Toothbrush + Toothpaste = Synergy
When performed well, toothbrushing can significantly reduce dental plaque in a single brushing session.13 If this occurs chiefly via mechanical means, is toothpaste superfluous? Several investigations have found that combining dentifrice with toothbrushing did not provide meaningfully greater plaque removal versus “dry brushing” (i.e., without toothpaste) when measured immediately after brushing.14 Should brushing without dentifrice then be the standard?
Before considering the merits of dentifrice exclusive of plaque volume reduction, it should be noted that the concept of toothbrushing without toothpaste has not typically proven popular. Dudding and colleagues found that about one-half of participants in a study who were assigned to brushing without paste (water only) dropped out of the trial.15 Van der Sluijs et al. reported that subjects in two investigations who were assigned to brush without dentifrice rated their experience negatively (means of 3.21 and 3.01 on a perception scale of 0‑10).16 Combining dentifrice with a toothbrush is the norm, and produces the widely sought freshness, flavor, and mouth refreshment that cannot be achieved with water brushing alone, and likely motivates regular usage.15-17 Data from the Simmons National Consumer Survey and census data showed the vast majority of Americans (306.19 million; 94%) use toothpaste,18 thus it seems reasonable to conclude that even if a professional recommendation called for skipping toothpaste when brushing, most would probably not heed it.