Because of long experience in the dental profession I have witnessed tremendous swings in what is considered “common” or accepted knowledge. I actually participated in research in the mid 1970’s that suggested implants were not a practical replacement for missing teeth. In the early 1980’s new, “exciting” research told us that implants made with special materials would solve all of our missing tooth problems and that the implants would last forever. A few more years passed and lo and behold we found implants have some of the same problems as natural teeth and they could be lost in similar ways including peri-implantitis or gum disease around an implant. We currently accept that implants are a very useful procedure for the replacement of missing teeth but that they are not the panacea they were thought to be as our real knowledge was being developed.
The point of this preamble is, neither I nor the “experts” “know it all” despite our best efforts to do the right thing by and for our patients. So when someone brings a new topic, procedure or product to my attention I like to do some real if superficial research regarding those topics, procedures or products and to wear my scientist’s hat and keep an open and malleable mind.
The most recent surge in questions being posed to me is related to the efficacy and safety of activated charcoal in dentifrices being promoted and sold; do they work and are they safe? So rather than just “blowing smoke” or admitting, “Hell, I don’t know,” I did some research that I will share here.
Many dentists and dental hygienist have taken the stance of not backing any charcoal dentifrice and suggest staying away from them because we do not have the clinical evidence to confirm or deny claims. We don’t! However, in order to best serve our patients, it is prudent to become informed on what products are on the market and what our patients are using.
A literature review in Journal of the American Dental Association (January 2017) concluded that there is “insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence.” We were also advised to be “cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.” To an old country dentist like me this is absolutely a “cover your butt” statement by an organization that has probably been burned in the past by publishing strong opinions that were later proved to be wrong.
I am skeptical but curious about the trend and the claims of activated charcoal containing products. I want to adequately inform my patients about the proper use of the products if asked. While I may not personally use or even advocate the use of the product I do not want to just give a biased opinion without any real facts because some of my patients do use the product and I feel obligated to be able to discuss the subject knowledgably.
Let’s take a look at a few questions surrounding the use of activated charcoal.. What is it? How/why is it supposed to work? What are the expectations of the patient? What have they been using, and what changes do we see that have occurred in their mouth since the last visit? Different people can and will react differently to a product containing activated carbon just as they will with a regular toothpaste.
Activated charcoal is not the same as your BBQ briquettes. There seems to be various ways to create activated charcoal but they generally seem to require exposure of charcoal to some chemical such as a solution of calcium chloride for several hours and then filtering and drying the charcoal.
The substance created is able to adsorb toxins such as bacteria and stains. A medical dictionary states that “activated carbon is pure carbon specially processed to make it highly adsorbent of particles and gases” by increasing the surface areaecffsabuqsvsxwebuyswq available for adsorption.
At this point I need to point the difference between adsorption and absorption. Absorption is a reaction of elements which allows assimilation into the blood stream. Adsorption binds to a surface due to a negative electric charge, causing positive toxins to bond without internal resorption.
While activated carbon (charcoal) is mostly beneficial when taken internally, it can also reduce the absorption of different medications. The Mayo Clinic advises, “Certain medicines should not be used at or around the time of ingestion of charcoal since interactions may occur.” It is generally believed the small amount potentially ingested with toothpaste is unlikely to have any serious effects on the body or health in general.
We need to clarify a couple more definitions. At least for the purposes of this blog, whitening is the removal of surface stains vs. bleaching which changes the inherent color of teeth. Professional bleaching definitely has longer lasting effects. This may be one reason the dental industry is slow to embrace other whitening dentifrices.
Thus the long-lasting white smile that many people are looking for and that is being promised through advertising for activated charcoal can be misleading, however, for an individual who consumes coffee, tea, red wine, and other foods containing tannic acids its use can obtain positive outcomes. Sometimes activated carbon has been described as a “sponge,” that extracts the stains off of teeth. The use of activated carbon in a dentifrice is intended to be used as a day-to-day maintenance.
Some products are available that contain an ingredient that coats the tooth surface with a blue tint that influences light reflection and reduces the yellow discoloration, thereby providing an additional whitening effect without the use of active chemical agents.
Toothpastes generally rely on mild abrasives to remove surface stains. Some contain polishing or chemical agents to achieve this. Charcoal is abrasive in the instance of direct application. Thus, activated carbon can potentially cause damage due to its abrasive consistency.
It is thought, but not yet proven in a clinical trials, a toothpaste containing activated charcoal is less damaging then powdered products since the activated carbon is a smaller portion within a mix of other ingredients.
The powdered formulations usually require a longer brushing time to achieve the whitening effect and tend to be messy to use.
The majority of products on the market today do not contain any fluoride, in particular the DIY products seen frequently on the Internet that are intended for internal use.
Advertising claims that a product “contains” activated carbon/charcoal doesn’t mean it’s an active ingredient, and the rest of the product’s ingredients should be considered as well. Using charcoal toothpaste from a reputable brand to avoid inflicting damage to that perfect smile is recommended!