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Being a dentist, I suppose I should chime in here. No, toothpaste isn't actually required for proper oral hygiene. Aside from cancer, and viral lesions such as herpes and cold sores, dental disease requires three factors--bacteria, a food source for them, and a location (tooth surface or gingival, or "gum," pocket). The bacteria first create a sort of spider web on the tooth surface, which we call plaque. This gives them a place to live and it collects more and more food for the little guys. They eat the food, and their waste products include acid. The pH of the area drops, and the result is tooth decay and/or gingivitis. Now, the key to good oral health is to break up the plaque formations regularly to keep the bacteria at bay (and reduce their numbers). These little guys are part of the mouth's oral flora, but they don't really do much damage unless they can form the plaque. After a thorough brush/floss, it takes the bugs about 24 hours to reform their plaque homes and return to causing trouble. Theoretically, once a day should cover it. But since we are all human, we aren't really that good at being perfect. So it is best if we brush and floss 2-3 times a day. The mechanical removal of plaque is the critical element here. Toothpaste does provide a topical fluoride application, which is perhaps more important for children than adults. Aside from that, toothpaste is unnecessary unless you like the taste.
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