeth.

For Fluoride Or Against?
Whether fluoride should be added to toothpaste remains a controversial topic. Proponents of the naturally occurring mineral say it prevents tooth decay by making tooth enamel less susceptible to acid, by reducing plaque's ability to produce acid and by promoting enamel remineralization in damaged areas.

Opponents say the mineral is too toxic to be added to drinking water or dental products. They say serious health risks are associated with fluoride intake, including cancer, dental and skeletal fluorosis, and bone fractures.

But because so many consumers turn to fluoride for cavity protection, some naturals manufacturers offer toothpaste with and without. "Fluoride is a controversial ingredient in toothpaste," says Dakshina Vanzetti, president of Auromere Ayurvedic Imports in Lodi, Calif. "Despite its widespread use in mainstream toothpaste and endorsement by mainstream dentists and the ADA, there is strong evidence that the overabundance of fluoride in public water supplies and from sources such as toothpaste, supplements and foods prepared with fluoridated water can lead to a toxic condition known as fluorosis, which is evidenced by discolored, mottled, weakened teeth and loss of bone density." She says many consumers are looking for alternative dental products without fluoride. Auromere's line is fluoride free.

Tom's of Maine, however, offers both fluoride and fluoride-free toothpastes. "We want to give our consumers a choice; we feel it is their decision to make," Taggersell says.

Many natural dentists recommend avoiding toothpastes with fluoride, but Thom says the extremely small amounts people are exposed to from toothpaste aren't worth worrying about. "People are exposed to a lot of other additives in the food they eat [compared with] what they're getting in toothpaste," he says. "I'm more interested that they brush their teeth."

By offering a diverse selection of oral care products, and by being armed with information on their various ingredients and benefits, you can make sales from this part of the HABA section shine.

Dena Nishek is a Boulder, Colo.-based freelance writer and editor.

Natural Foods Merchandiser volume XXIV/number 3/p. 100, 102

Natural Foods Merchandiser volume XXIV/number 3/p. 102