FAQs
What does fluoride do?
"Fluoride helps protect the tooth's enamel and provides a natural protectant against cavities," said Dr. Carrillo.
Now, you might think brushing is solely meant to fight cavities but it serves a different purpose: "The goal of brushing your teeth is to have the mechanical action disrupt and remove the physical plaque that sits on our teeth," said Dr. Ogbevoen.
The goal of conventional toothpaste and mouthwashes with fluoride is to help remineralize and strengthen your enamel — which is constantly breaking down due to the foods and drinks we consume throughout the day, Dr. Ogbevoen explained.
Is it OK to use fluoride-free toothpaste?
Just like fluoridated varieties, fluoride-free toothpaste is completely safe, Dr. Saw tells Insider.
However, while fluoride-free toothpaste may be a safe alternative for some people, they're not necessarily the safest option for your oral health, said Yvette Carrillo, DDS, MS, a board-certified periodontist and implant surgeon in San Diego. If you're at high risk for tooth decay or cavities, your safest toothpaste is one with fluoride.
Is fluoride necessary?
Yes, fluoride is necessary and all our experts agree it's essential for dental health.
Nehi Ogbevoen, DDS, and certified orthodontic specialist at Barkate & Nehi Orthodontics in California told Insider, like many other dentists, feels that fluoride in your toothpaste specifically "is a must."
But other experts feel the mineral doesn't have to come via your toothpaste. Dr. Saw believes fluoride-free toothpaste can be safe for some patients, but she still recommends getting fluoride elsewhere for your teeth. "I always recommend to my patients to have fluoride varnish [a treatment applied by a dentist] at least once a year."
She also points out that some people get fluoride through their city water — but this isn't universally applicable. "If your water is fluoridated and you are always drinking that water, then you should be fine without a fluoride toothpaste," says Dr. Saw. "However, most people are drinking bottled or filtered water, and the fluoride is removed."
Why avoid fluoride in toothpaste?
In most cases, you shouldn't be using fluoride-free toothpaste. Fluoride is essential for healthy teeth and the concentration in toothpaste doesn't pose a risk, all our experts agree. That being said, there are a select few categories for whom it makes sense to avoid fluoride in toothpaste:
- If you have fluorosis. "Fluoride can strengthen your existing teeth and make them more resistant to cavities; however, when fluoride is ingested in large amounts, it can cause a condition called dental fluorosis, which causes discoloration and pitting in the teeth along with brown or white spots," says Dr. Saw. This is pretty rare and comes from overconsuming fluoride in the past–so you're not going to develop it from using fluoridated toothpaste or water.
- If you have a fluoride allergy. Some people are allergic to fluoride, but it's incredibly rare (Dr. Ogbevoen put that number at roughly 1% of people). Still, if this is you, you should switch to a fluoride-free option.
- If you're a child under 6 who keeps swallowing the toothpaste. "The American Dental Association recommends a smear of toothpaste with fluoride from the eruption of the first tooth," said Dr. Palmer, adding this should be a pea size for children ages 3-6. That being said, if a child under six can't properly spit out the toothpaste, you can switch them to a fluoride-free toothpaste to avoid an upset stomach, Dr. Ogbevoen said.
Is it OK to ingest fluoride?
You do get some amount of fluoride from food and drinks. And for people who have perfect oral health and are at low risk for developing cavities, this may be enough, Dr. Saw says.
But if you aren't earning an A+ on your dental hygiene, every day, with a seal of approval from your dentist, you should still opt for fluoridated toothpaste.
"Patients who aren't cavity-prone, who are systemically healthy, don't have dry mouth, don't have acidic saliva, don't have hormonal imbalances, are not prone to stress, and who are effective brushers [are good candidates for fluoride-free toothpaste]," says Dr. Carrillo.
But this is a very small group of people.
For reference, "effective brushers" means those who "brush for the recommended two minutes twice a day and floss at least once a day, every single day without fail."
Who should not use fluoride-free toothpaste?
Most people should always use toothpaste with fluoride, especially if you're cavity-prone (think: if you have more than one to two fillings or crowns in your mouth).
"Fluoride makes tooth enamel more resistant to attaching acids," said Dr. Saw. "It works with saliva to protect tooth enamel from plaque and sugars."
You should also keep fluoride in the mix if you:
- Have dry mouth (xerostomia)
- Are undergoing radiation therapy
- Have systemic or chronic illnesses
- Are not effective at brushing (such as elderly patients)
If you're at high risk for cavities or have weaker enamel, your dentist may recommend an even higher fluoride content in your toothpaste to protect against future dental decay, says both Dr. Saw and Dr. Palmer.
What's wrong with fluoride in toothpaste?
Some people worry fluoride toothpaste is bad because they've heard stories about the potential side effects, but these only really happen with extreme over-consumption and usage, like fluorosis of teeth and bones causing poor mineralization, said Dr. Ogbevoen.
A 150-pound person would have to ingest around 340mg of fluoride to reach acute toxicity, and brushing twice a day with a pea-size of toothpaste delivers roughly 0.1mg per day.
For adults, the potential dangers of fluoride — chronic fluoride toxicity — typically do not come from toothpaste. They might come from fluoridated water ("groundwater with a fluoride concentration over 1.5 mg/L"), but Dr. Ogbevoen pointed out the current government-approved fluoride amount in the public water supply is just 0.7mg/L — "a much lower amount than what would cause concern for Fluorosis."
Sometimes people also fear the white and brown spots they may see on other people's teeth, but this is also a risk exclusive to fluoridated water (or poor-quality water in remote areas or certain countries), Dr. Saw added.
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