The BEFORE Brand of Toothpaste Delivers Oral Health Now

As the one-time publisher of Doctor of Dentistry-Los Angeles in Hollywood, with gleaming smiles on screens large and small everywhere, I thought I knew everything about keeping smiles healthy and beautiful.

Like most people, I grew up thinking dentists were mainly useful for removing cavities (aka dental caries), the second most common disease compared with the more common cold. We assumed you just had to brush and floss once every couple of days to avoid these and I had only a few cavities until my 50s.

I was then shocked to find out that periodontal (gum) infections, caused by inadequate brushing and flossing, led to my gums pulling away from their support of the teeth, with five becoming so loose that they had to be extracted and replaced by expensive dental implants over the next two decades. That is actually the average number of missing teeth for Americans 50-64, while 26% of those 75 or older have no teeth left. It's no wonder, since a third of adults do not see even see a dentist once a year (twice is recommended because small dental problems can become big ones within six months).

According to the Centers for Disease Control and Prevention, 47% of Americans 30 or older have some form of periodontal disease.

Americans oral health problems could be greatly reduced if they knew how thoroughly they need to brush and floss. It's easy to assume that you can just brush and floss quickly at the end of the day and you'll be okay. But dentists are unanimous that you need to brush on both sides of your teeth (as well as the chewing surfaces) for a full two minutes twice a day (this is best after breakfast to eliminate the bacteria that accumulate overnight in the mouth, then after your last snack of the night). You should use a soft bristled brush (manual or electric) and change the head every few months.

Flossing only needs to be done before going to bed, but to really clean off the food particles and traces of beverages requires scraping against both sides of each tooth and moving the string each time, which most people do not. Some may require using a small dental pick or a water flosser. If you are not thorough in brushing and flossing, a bacterial film will form around particles that are left called plaque, which causes cavities and gum infections.

All of this does not replace the need for having a dental hygienist use her special tools, techniques, and perhaps an antibacterial solution to do a professional cleaning at least twice a year.

But avoiding the loss of teeth is actually not the worst consequence of inadequate cleaning. I now blog for dentists and dental laboratories (which craft everything from veneers to dentures) and have learned how periodontal bacteria can spread throughout the body and significantly increase the risk for cardiovascular disease, pneumonia, rheumatoid arthritis, pre-term birth and low birth weight, and diabetes, according to the Mayo Clinic https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473. Hannah Seo, in "Why Oral Hygiene Is Crucial to Your Overall Health," New York Times, April 6, 2023, cites experts who add to that list dementia, osteoporosis, kidney and liver disease, and colorectal and breast cancers.

Why Is Carrageenan Included in so Many Toothpastes?

It might seem like brushing done right would be enough to prevent plaque from developing (which turns into a hardened form called tartar in 72 hours after eating and continues to damage the gums and teeth, but can only be removed eventually by a hygienist).

The ingredients in toothpaste also matter to overall oral health. Charcoal has been added to some toothpastes because of its reputation for detoxification and cleaning, but it is so abrasive it can harm the enamel (the outer surface of the tooth, which is the hardest bone in the body, but still vulnerable).

The household disinfectant hydrogen peroxide in the 3% form is being used in some toothpastes and mouthwashes to clean gums and whiten teeth by many people who do not realize it needs to be diluted one part to two parts of water or it will harm enamel (even then, it should not be used regularly).

A common ingredient in popular toothpaste brands, such as Colgate, Crest, and Tom's, is carrageenan, a thickening agent derived from seaweed that keeps ingredients from separating, approved by the Food and Drug Administration for a range of foods from yogurt to cheese.

However, there are numerous anecdotal reports that people with digestive problems eliminated them by avoiding products with carrageenan. This research report with 82 footnotes documents gastrointestinal upset, colonic ulcers, and neoplasms (abnormal tissue growths) in lab animals https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242073/. It notes that while the FDA considered restrictions on carrageenan in 1972, these were not approved, but "because of the acknowledged carcinogenic properties of degraded carrageenan in animal models and the cancer-promoting effects of undegraded carrageenan in experimental models, its widespread in the Western diet should be reconsidered."

