The flavor of dental hygiene

Hygienists fuel the demand for tasty choices during treatment

By Cathleen Terhune Alty, RDH, BA

Dental hygiene could be defined as:

Our founder is Fones.
Our focus is prevention.
Our color is purple.
Our flavor is mint.

From chewing gum to mouthwash, from prophy paste to fluoride varnish, if it goes inside your mouth, there is a good chance it is mint flavored. Love it or hate it, mint's cooling pungency makes it number one in the oral hygiene business. Consumer demand has pushed mint into the oral hygiene hot spot for that "fresh breath, clean mouth" feeling. Oral hygiene product manufacturers like mint because it is easy to procure, abundant, and inexpensive. Approximately 60% of all U.S. prophylaxis paste sales contain the mint flavor. With approximately 200 million prophies performed per year, that's a lot of unit-dose mint paste being swirled on teeth.

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Seems like mint prophylaxis paste has always been the old standby but actual commercially formulated, ready-to-use mint prophylaxis paste is a relative newcomer.

During most of dental hygiene's existence, we made our own prophy paste. Many dental hygienists will remember a scoop of gray pumice mixed with a splash of mouthwash made a slurry for polishing a patient's teeth. It was messy, rather unsanitary, and certainly looked unappealing with its drab gray color. Dental supply manufacturers only offered ready made paste in 12-ounce jars in kid-friendly flavors such as cherry and orange. Suppliers knew from other consumer products that mint was the number one seller in gum and mints at the retail level. They reasoned commercial sales of mint prophy paste would be huge. But they were told repeatedly by hygienists in focus groups that the doctor would never pay for a product that we were mixing up for ourselves in-office.

In time, the product was introduced anyway and prophy paste sales practically doubled overnight. Unit-dose sealed cups were introduced a few years later, and color coding the grit choices (fine, medium, coarse) came soon after unit dosage.

Apparently, mint wins the favorite flavor popularity contest with everyone except hygienists. "RDHs care very much about flavors," said one dental products manufacturer. Hygienists like patients to have choices, and we know not everyone appreciates the mint experience. I have been told by manufacturer's representatives at events such as the RDH Under One Roof conference that the first thing a hygienist will ask is, "What are your new flavors?"

"We manufacturers get it," one representative said, "and we want to give you choices." Consumer products such as toothpaste and mouthwash don't offer the great flavor varieties because of the quantity and costs involved in bringing consumer products to market.

"As consumers, we really don't see many choices beyond mint or cinnamon when it comes to oral care," said a member of the Dentsply marketing team. "In the professional category, however, we do step out of the flavor box to provide some variety for patients."

Prophy pastes such as the Kolorz brand are advertised as being created specially by chefs to have a good taste. With demand from hygienists for new flavor choices, it appears we drive the professional product market to offer exotic flavors such as pina colada, chocolate mint, cookie dough, chocolate, vanilla, cinnamon, bubblegum, vanilla orange, orange sherbet, cotton candy, strawberry, and raspberry. With all of these choices, it appears the manufacturers enjoy coming up with the new flavors as much as we enjoy receiving them.

So the big question is what drives dental hygienists' obsession with flavors? We're usually not the end consumers or tasters of the products we use in office. Certainly, the smell is a nice benefit. Maybe we are so aware of our patients being apprehensive about dentistry that we want them to feel comfortable, and a choice of flavors gives them a small bit of control over the dental experience. Maybe it's just the simple fact that flavors are fun.

"Giving patients a choice of prophy paste flavors is a simple opportunity to enhance their overall satisfaction with their hygiene appointment," the Dentsply marketer said. "It's one reason NUPRO prophy paste offers 13 great-tasting flavors from which to choose."

Just like your favorite restaurant or ice cream store, it helps to have the different flavors written down. Preventech offers a free, downloadable menu of flavors to offer to patients in our private "tasting room" operatories. NUPRO offers a free laminated poster for writing in the "daily flavor" specials.

So why aren't all dental products flavored in a fun way?

"Dental products are often flavored to make them more palatable for patients," the DENTSPLY representative said. "Flavors mask any unpleasant flavor in the product formulation and provide an opportunity to enhance the dental experience for patients. Many flavors are oil based, and this could interfere with the material properties of the product. For example, flavors in sealants or composites could interfere with the bonding requirements needed to adhere to the tooth."

Flavors are tested and tried out on focus groups before release.

"We always have flavor trials and pilot testing with kids and adults," said one manufacturer's rep. "Chocolate mint was a particularly difficult flavor to get right, but I think we made a really good one."

