Concerned about gum disease, Gerald Dageford decided to try an anti-tartar toothpaste. Within days, his gums bled and his teeth ached. When he stopped using the toothpaste, his painful symptoms disappeared.
Dentists say Dageford's problem isn't unusual. His dentist sees one patient a week with similar ailments. "We used to see more cases," said Torrance dentist Alan Jones. "But we've taken most of our patients off the toothpaste."
Though the toothpastes have been around for six years, dentists are just now starting to link them to otherwise unexplained ulcers and toothaches that patients experience. Supporting these clinical observations is research at UCLA that shows that one person in 20 develops adverse reactions. What's more, the U.S. Food and Drug Administration has questioned the claims of anti-tartar toothpaste makers.
These developments are threatening to take a bite from the nation's $1-billion toothpaste business.
The anti-tartar toothpastes are important to Procter & Gamble Co., Colgate-Palmolive Co. and other toothpaste makers. When introduced in 1985 as a weapon against gum disease, anti-tartar toothpastes were an overnight success. Snapped up by aging baby boomers worried about their teeth, the anti-tartar formulas account for nearly one-third of all toothpaste sales.
Until the products came along, toothpaste sales stagnated due to a steep drop in cavities among the nation's children. "Cavities have gone the way of polio," said Cornelia Stanek, an analyst with Kline & Co., a Fairfield, N.J., consumer products research firm. "The big growth area of the 1990s is gum disease."
Indeed, gum disease is the common cold of dentistry. According to the government-run National Institute of Dental Research, about 80% of adults have it. Infected with bacteria, gums bleed and separate from teeth. Severe gum disease may cause teeth to fall out.
The nation's leading toothpaste makers, Procter & Gamble and Colgate-Palmolive, say they've received few complaints about the toothpastes, although some consumers have noted a "hot mouth" sensation. Procter & Gamble is critical of the UCLA study. It says it has received just one telephone complaint about its Tartar Control Crest for every 2 million tubes sold. Nonetheless, Colgate-Palmolive recently changed the formula of Anti-Tartar Colgate, significantly reducing the amount of the suspected irritant--a tartar-fighting salt called pyrophosphate. Colgate says it made the change mostly to improve taste.
The anti-tartar toothpastes appeal to such people as Dageford, who bought Tartar Control Crest after a bout with gum disease. Like Dageford, some people end up with new gum problems. "Patients complain, 'My mouth is killing me. Could it be the tartar control?' Often it is," said Peter Jacobsen, an associate professor of oral medicine at University of the Pacific.
The question, for some people at least, is whether the discomfort is worth it. As disease fighters, experts say, anti-tartar toothpastes fall short. They prevent build-up of yellowish tartar above the gums, where it's mostly a cosmetic problem. But the toothpastes don't block tartar accumulation below the gums, where it can lead to health problems. The toothpastes can't brush away old tartar either.
Even with these shortcomings, the toothpastes are useful, some dentists say. With tartar under control, "teeth cleanings are easier for the hygienist and more comfortable for the patient," said Kenneth Berrell of the American Dental Assn.'s Council on Dental Therapeutics. Berrell said, however, that it is the official position of the council that the toothpastes "do not inhibit the disease process."
The FDA is reviewing the accuracy of anti-tartar claims but said the process will take at least a year. At the same time, it is examining Colgate's claim that its toothpaste also fights plaque, the sticky, bacteria-laden film responsible for gum disease. Procter & Gamble dropped its plaque claim two years ago. The manufacturers are confident their claims will be approved by the FDA.
The FDA will also take a look at reports of adverse reactions, a spokeswoman for the agency said.
Dentists say adverse reactions seem to have increased in the last two years, as the anti-tartar wars heated up. Vying for supremacy as a tartar fighter, Colgate put a chemical booster in its toothpaste that raised the tartar-busting power of pyrophosphate. Not to be outdone, Procter & Gamble put more pyrophosphate in its toothpaste, increasing the percentage to 5% from 3.3%.
Pyrophosphate hasn't been closely studied outside the companies and hasn't been reviewed by the FDA. But researchers think that mouth sores and other inflammations are allergic reactions to the pyrophosphate or to flavorings added to mask the compound's salty flavor. UCLA associate dentistry professor Gerald Kowitz said another complaint--a painful sensitivity to hot and cold--appears linked to pyrophosphate.
This kind of toothache is especially threatening to toothpaste makers because it strikes people with exposed roots, who tend to be older and make up the prime market for anti-tartar products. Kowitz said the pyrophosphate appears to dissolve a protective film that covers the roots, making them sensitive to hot and cold.
In January, Colgate reduced its pyrophosphate formula to 1.2%, but Procter & Gamble has maintained Crest's higher pyrophosphate level. "P&G; has been hit with oodles of complaints," said Kowitz, a specialist on toothpaste formulations. A Procter & Gamble spokeswoman denied it.
The number of people affected by the toothpastes is a matter of scientific dispute. In testimony before the Council on Dental Therapeutics several years ago, manufacturers said the anti-tartars caused reactions in one person out of every 100, said Jacobsen, a former council chairman. (The manufacturers would not disclose their reaction rates). Regular toothpaste produces reactions in one person out of every 200.
Independent research suggests that the reaction rate is higher. A 1987 field study at Clinical Research Associates in Provo, Utah, found that one person in 20 experienced a wide range of side effects, including mouth ulcers and an unusual sensitivity to hot and cold beverages. A few people reported "a strange reaction--a feeling that their teeth were on edge, like they just sucked a lemon," said Rella Christiansen, Clinical Research director.
When people stopped using the toothpastes, Christiansen said, the symptoms cleared up.