The (Serious) Toothpaste-Cap Index

My Invention, Backed by Research I Did This Morning

Before anyone says it, this is not another article about how to squeeze toothpaste properly. This article is about the cap.

More specifically, it is about the tiny screw cap on my specialist anti-infection toothpaste. Until recently, I would not have described opening toothpaste as an activity. It was simply the brief administrative process before brushing my teeth. Unscrew cap, apply toothpaste, replace cap. Job done. Nobody sits down afterwards and thinks, “Well, that was a demanding few minutes.”

With PSP, or at least my atypical version of it, ordinary activities have a habit of quietly promoting themselves into projects.

The toothpaste cap is a surprisingly good example. You have to grip it, twist it, put it somewhere sensible, coordinate the tube and toothbrush using eyes that may have their own interpretation of where everything is located, find the cap again, align the thread and put the whole thing back together.

None of that sounds remotely difficult, which is precisely the point.

This morning, I completed the entire process without noticing. Last night, I looked at the toothpaste, mentally reviewed the sequence required to get toothpaste from tube to toothbrush and decided that mouthwash was an entirely reasonable substitute for dentistry.

It isn’t, of course. I know that. The problem was never understanding. It was fuel.

That was what made me notice a pattern. My brushing success rate in the morning is essentially 100%. Late at night, it is closer to 80%.

I do not normally brush my teeth during the day. I still remember an early-career trip to South Korea when I saw large numbers of office employees brushing their teeth after lunch. I found it fascinating. I do not know whether the practice continues, but it clearly made a lasting impression on me.

Not quite lasting enough to make me copy them, obviously.

The cap does not become tighter after sunset and the laws of physics remain broadly consistent.

The variable in this equation is me.

More specifically, it is my exhaustion and my eyes. Double vision, blurred vision and the challenge of persuading my hands to cooperate with what I think I am seeing can turn a simple sequence into something far more demanding. When my condition was originally thought to be Parkinson’s disease, tremor was the main culprit. Ironically, the tremor has largely disappeared as my condition has evolved. The exhaustion and visual problems have more than filled the vacancy.

The toothpaste cap has therefore accidentally become a measurement. My own Body Battery, although, as an atypical patient with an atypical condition, I would not recommend building a research programme around it.

Garmin has spent years developing algorithms to estimate how much energy I have left.

I have apparently developed a toothpaste tube.

If I can open it, use it and put everything away without a second thought, I still have charge remaining. If I find myself negotiating with the mouthwash instead, the warning light is on. If I am simply put to bed, often still wearing my clothes, and the entire question of a bedtime routine quietly disappears, we are operating on emergency reserve power.

The more I thought about it, the more ridiculous it sounded. Naturally, that prompted me to investigate whether there was any science behind it. One of the occupational hazards of disability is that you eventually find yourself researching questions that would never occur to healthy people.

It turns out there may be.

A study of 92 dental students at Vilnius University found that fatigue and sleep problems were associated with poorer oral-health behaviour. Students reporting fatigue had almost seven times the odds of brushing once a day or less, while students with sleep-quality disorders had eleven times the odds. These were dental students. Knowledge was not the issue. Nobody needed to explain why brushing their teeth was important. Yet fatigue still influenced behaviour.

We often assume that knowing the right thing is enough. Fatigue has other ideas. The task stays the same while the resources available to complete it shrink.

There is also research showing that difficult packaging can become a genuine barrier to independence. Research involving people with hand impairments found that hard-to-open food packaging caused frustration, reduced independence and, in some cases, led people to avoid eating rather than struggle with it. Another study found that more than one in four older people experienced problems opening medication packaging, and not all of them had a successful strategy for overcoming those difficulties.

That sounds extreme until you realise that most of us have done some version of it. Everyone has looked at a task and thought, “Not today.” Not because it was impossible. Not because they did not understand its importance. Simply because the effort required exceeded what was available at that moment.

Most people encounter that occasionally. Some of us budget for it.

The energy budget becomes very real. Every activity has a cost attached to it. Most people never need to calculate that cost. Some of us do it all day long.

That is why the toothpaste cap matters. I am learning that small things can matter enormously.

When something ordinary develops unexpected resistance, it tells you something useful about your condition. It becomes less of a hygiene task and more of a diagnostic instrument.

Possibly not one approved by the medical profession.

Independence plays a role as well. I accept help with many things because reality eventually wins every argument. I have a wonderful live-in carer who would happily open the toothpaste if I asked. The solution is standing only a few feet away, yet I remain strangely reluctant to outsource responsibility for my toothpaste.

Logically, that makes very little sense. Emotionally, it makes perfect sense.

Independence rarely disappears all at once. It retreats gradually, often from surprisingly small territories. A toothbrush. A toothpaste tube. A screw cap. Tiny places where we continue planting our flag long after common sense has suggested a strategic withdrawal.

Perhaps that is why last night’s failure bothered me more than it should have done.

I am not really worried about the toothpaste. I am worried about what happens when the toothbrush eventually joins the list.

So this is not really an article about toothpaste.

It is about the unexpected measurements illness creates. Doctors have rating scales. Researchers have validated questionnaires. Smartwatches have algorithms.

I have a toothpaste cap. Not because it tells me anything about my teeth, but because it tells me something about my energy.

My morning success rate remains close to 100%. By evening, it falls to about 80%.

The Toothpaste-Cap Index is scientifically unvalidated, statistically questionable and very unlikely to appear in a neurology textbook. Yet, as personal indicators go, it is remarkably accurate.

I would be interested to know whether anyone else has something similar. Not a symptom, a score or a number on a watch.

Just one small, supposedly effortless task that quietly tells you your battery has run out.

Have you ever looked at it, turned away and decided that, tonight, it was simply one obstacle too many?

Comments, thoughts, ideas or feedback? Please feel free to email me at benlazpsp@gmail.com or use the feedback form. I introduced it because I genuinely want to hear what you think I could or should be writing about.