Chocolate Lovers Find New Reason to Embrace Home Care

New toothpaste substitutes cocoa extract for fluoride

A New Orleans start-up has developed a toothpaste that uses a naturally occurring compound found in cocoa instead of fluoride to help strengthen teeth.

Theodent relies on Rennou, a proprietary blend of a cocoa extract and other minerals that work together to strengthen teeth. The extract is a white crystalline powder with a chemical makeup similar to caffeine, according to Arman Sadeghpour, PhD, Theodent president and CEO.

Theodent Classic and Theodent 300 toothpaste, both

of which use a cocoa extract in place of fluoride. 

Theodent Classic ($9.99) hit store shelves at Whole Foods Markets last week. Theodent 300, an extra-strength and luxury version ($99.99) for supersensitive teeth, will be marketed to select cosmetic dentists and medical professionals, according to the company."Theodent is more effective at strengthening enamel than fluoride," he said in an interview with DrBicuspid.com."More and more people are shying away from fluoride due to concerns about toxicity."

Rennou was discovered by Tetsuo Nakamoto DDS, PhD, chief scientific officer and chairman of the board at Theodent, while researching the effect of caffeine on teeth at the Louisiana State University (LSU) School of Dentistry. Dr. Nakamoto collaborated with two experts in analytical geology from the University of New Orleans, and together they discovered Rennou's effects on teeth and enamel.

How it works

Enamel is made up hundreds of thousands of calcium and phosphorus unit crystals that form the mineral component of enamel, hydroxyapatite. Through a series of laboratory tests, Dr. Nakamoto's team identified that Rennou increases the size of the surface unit crystals of enamel by four times. Larger unit crystals make teeth less susceptible to bacterial acid demineralization.

Sadeghpour joined this scientific team and completed his doctoral thesis at Tulane University by comparing Rennou head to head with fluoride and confirmed that it was more effective than fluoride at strengthening teeth.

He used a neural network analysis model to study the effect of Rennou versus fluoride on the enamel surface of human teeth. Two experiments were performed for the study: the first examining enamel surface microhardness, followed by an acid dissolution study.

Through this research, Sadeghpour found that human teeth treated with varying doses of Rennou were generally stronger than those treated with fluoride and also more resilient to bacterial acid demineralization. His research became the foundation of taking this discovery and turning it into a product.

After Sadeghpour finished his doctoral thesis, Tulane University did a small press release on the findings. He then received a call from Clifton Carey, PhD, director of independent research at the ADA, who then independently studied Rennou.

In his research, Carey took initial radiographs of teeth before placing them in distilled water, fluoride, or Rennou for two minutes, Sadeghpour explained. He then subjected these teeth to an acid attack (1% citric acid at a pH of 3.9) for 10 minutes and measured how many microns of enamel were lost.

Carey found that the tooth in distilled water lost 8.88 microns, the one in fluoride lost 5.47 microns, and Rennou beat both fluoride and control group with 3.12 microns of erosion.

That in itself was interesting, according to Sadeghpour. But he also was intrigued that the concentration of Rennou used in the study was very small compared with the concentration of fluoride.

30 years of research

Rennou has also been studied by researchers from Tulane University, the University of New Orleans, Marmara University Dental School in Turkey, the University of Groningen's Faculty of Medical Sciences Department of Dentistry and Dental Hygiene in the Netherlands, the University of Texas at San Antonio, and the ADA.

"Theodent is the culmination of 30 years of research, and its effectiveness has been verified by two issued U.S. patents and a third worldwide patent pending," Sadeghpour said.

Theodent has a minty taste, is nontoxic, and safe for adults and children of all ages, according to the company. The developers hope to expand the product line to include dental floss, mouthwash, and a chocolate-flavored, sugar-free toothpaste for children.

It is now commercially available in 20 U.S. states -- Arizona, Arkansas, California, Connecticut, Hawaii, Illinois, Indiana, Louisiana, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, Oklahoma, Oregon, Texas, Washington, and Wisconsin -- as well as in Canada in Ontario and British Columbia.

At a January 4 press conference announcing Theodent, Henry Gremillion, DDS, dean of the dental school at LSU, called the new toothpaste a "major step forward in oral health maintenance and prevention."

The Fight Against Cavities: Is Fluoride Winning the Battle?

New study reveals how bacteria fight fluoride

Researchers from Yale University have uncovered the molecular "tricks" used by bacteria to fight the effects of fluoride (Science, December 22, 2011).

The researchers found that sections of RNA messages called riboswitches -- which control the expression of genes -- detect the buildup of fluoride and activate the defenses of bacteria, including those that contribute to tooth decay.

"These riboswitches are detectors made specifically to see fluoride," stated senior study author Ronald Breaker, PhD, chair of the department of molecular, cellular, and developmental biology, in a press release.