WebMD notes, "A broken down form called poligeenan is possibly unsafe and might damage the colon and cause bleeding and cancer...slow blood clotting...and ulcerative colitis" https://www.webmd.com/vitamins/ai/ingredientmono-710/carrageenan. While toothpaste is not supposed to be eaten, swallowing does occur, especially among children.

Cellulose gum, xanthan gum, vegetable glycerin, and titanium oxide (an inorganic chemical in many foods) are the harmless alternatives that Before toothpastes use to bind ingredients, provide texture, and impart the desirable flow.

?Sodium Laurel Sulfate and Other Unnecessary Ingredients

Sodium lauryl sulfate (SLS) is also a primary ingredient in most major toothpaste brands and not found in Before. As the medically-reviewed resource on the health effects of food and beauty products, Healthline, explains https://www.healthline.com/health/beauty-skin-care/what-is-sodium-lauryl-sulfate:

"SLS is found in both beauty and cleaning products and is...not harmful if used briefly and rinsed from the skin." Of course, you can rinse off shampoo from your hair or household bleach from surfaces, but it would be hard to thoroughly wash it off teeth and the article notes it is a "mild to moderate irritant in animals" if skin contact is "continuous." It has also been linked to a significant recurrence of mouth ulcers according to a 2018 study.

The World Health Organization has warnings about SLS's effect on any skin https://www.100percentpure.com/blogs/feed/a-reminder-on-why-sodium-lauryl-sulfate-is-bad.

A long analysis of potential SLS risks published by the National Institute of Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651417/ would be reassuring at minimizing SLS risk, but it notes that "diluted concentrations are not necessarily toxic...which holds true for the use of SLS in food products...which is why it is on the FDA's list of multipurpose additives allowed to be added to food...Every chemical has a toxic dose and many common foods can be classified as toxic...such as table salt." It goes on to note "The potential for some surfactants like SLS to be cross-contaminated by the carcinogenic by-product 1,3-dioxane...by manufacturing equipment."

So why is it included in so many toothpastes? It creates foam, which can help remove food debris. Before products use cocamidopropyl betaine, naturally derived from coconut oil, to accomplish the same thing.

Triclosan: It is included not only in some toothpastes, but body washes, antibacterial soaps, and cosmetics. An FDA study found that it decreased some thyroid hormones, which help control metabolism in animals. There are also reports that it may be linked to antibiotic resistance and development of skin cancer.

Propylene Glycol: It is used to give products a longer shelf life, but in large quantities may damage the liver, heart, and central nervous system.

Diethanolamine (DEA): Topical application was found to be linked to cancer in animals and hepatic choline deficiency of the liver.

Parabens: These are preservatives, but may disrupt hormone function and lead to breast cancer.

Sodium Hydroxide: This is a caustic soda used in textiles, drain cleaners, and industrial detergents https://www.tn.gov/health/cedep/environmental/environmental-health-topics/eht/sodium-hydroxide.html. It is common in toothpastes to neutralize the pH (acid-alkaline balance) of other ingredients.

But What About Fluoride?

Before Company toothpastes contain fluoride, a mineral common in food and water that helps keep the enamel outer surface of teeth strong, preventing cavities and increasing resistance to acid attacks from plaque. It also prevents the mouth from becoming dry and making it difficult for food particles to be removed (saliva helps do this and neutralizes acids).

It is not included in many "natural" toothpastes because of a misunderstanding about the risks of toxic doses. WebMD, which allows experts to make the case for integrative medicine of all types (including preventive, mainstream, and alternative approaches) takes a clear stand on the evidence: fluoride in the small doses found in toothpastes is the only clinically-proven method of preventing tooth decay https://www.webmd.com/oral-health/fluoride-treatment.

Virtually all dentists agree. Of course, no one should swallow toothpaste and children may be prone to do this, but excess fluoride in blood tests is usually due to well water and revealed through white specks on teeth. Known as fluorosis, these spots can be lightened by a dentist, but "it is very difficult to reach hazardous levels in home-based fluoride-containing products," WebMD notes.

While 62% of U.S. community water systems (including 43 of the 50 largest cities) have fluoride, those who drink bottled water or home treatment systems that distill it or put their water through reverse osmosis may will not get enough, according to the American Dental Association. Water softeners and water that goes through charcoal or carbon filters do not remove the fluoride.

