With grocery list in hand, organized by aisle, you are on top of your game.

Suddenly life and shopping cart screech to a halt and your eyes glaze over in a dull stupor-you've just reached The Toothpaste Aisle.
It's hypnotic. It's overwhelming.

Gone are the days of "running in for a tube of toothpaste." Chances are it's not even in a tube anymore.

Toothpaste now contains ingredients in several dizzying combinations for tartar control, staining, breath freshening, cavity protection, gum health, sensitivity—in gels, creams, pastes, flavors, stripes.all in the same formula.or.not.

They also contain whiteners and brighteners-from bleach to abrasives-(and serious advertising dollars) that challenge your enamel and your common sense.

What do we really need?

Approval from the American Dental Association, for starters, says Richard Bebermeyer, DDS, professor and vice-chair of restorative dentistry and biomaterials at The University of Texas Dental Branch at Houston. So, look for the seal of approval, regardless of your preference.

"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.

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. Dying bacteria produce odor, and plaque produces acids, which cause dental decay when you eat carbohydrates. Bacteria and plaque deliver the one-two punch that leads to tooth decay and gum disease.

Fluoride, the Hero

One of the essential ingredients that should be in toothpaste is fluoride, the most effective anti-cavity treatment today.

"Children and adults need fluoride in their toothpaste. That is one key point," Bebermeyer says. "Fluoride found in saliva will absorb on to the surface of a tooth where tooth decay has begun to form and will re-mineralize the teeth. So you could say it hardens the teeth. For this process to occur, the fluoride must be present in saliva."

Binds and Bonds

One of the most exciting developments in toothpaste is the addition of co-polymers that help fluoride and anti-plaque agents bind to the teeth for up to 12 hours. The co-polymers provide long-acting protection, helping the fluoride decrease the rate that bacteria (which live in dental plaque) can produce acid, the dentist says. Colgate Total is one such toothpaste.

Pearly Whites or Scratched Enamel?

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

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.

Most of the ADA-approved whitening toothpastes contain low-abrasive materials, while some off-brand toothpastes contain high-abrasive materials.

"In general it is not good to use highly abrasive toothpaste for a long period of time nor use a hard toothbrush because you can wear away tooth structures, particularly at the gum line," he says.

If you have porcelain veneers, steer clear of abrasives since they can scratch the surfaces. It's no different than 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 who have some types of cosmetic dentistry. And bleaching chemicals do not lighten artificial veneers.

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 brushing 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 problem.

"Certainly it doesn't hurt people to pick up one of these desensitizing toothpastes," Bebermeyer says.

Typically they are low abrasion and have one or another chemical that helps to relieve pain. "There is not strong evidence for major pain relief," he says, but desensitizing pastes do seem to help some people, particularly those whose roots are exposed or those with gum disease.

The Tartar-Control Blues

In some rare cases, toothpastes have created problems. Pyrophosphate, a common ingredient in tartar-control toothpastes, has been linked to a minor gum problem, such as sloughing where the top layer of skin on the gums peels like a sunburn.

"If people notice gum problems that may arise from chemicals in toothpaste, they should consult their dentist," Bebermeyer says.

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."

Proper daily care should clear out the sediments of gunk in your mouth. The procedure is simple: two to three times each day-particularly after eating-floss and brush. 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 each tube of toothpaste.

UPDATED: 4-20-2004

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