Fluoride in over-the-counter and prescription toothpastes is widely credited with the large reduction in dental cavities, which is largely caused by fluoride bonding to the enamel of teeth. However, it has been known for many decades that fluoride at high concentrations also is toxic to bacteria, causing some researchers to propose that this antibacterial activity also may help prevent cavities.

The riboswitches work to counteract fluoride's effect on bacteria.

"If fluoride builds up to toxic levels in the cell, a fluoride riboswitch grabs the fluoride and then turns on genes that can overcome its effects," Breaker said.  "Since both fluoride and some RNA sensor molecules are negatively charged, they should not be able to bind," he noted.

"We were stunned when we uncovered fluoride-sensing riboswitches" Breaker said. "Scientists would argue that RNA is the worst molecule to use as a sensor for fluoride, and yet we have found more than 2,000 of these strange RNAs in many organisms."

The new findings from Yale only reveal how microbes overcome fluoride toxicity. The means by which humans contend with high fluoride levels remains unknown, Breaker noted. The use of fluoride has had clear benefits for dental health and that these new findings do not indicate that fluoride is unsafe as currently used, he added.

Whitening Toothbrush Maker Responds to Criticism

J&J to Modify Some Toothbrush Whitening Claims

September 9, 2011 -- The National Advertising Division (NAD) of the Council of Better Business Bureaus has recommended that Johnson & Johnson Healthcare Products modify certain claims for its Reach Total Care + Whitening toothbrush to clarify that the brush whitens teeth through the abrasive action rather than through bleaching.

As part of its routine monitoring program, NAD -- the advertising industry's self-regulatory forum -- requested substantiation for express claims that included the following:

• "Ordinary toothbrushes clean teeth. Reach whitens them."
• "At the core of this revolutionary toothbrush Reach has engineered a unique row of bristles infused with calcium carbonate microwhitening technology. That means each time you brush, you're whitening teeth and removing stains.*" (*in lab tests)

NAD also examined the implied claim that the Reach Total Care + Whitening toothbrush has been proven to actually whiten teeth when used in the same manner as an ordinary toothbrush.

According to Johnson & Johnson, the toothbrush, launched in 2010, was designed with bristles embedded with calcium carbonate, recognized by the U.S. Food and Drug Administration as an abrasive used in fluoride toothpastes.

In support of its claims, Johnson & Johnson provided NAD with evidence that demonstrated that bristles infused with calcium carbonate do, in fact, provide statistically significantly better stain removal than brushes with ordinary bristles. The company also provided testing to demonstrate that its advertised toothbrush provided significantly better plaque removal than the other two ordinary toothbrushes tested. In addition, Johnson & Johnson's evidence demonstrated that the difference in whitening and stain removal was meaningful to consumers, according to NAD.

Following its review of evidence, NAD determined that Johnson & Johnson could support the claim that "[o]rdinary toothbrushes clean teeth. Reach whitens them."

However, NAD recommended that the company modify the claims "whitens and removes stains" and "each time you brush you're whitening and removing stains" to ensure that consumers are aware that stain removal is accomplished extrinsically, through the stain-removing abrasive action of the bristles, not intrinsically through bleaching.

According to NAD, Johnson & Johnson said it is disappointed with the NAD recommendation, "given the industry practice of making unqualified whitening claims based on data showing extrinsic whitening only. Nevertheless, we understand NAD's recommendations and will take them into consideration in future advertising."

      - Dr. Green's sidenote


Patients often ask me for product recommendations (the best toothpaste, toothbrush, etc.) that they can use at home.   We evaluate 100s of products every year to make these recommendations.  Johnson & Johnson is one of the leading manufacturers of these at-home products and to be fair, I will say that the vast majority of their products are excellent and safe.  By posting this article I am in no way suggesting to my readers that they should ban J&J products from their household.  The objective of this post is to educate my readers on the potential dangers of store-bought whitening products.
When I recommend any product to my patients, I always consider it's method of action (how it does what the manufacturer claims it does).  With whitening toothpaste or toothbrushes the method of action usually involves the removal of surface staining rather than through the whitening of the tooth enamel (which is how whitening solutions and gels work).  This is accomplished through the use of coarse abrasives, not whitening solutions.

The best analogy I can use would be to compare toothbrushing to sanding a piece of wood.  In order to take raw wood from being splintery and rough to a smooth surface that's ready to stain, a carpenter will start with a fairly coarse grit of sandpaper and use progressively finer grits until the board is smooth.  When you brush your teeth you are basically doing the same thing-you use a toothbrush and toothpaste containing a minty abrasive to remove the plaque and food debris from your teeth.  I always recommend the use of a soft or ultra-soft bristled toothbrush and a traditional toothpaste (non-whitening and non-tartar control) for my patients.  This will do more than enough to clean your teeth on a daily basis - without damaging or removing the protective enamel.  If you have issues with stain accumulation related to heavy coffee consumption, smoking or drinking colas or red wines, that's where we come in.

Regular visits to a dental hygienist are always essential to maintaining optimum dental health, especially if you accumulate stain easily!