The Dentsply rep added, "The research and development team conducts robust testing of various flavors to ensure the flavor doesn't change over time, it remains stable under temperature conditions, and it meets the quality expectations of our customers. The flavors are driven by customer requests and input. While our product marketing and clinical teams provide guidance and direction for flavors, it's customers who evaluate the final flavors of products before they are introduced."

Flavorings are used to make the product the correct texture as well. "Flavor oils add moistness to the product so the paste doesn't have a hockey-puck consistency," said one manufacturer. "The product wants to dry out quickly without it." Containing basically glycerol, pumice, and flavoring, the flavor ingredients are the most expensive ingredients in prophy paste.

Where do these flavors come from?

Flavors themselves come exclusively from "flavor houses" using GRAS (generally recognized as safe) flavoring products. These flavors are a very closely guarded secret and are proprietary to the flavor house that manufacturers them, meaning that even the manufacturers using the flavors don't know exactly what is in them. If you have a patient with allergies or sensitivities, using a paste without any flavor is probably your safest choice as there is no way to find out if gluten or other potential irritants are in the product.

Why all the secrecy? According to the Flavor and Extract Manufacturers Association, a trade organization to flavor houses: "It is difficult to trademark a flavor or flavor compound, which is why flavorists and flavor companies protect their creations. They are not hiding something from the public; they are protecting their innovations. Patents and trademarks are rarely awarded to flavors, which leaves flavorists and flavor companies vulnerable to intellectual property theft if they reveal all the ingredients involved in creating the flavors they design for consumer product companies."

Flavor preferences certainly vary by age, with bubble gum beating out every other flavor with the under-12 age group. Patients with mint sensitivity seem to be increasing, as well as patients who do not want fluoride in their paste. Flavor preferences also vary by geographic location. One manufacturer told me how popular pina colada is in South America. But he wasn't sure if its popularity was due to the ethnic community desire or because it is the flavor the distributor carries.

Cost and inventory are factors behind our desire to offer flavor choices to our patients. Pastes that sit too long tend to dry out. With an average of 200 individual-dose cups per box, we have a limit of how many flavors we can stock and use before the expiration date.

One manufacturer said, "Purchasing a whole box of an unknown flavor is a big commitment. Sampling the product or purchasing assortment flavor boxes gives the variety hygienists crave." Another commented how manufacturers often offer a "buy three, get one free" deal, so hygienists will buy two boxes of mint, one of bubble gum, and then try a new flavor.

Not just flavor driven

We also push choices in the features of prophy paste products. We want stain, plaque, and biofilm removal but gentle on enamel. We want no splatter but a soft, consistent texture to scoop into the prophy cup, a good ability to be rinsed, and texture. We want to know what is in the product for our allergic or health-conscious patients. A few examples of the incredible number of choices hygienists have include:

Gluten-free Sparkle from Crosstex
Young Dental's pumice based D-lish
Biotrol's ring pop lookalike
Perfect Choice Gems
Kerr's Perfect Pearl
3M ESPE Clinpro breaking down from coarse grit to fine as it swirls on the teeth
Keystone's Gelato ice cream flavors
Sultan Healthcare's flavors for Topex include pina colada, neapolitan, and chocolate mint
Waterpik's Soft Shine nonabrasive paste
Preventech's MAXmin with NovaMin for remineralization
Premier's splatter-free Glitter
Preventech's Nada with no fluoride, flavor, or oils added
Premier Enamel Pro with ACP and DENTSPLY NUPRO with Sensodyne for sensitivity

While mint may reign supreme over dental hygiene land, hygienists always have our eyes on the next new flavor at a dental convention. After all, there are so many flavors, and so little time!

Author's note: Thanks to Bill Berry of Preventech, the NUPRO Marketing Team, and Derek Keene of Keystone Industries for their input into the information in this article.

CATHLEEN TERHUNE ALTY, RDH, is a frequent contributor who is based in King George, Va.

Why does mint make the mouth feel cool?

That cool, minty-fresh feeling is really just a thermal illusion that happens as the sensory receptors in your mouth are fooled into believing something cold is in your mouth. Only certain stimulants can open the lock on the ion channel of a cell that changes the electrical charge within the neuron. The menthol in mint oil fits the sensory cellular "lock" and allows calcium and sodium ions to enter the cell. The electrical charge within the neuron changes and this information is sent to the central nervous system and signals the brain to feel the perception of cold.

So even though the actual temperature in the mouth does not change, your brain is tricked into believing your mouth is indeed cold. A similar situation happens in the presence of cinnamon oil. Remember as a kid having one of those red-hot cinnamon jawbreakers that was so hot you had to take it out of your mouth because it was on fire? Again, the mouth is not actually hot. The sensors are stimulated by the cinnamon oil and are tricked into believing the mouth is hot!