Should you use fluoride-free toothpaste? We asked dentists

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I’ve reported about oral care for five years, so I talk to dentists at least once or twice a week. Regardless of what topic we’re discussing, fluoride comes up. The ingredient, most commonly found in toothpaste, has cavity-fighting superpowers. “It’s truly one of the only ingredients that’s ever been proven to effectively combat cavities, making it so important in dentistry,” says Dr. Lisa Creaven, a dentist and the co-founder of Made By Dentists. (Ed’s note: The inclusion of products sold by Made By Dentists in this article was made independently of Creaven.)

But with more brands now selling “natural” and “chemical-free” toothpastes, some people are wondering: should you use fluoride-free toothpaste? The answer is a resounding no, according to dentists I spoke to. Here’s why, plus everything you need to know about fluoride in your dental products (and drinking water). I also break down how to choose the best toothpaste for adults and kids.

SKIP AHEAD What is fluoride? | Is fluoride toothpaste safe? | Should you rinse after using fluoride toothpaste? | The best fluoride toothpaste for adults and kids | What is fluoride-free toothpaste? | Should you use fluoride-free toothpaste? | Why is there fluoride in drinking water?

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Fluoride is a naturally occurring mineral that’s most commonly found in water, says Dr. Matt Messina, an associate professor at The Ohio State University College of Dentistry. It’s also in soil, plants and some foods. There’s numerous types of fluoride, but three are used as active ingredients in dentistry due to their equally effective cavity-fighting properties: sodium fluoride, sodium monofluorophosphate and stannous fluoride.

To understand how fluoride benefits teeth, you have to understand how you get cavities.

When you eat or drink something, including sugary foods and drinks, the bacteria in your mouth breaks it down and creates acid. Acid weakens and dissolves enamel, which is the hard outer layer of your teeth. Over time, this process can lead to cavities, a.k.a tiny holes in your teeth. To prevent cavities, you need to break the enamel erosion cycle, says Messina — that’s where fluoride enters the picture.

Adult teeth have all the enamel they’re ever going to get once they come in, so you can’t replace what’s lost, says Messina. You can, however, harden remaining enamel by using dental products made with fluoride, like toothpastes and mouthwashes. The ingredient chemically changes the crystalline structure of enamel to become part of it, strengthening it and making it more resistant to acid and decay, says Creaven. Fluoride also has an antibacterial effect, so it reduces bacteria growth and the overall number of bacteria in the mouth, says Messina.

Yes, fluoride toothpaste is safe for kids and adults to use. Brands add fluoride to toothpaste in controlled, measured amounts — the FDA sets limits for exactly how much depending on the type of fluoride and what age group the toothpaste is made for. At low levels typically ranging from 1,000 to 1,500 parts per million, “you’d have to consume [swallow] tube after tube after tube of toothpaste to have an issue,” says Creaven. Fluoridated toothpaste is designed to be spit out, which is explicitly stated on product labels, and even if you swallow a teeny tiny amount while using it, you shouldn’t worry, she says.

Developing fluorosis — little white dots on tooth enamel — is one of the main concerns people express about fluoride in dental care and water, says Dr. Scott Tomar, a dentist and spokesperson for the American Dental Association. This can only occur in children when their teeth are developing under their gums. But the risk of fluorosis is greatly minimized by the FDA’s limits around how much fluoride is allowed in dental care products and water, further emphasizing how safe the ingredient is.

Overall, scientists and doctors have researched using fluoride in dental care for decades, and evidence consistently proves its safety and efficacy, says Tomar. “Considering the extent to which fluoridation has been implemented in numerous countries for decades, the lack of documentation of adverse health effects is remarkable testimony to its safety,” he says.

It takes some time for fluoride to fully work its magic, which is why dentists don’t recommend rinsing after you brush, and waiting about half an hour before you eat or drink. “You want to let fluoride sit there for a little bit to do its job,” says Creaven.

The best anticavity toothpaste for adults and kids is one that has the American Dental Association’s Seal of Acceptance, which is the gold standard for oral care products, dentists told me. To earn the Seal of Acceptance, brands have to submit evidence showing that their products meet specific safety and efficacy requirements. The ADA reviews the evidence, and if a product meets all the necessary criteria, it earns the seal. You can browse through all the products that currently have the seal here.