The type included in Before toothpastes is sodium fluoride, which in lab testing usually outperforms sodium monofluorphosphate, which is included in some other toothpastes, according to the company's scientific experts. Stannous fluoride in a few brands is the only type that can allow a claim that a toothpaste has anti-plaque effects and can reduce tooth sensitivity, however, Before says sodium fluoride usually delivers more fluoride uptake into enamel than stannous fluoride.

Before's leaders do recognize that despite the scientific evidence that fluoride in toothpastes is safe and helps fight cavities, some people will always be more comfortable using one that does not include it, so there are plans to create products without it.

Before products include other natural ingredients for anti-plaque and anti-sensitivity activity:

Potassium Nitrate: This has proven effective to prevent tooth sensitivity by decreasing blood flow through the tubules and the activity of dental sensory nerves, while preventing sensation signals from reaching the brain.

Sodium Bicarbonate (aka baking soda): It neutralizes plaque-forming acids, while removing surface stains and whitening teeth naturally. Hydrated silica, a mineral combined with water, is also included to promote whitening.

Sodium Saccharin: This helps kill plaque microbes, while adding a sweet taste to make brushing more pleasant (sorbitol, made from fruits and vegetables, also delivers sweetness without contributing to tooth decay).

Xylitol: This is a sweetener derived from birch bark that is favored by all dentists because it has anti-microbial properties, prevents decay, and helps keep the mouth moist.

Potassium Sorbate: It has powerful antimicrobial properties and is a natural preservative.

Menthol: This is naturally derived from peppermint and supports good bacteria development while providing a soothing and cooling effect.

Peppermint Oil: It kills bacteria while freshening breath (the combination with menthol and spearmint creates what Before calls SuperMint).

Citric Acid: This is used to reduce the buildup of tartar, the hardened form of plaque.

Aloe Barbadensis Leaf Extract (aka aloe vera): High in health-building antioxidants, it reduces sensitivity, can fight gum infections, and repair soft tissue cells.

Arginine: An amino acid (constituent of protein), it plays a direct role in altering plaque metabolism and content and protecting soft and hard tissues.

Zinc Sulfate: An anti-bacterial agent that controls plaque and prevents tartar formation while reducing bad mouth odor.

The Vision of Before's Founders?

The founders of Before were motivated to start the company with a vision that went far beyond simply providing a healthy, natural, and effective toothpaste, which is just the start as far as the products go.

Steve Thorp, the CEO, started his first business that involved snowboarding, surfing, fishing, and exploring. "My appreciation grew for companies that respected the environment and brought that ethos into their values," he told me. "It took me a few entrepreneurial journeys to come back to my passion, rooted in self-care, and along the way I honed my love for beautifully designed and crafted consumer products that have a positive impact on people and the planet."

Jamie Collins, Chief Marketing Officer, grew up in a small Labrador (Canadian) town where he spent most of his time immersed in nature. "I also logged considerable hours in the dentist's chair because of my affinity for sweets and junk food, so I've been motivated to have cleaner, stronger teeth all my life."

He has helped shape public appreciation for iconic brands for two decades in everything from sports and product packaging to food and beverage and fashion. "The opportunity to launch and build Before combines all my life-long passions into one exciting vision of self-care that will continue to evolve and thrive."

Kevin Shaw, CFO, said, "I learned already in my pre-teens the importance of diet as it relates to athletic performance and have been a lifelong athlete, including playing basketball at the collegiate level. My curiosity began to flourish as I became aware of the differences in the products of my family's everyday life, from cleaners and soaps to products for my kids and toothpaste. Now I am passionate about making Before a business that will help people forge a cleaner, healthier lifestyle ." He has an MBA and is also president and managing director of Baker Tilly Canada Corporate Finance.

In line with their values, the founders say that all of their products (initially Purifying Toothpastes that include the Classic, another for Whitening, and a third for dental Sensitivity) use 100% recyclable tubes made from sugarcane (the first in North America), diverting packaging from landfills and an alternative to traditional plastic tubes. They plan to donate one percent of profits to support social and climate change causes through the BeforeCares Foundation https://beforecompany.com/pages/beforecares.

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