COMMENTARIES

INTRODUCTION


Baking soda dentifrices

and oral health

T
his supplement to The Journal of the American Dental Association
Sebastian G. Ciancio, DDS
(JADA) is a compilation of a number of reports based on research
of the effects of sodium bicarbonate (baking soda) as a dentifrice
ingredient. This supplement provides information of value to dental
practitioners on the benefits of baking soda dentifrices on oral health. The
authors chosen to develop this supplement of JADA were selected because of
their expertise in the topics included in this issue and their involvement in
dental research both clinically as well as in the laboratory.
As dental professionals, we are aware that the removal and prevention
of supragingival bacterial plaque by good oral hygiene is necessary to
achieve and maintain oral health from both a caries and periodontal
perspective.
In addition to prevention of caries and periodontal disease, a dentifrice
may serve as a delivery system for agents to reduce tooth sensitivity as well as
for esthetic benefits. However, we also realize that although a dentifrice may
have a variety of benefits, patient compliance primarily is affected not only by
the health benefits but also the taste. The impact of taste on patients’ oral
hygiene was demonstrated in a study in which 1 group of college students was
given a mixture of baking soda and salt to brush with, another group was
given water only to brush with, and a third group was given a well-flavored
dentifrice.1 In this study, plaque was measured as an indicator of oral
hygiene, and the highest plaque scores were recorded in the no dentifrice
group. Dropout rates were 20% in the unflavored mixture group, 46% in the
water group, and only 5% in the well-flavored dentifrice group. Since taste is
important for compliance with brushing, current dentifrices on the market
have successfully masked the taste of baking soda by the judicious use of
flavoring and sweetening agents. The role of flavoring for patient compliance
is discussed in an article by Newbrun2 in which he states that dentifrices
containing baking soda (sodium bicarbonate) are widely used and have been
shown to motivate patients to improve their oral hygiene.
Although modern research methods on dentifrices containing baking soda
did not begin until the 1970s, in 1911 an article in a leading dental journal
described “the ideal tooth powder” as being “capable of giving a high pol-
ishing to the teeth but without the danger of scratching them in the least. It
must, in addition, have a stringent stimulant, actively cleansing, antiseptic
and alkaline properties, just enough to be helpful to the gums without any
danger of irritating them.”3 As you will see from the articles in this sup-
plement, this is almost a perfect description of our modern-day baking
soda dentifrices and the advantages that they have to offer. In fact, the author

JADA 148(11 suppl) http://jada.ada.org November 2017 1S


of the 1911 article went on to
recommend baking soda as one
of the ingredients that should be
in this ideal tooth powder.3
In 1974, Colgate introduced a
dentifrice containing baking soda
and, in the early 1980s, the Church &
Dwight Company began the devel-
opment of a baking soda–containing
dentifrice, which, although it con-
tained 94% baking soda, had a taste
that was pleasing to the public. It was
first sold in 1986 regionally and, in
1988, was sold nationally.4 Soon
other manufacturers introduced new
baking soda toothpastes, including
Colgate Palmolive, Procter &
Gamble, and Unilever. Concentra-
tions of baking soda in the various
dentifrices on the market at that time
ranged from 5% to 94%. Currently,
the major producer of baking soda
dentifrices in the United States is the
Church & Dwight Company, spon-
sors of this supplement to JADA. It
is noteworthy that most baking
soda–based dentifrices contain fluo-
ride, which is compatible with
baking soda.
The articles selected for inclusion
in this supplement were based on the
safety and efficacy of baking soda–
containing dentifrices for a variety of
uses. Safety issues of concern to cli-
nicians include effects on enamel
and dentin, the oral microflora, oral
soft tissues including gingival health,
and remineralization and deminer-
alization. In reviewing the various
articles in this issue, I noted that a
significant amount of research data
have been generated over the years
regarding the safety and efficacy of
baking soda–containing dentifrices.
Some of the highlights of the
research findings discussed in this
supplement are summarized below.
LOW ABRASIVITY OF BAKING
SODA DENTIFRICES
The abrasivity of a dentifrice on the
tooth depends on a number of fac-
tors, including the inherent hardness
of the abrasive ingredient, its particle
size and shape, the pH of the denti-
frice, the overall formulation, and
2S JADA 148(11 suppl) http://jada.ada.org
COMMENTARIES
factors unrelated to the dentifrice per
se, such as the frequency of brushing,
the hardness of the toothbrush bris-
tles, and the pressure applied.5 The
intrinsic hardness of baking soda is
relatively low, of the same magnitude
as dentin itself, and less than that of
enamel or of other commonly used
dentifrice abrasives, such as calcium
carbonate, anhydrous dicalcium
phosphate, and calcium
pyrophosphate.6
Therefore, the use of a baking
soda dentifrice provides a measure of
safety to enamel and dentin in spite
of the “vigor” patients may use while
brushing their teeth. The low abra-
sivity of baking soda dentifrices
makes them especially suited for safe
daily use in oral hygiene regimens.7
EFFECT ON PLAQUE ACIDITY
Neutralization of plaque acids by
baking soda is anticariogenic by
facilitating remineralization of
incipient carious lesions. Patients in
the fasting state have plaque that is
normally supersaturated with respect
to the tooth mineral,8 which means
that mineral tends to precipitate out
of the fluid, and the teeth have no
tendency to dissolve. At the so-called
critical pH of approximately 5.1 to
5.5, the plaque fluid is barely satu-
rated with respect to tooth mineral
(that is, teeth do not dissolve, and
mineral does not tend to precipitate
out). However, if the pH of the pla-
que falls below the critical pH, the
plaque fluid becomes unsaturated,
and the teeth begin to dissolve,
which initiates dental caries. When
the pH returns above the critical pH,
an early caries lesion will tend to
remineralize, particularly in the
presence of fluoride, which is
included in most baking soda–
containing dentifrices.9 Baking soda
has been shown to be efficacious in
reducing the acidity of plaque fluid.
Therefore, its impact on oral remi-
neralization and demineralization is
significant. Dawes10 reported that
simulation of the use of a high-
bicarbonate dentifrice at a time when
plaque pH had fallen to about 4.5
November 2017
caused a rapid return of the pH
toward neutrality, whereas simula-
tion of the use of a low-bicarbonate
dentifrice had much less effect.
EFFECT ON ORAL BACTERIA
Microbiological studies have shown
that baking soda solutions have sig-
nificant bactericidal activity against
oral pathogens.11 Concentrated solu-
tions of baking soda suspensions
from periodontal pockets have been
shown to rapidly immobilize oral
spirochetes and motile rods obtained
in mixed pockets and viewed in wet
mounts under phase contrast mi-
croscopy.12 Subsequent in vitro
studies using pure cultures
of putative periodontal pathogens
established the minimal bactericidal
concentration of baking soda13 and
of baking soda–hydrogen peroxide,
which exhibited synergistic activity.14
Periodontal pathogens were more
susceptible to baking soda than were
organisms representative of soil,
skin, and fecal flora. These findings
help one to understand the basis
for the reduction of plaque and
improvement of the health of oral
tissues that researchers have re-
ported in clinical studies in which
they found plaque reduction and
improvement in periodontal health
in patients who used a baking soda–
containing dentifrice.15,16
EFFECT ON TOOTH WHITENING
AND STAIN REMOVAL
Researchers in a number of studies
have reported that, in spite of its low
abrasivity, dentifrices containing
baking soda are more effective in
stain removal and whitening than
some non–baking soda—containing
dentifrices with a higher abrasivity.17
In view of the current interest by
patients in tooth whitening, this
feature may improve patients’
compliance with oral hygiene. Also,
for patients whose oral condition
benefits from the use of chlorhexi-
dine mouthrinses, the offensive stain
caused by chlorhexidine has been
shown to be reduced by the use of
baking soda–containing dentifrices.

