Fluoride-free toothpaste has been on the rise lately — but why?
It seems we’ve been brushing our teeth with a fluoride toothpaste to strengthen them and prevent cavities for our whole lives. Now there are mixed reviews and controversies, with dental professionals on both sides of the debate: some who are very opposed to fluoride-free toothpaste, and some who are opposed to traditional toothpaste with fluoride.
Here’s what you need to know so you can make your own personal decision on what kind of toothpaste you want to be brushing with.
What Is Fluoride?
It’s also added to many communities’ water supplies, which is known as water fluoridation. This practice began even before fluoride was added to dental products.
In the ‘30s, researchers found that children who drank from water supplies naturally higher in fluoride had less tooth decay. Grand Rapids, Michigan, was a pioneer in water fluoridation, being the first city to add fluoride to its water for cavity prevention.
In the 1950s, fluoridated toothpaste was developed, and clinical studies were conducted to test the effect on preventing tooth decay. After the studies showed promising results, Procter & Gamble launched “Crest with Fluoristan” in 1955, and five years later, the American Dental Association endorsed the product, confirming its efficacy.
Heather Kunen, DDS, MS, co-founder of Beam Street Dentistry in New York City, advocates for patients brushing their teeth with fluoridated toothpaste. She told Public Goods that fluoride serves to help remineralize and strengthen tooth enamel, adding a protective layer against bacteria.
“Simply put, fluoride is one of our best-known defenses against cavities,” she said.
Does Fluoride-Free Toothpaste Work?
So, we know fluoride is a great cavity fighter — but does toothpaste without fluoride work? Well, it depends what you’re looking to get out of a toothpaste.
E. Griffin Cole, DDS, NMD, has a practice in Austin, Texas, where he uses a biocompatible focus and integrative approach to treating patients. He is anti-fluoride, and argues that there are plenty of benefits to using toothpaste that is fluoride-free. He questions whether fluoride is actually necessary for dental hygiene products, and is wary of long-term effects, stating some science shows the ingredient can actually be harmful to enamel.
Toothpaste without fluoride uses other ingredients that will physically scrub your teeth when you brush, remove bacteria or use prebiotics (not to be confused with probiotics) that create an environment where bacteria are “happy” rather than killing them all off, according to Cole.
Most no-fluoride toothpaste has a calcium-mineral base, usually calcium carbonate. This ingredient acts as a gentle abrasive that can remove plaque.
Charcoal or clays also act as abrasives, serving as stripping and whitening agents. Usually, you’ll see “bentonite clay” or “activated charcoal” in the ingredients list, or as ingredients in DIY toothpaste recipes.
Xylitol is another common ingredient that helps to prevent bacteria from sticking to teeth. Here are some studies on the efficacy of xylitol:
- “Xylitol in preventing dental caries: A systematic review and meta-analyses,” Journal of Natural Science, Biology, and Medicine
- “The effect of xylitol on dental caries and oral flora,” Clinical, Cosmetic and Investigational Dentistry
Toothpaste that is fluoride-free might also contain tea tree oil or clove oil for antibacterial purposes, and peppermint oil for flavor. As for a prebiotic, plant-based inulin fosters a healthy environment for bacteria.
Fluoride-Free vs Fluoride Toothpaste: Which is Better?
Depending on who you ask and your personal preferences, you’ll get a different answer on which is “better.” Here are some pros and cons for both.
Pros of Fluoride
- The American Dental Association recognizes both commonly used types of fluoride (sodium fluoride and stannous fluoride) as safe, effective ingredients.
- Fluoride remineralizes enamel by attracting other minerals to the surface of the tooth to help harden it, preventing damage.
- According to Kunen, fluoride also forms fluorapatite crystals on top of tooth enamel that protect against acids.
- There’s a huge variety of fluoridated toothpastes approved by the ADA to choose from.
- There’s plenty of evidence that shows fluoride helps prevent cavities.
- The American Academy of Pediatrics stresses the importance of using fluoride toothpaste (in tiny amounts) in children, as soon as teeth start to erupt to protect new teeth.
Cons of Fluoride
- Can be toxic when consumed, especially in children
- Dental fluorosis can occur when teeth are exposed to too much fluoride, resulting in white speckled teeth. However, according to the CDC, this symptom really only occurs in children under eight years old
- Anti-fluoride activists argue it’s really not necessary for good dental health, and that possible negative long-term effects are not fully known.
- The International Academy of Oral Medicine and Toxicology claims fluoride can cause various negative health effects such as acne and other skin conditions, bone weakness, cognitive deficits, and more.
- Fluoride is often a byproduct of phosphate fertilizer mining that damages the environment.
Pros of Fluoride-Free
- The formulations of non-fluoride toothpastes tend to be more natural overall, which is good for people who are looking to move towards a more natural lifestyle.
- Can ease the mind of a nervous consumer who doesn’t want to experience possible/unknown long-term effects of fluoride.
- No risk of accidentally ingesting too much fluoride and experiencing fluoride toxicity.
- No risk of dental fluorosis.
Cons of Fluoride-Free
- According to the American Dental Association, toothpaste must contain fluoride to have the ADA “Seal of Acceptance.” Therefore, flouride free toothpastes aren’t ADA-approved.
- While a fluoride-free toothpaste will have the abrasives needed to physically scrub away food debris and plaque, it won’t remineralize or strengthen weakened enamel in the way that fluoride does, according to Kunen.
- Certain ingredients can take a toll on tooth enamel. For example, Kunen said that while charcoal can scrub your teeth clean, it won’t remineralize enamel and it can possibly wear down your enamel if you use it excessively.
- People with genetic predisposition to tooth decay will not experience protection from toothpaste without fluoride.
How to Pick the Right Toothpaste
If you’re set on a fluoridated toothpaste, you can check out the ADA’s shopping list of approved products and find one that suits your specific needs.
Shopping for a fluoride-free alternative can be tricky, since they are not ADA-approved. Griffin’s advice is to look for “good ingredients combined with good science.” He recommended Revitin, Tooth & Gums and Risewell. It should be noted that even if you do not use fluoridated toothpaste, you will still likely come in contact with fluoride from water sources and possibly even dietary sources. There are several methods that can be used to remove fluoride from their water sources.
If you ask a traditional dentist, fluoride-free toothpaste is not better for your teeth, especially if you have weak enamel or are genetically at higher risk for tooth decay. Kunen does not advise patients to use toothpaste without fluoride, but if a patient really wants to opt for a fluoride-free toothpaste, she recommends looking for accredited brands, such as Tom’s of Maine.
You may want to talk to your dentist to see if they think a toothpaste without fluoride would be good for you. Also, regardless of the type of toothpaste you use, make sure to practice good dental hygiene: brushing twice a day, flossing and changing your toothbrush every three to four months.
As we’ve broken it down, there are pros and cons to each type of toothpaste, and everyone has their own opinion on what is best. After all, it’s your mouth, and you have the right to choose.
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