Only fluoride toothpastes are eligible to earn the ADA’s Sea of Acceptance because the ingredient’s efficacy is so well-established, says Tomar. The organization doesn’t currently recommend any fluoride-free or toothpaste alternatives — evidence of efficacy is too new and ambiguous to draw conclusions yet. Below are a few of our favorite ADA-accepted toothpastes.

As its name implies, fluoride-free toothpaste is toothpaste without fluoride in it. It’s formulated with detergents and abrasives that scrub teeth clean of dirt, grime and stuck-on food when you brush with it, but it doesn’t have anticavity benefits, says Creaven.

Many fluoride-free toothpastes are made with nano-hydroxyapatite, the synthetic form of hydroxyapatite, which is a compound in tooth enamel, says Messina. Using nano-hydroxyapatite in over-the-counter dental care products is still being studied, but evidence currently shows that it can help remineralize (add minerals back to) eroded areas on teeth, says Tomar. It doesn’t chemically change the crystalline structure of enamel to make it more acid-resistant or offer antibacterial properties like fluoride does, however. That gives fluoride an advantage over nano-hydroxyapatite as far as preventing decay is concerned, says Tomar.

The dentists I spoke to unanimously agree that you should not use fluoride-free toothpaste. “If you brush twice a day with fluoridated toothpaste, floss once a day, maintain a healthy diet and regularly see your dentist, you’re going to keep your teeth for a lifetime,” says Messina. “But if you use a fluoride-free toothpaste, you’re leaving one of your best tools in the toolbox.”

That said, if you opt to use fluoride-free toothpaste, you need to practice near-flawless tooth brushing and flossing, cut out as much sugar from your diet as possible and potentially visit the dentist more often, says Messina. “Can you survive without fluoride? Sure, but you make your life harder,” he says.

Additionally, the FDA regulates fluoride in dental products, so brands have to follow strict guidelines around marketing claims — for example, all fluoridated toothpaste and mouthwash must be labeled “fluoride” and/or “anticavity.” Brands can’t make any anticavity claims about fluoride-free toothpaste, per the FDA, but their marketing is otherwise unregulated. Dentists say this can lead to misleading information on fluoride-free toothpastes’ packaging, so be extra cautious if you’re shopping for it.

“Adding fluoride to water is very much like adding vitamins and minerals to certain foods and drinks: it’s a step that helps us get the nutrients we need,” says Tomar. “Fluoride is a natural element found in groundwater and oceans, so when we add it to drinking water, we’re adjusting it to the level that science shows will help prevent tooth decay.”

The Environmental Protection Agency’s current recommendation for fluoride levels in drinking water is seven parts per million. To understand how low that level is, think of it like a minute in 1,000 days, says Messina. “This concentration provides the best balance of protection from dental cavities while limiting the risk of dental fluorosis,” says Tomar. “It would be very difficult for the average person to reach dangerous fluoride levels, even in conjunction with fluoridated toothpastes.”

In most parts of the United States, communities add fluoride to water to reach the EPA’s recommended level. But in some areas, the amount of fluoride in water is naturally higher than the recommended level, so some is taken out before it gets to you.

Overall, fluoridating water is one of the most studied public health measures in history, says Tomar. “Fluoride in water benefits everybody,” says Messina. “It helps you get the benefits of fluoride without doing anything, which is great from a health equity perspective.”

At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also ensure that all expert advice and recommendations are made independently and without undisclosed financial conflicts of interest.

• Dr. Matt Messina is an associate professor at The Ohio State University College of Dentistry and the clinic director of Ohio State’s Upper Arlington Dentistry.
• Dr. Scott Tomar is a dentist and spokesperson for the American Dental Association.
• Dr. Lisa Creaven is a dentist and the co-founder of Made By Dentists. (Ed’s note: The inclusion of products sold by Made By Dentists in this article was made independently of Creaven.)

I’m a reporter at NBC Select who has covered oral care since 2020, including articles about adults and kids toothpaste, floss, water flossers and teeth whitening. To write this article, I interviewed three dentists about fluoride-free toothpaste, fluoride and water fluoridation.

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Zoe Malin

Zoe Malin is a reporter for NBC Select who leads coverage for tentpole sale events including Amazon Prime Day, Black Friday and Cyber Monday.