EFFECT ON GINGIVAL HEALTH
In clinical gingivitis studies, re-
searchers evaluate inflammation as
measured by bleeding points and
gingival health as measured by a
gingival index and plaque reduction.
The US Food and Drug Adminis-
tration and the American Dental
Association have published helpful
guidelines on study design and re-
sults interpretation. Beneficial effects
of baking soda on gingival health
have been found by researchers in 3-
to 6-month clinical studies of baking
soda–containing dentifrices as
compared with placebos.11,18 How-
ever, clinical data have shown vari-
able results because of variation
across studies in baking soda for-
mulations, study duration, and
choice of controls. The beneficial
effect of baking soda in gingival
health is anticipated in view of its
antibacterial and biofilm-disruptive
activity. Additional clinical studies
would be useful to confirm the role
of baking soda on gingival health.
SAFETY
The safety of dentifrices containing
baking soda has been extensively
studied.15,18,19 Researchers in both
clinical and laboratory studies have
found these products to be safe,
to be low in abrasiveness, to not
contribute to root sensitivity, and to
be safe for use by patients on low-
salt diets. This latter finding is
important, given that patients swal-
low 5% to 7% of a dentifrice with
which they brush.20
CONCLUSIONS
In reviewing the evidence presented
in this supplement of JADA, the
following summary statements are in
order:
- The low abrasivity of dentifrices
containing baking soda makes them
COMMENTARIES
especially suited for safe daily use in
oral hygiene regimens.
- Microbiological studies have
shown that baking soda products
have significant bactericidal activity
against oral pathogens, which ex-
plains benefits demonstrated in
clinical studies on plaque biofilm
and gingivitis reduction.
- Baking soda dentifrices favor pa-
tient compliance because they have
stain-reducing and whitening prop-
erties, a feature which motivates pa-
tients to brush as instructed by their
oral care practitioner.
- Neutralization of plaque acids by
baking soda supports caries reduc-
tion as well as facilitation of remin-
eralization of incipient carious
lesions. n
http://dx.doi.org/10.1016/j.adaj.2017.09.009
Publication of this article was sponsored by
Church & Dwight Co., Inc.
The articles in this issue have an accompanying
online continuing education activity available
at: http://www.ADA.org/bakingsoda.
Copyright ª 2017 American Dental
Association. All rights reserved.
Dr. Ciancio is distinguished service professor
and chair, Department of Periodontics and
Endodontics, School of Dental Medicine, Uni-
versity at Buffalo, The State University of New
York, Buffalo, NY 14214. He is also the guest
editor of this supplement, e-mail ciancio@
buffalo.edu. Address correspondence to Dr.
Ciancio.
Disclosure. Dr. Ciancio received an honorar-
ium from the American Dental Association and
has consulted with Colgate.
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