Table of ContentsView AllTable of ContentsHow Fluoride in Toothpaste HelpsDiscovering the Benefits of FluorideRecommendations for Fluoride ToothpasteTypes of Fluoride ToothpasteRisks of Fluoride in ToothpasteControversies Surrounding FluorideAlternatives to Fluoride Toothpaste
Table of ContentsView All
View All
Table of Contents
How Fluoride in Toothpaste Helps
Discovering the Benefits of Fluoride
Recommendations for Fluoride Toothpaste
Types of Fluoride Toothpaste
Risks of Fluoride in Toothpaste
Controversies Surrounding Fluoride
Alternatives to Fluoride Toothpaste
Fluoride in toothpaste is essential inpreventing cavities, also known as dental caries. It does this through several mechanisms. Some of these include delaying the demineralization of toothenamel, preventing bacteria in the mouth from producing harmful acid, and strengthening teeth during tooth development.
Due to its effectiveness, many areas also add fluoride to the water supply to reduce the risk of cavities, especially in kids. The Centers for Disease Control (CDC) named waterfluoridationone of its 10 great public health interventions of the 20th century. This is due to the significant decrease in cavities after fluoride was first added to water in 1945.
Given fluoride’s effectiveness, the American Dental Association (ADA) supports fluoride and requires it in any products with its ADA Seal.Most dentists and healthcare professionals follow ADA guidelines and recommend daily use of fluoride toothpaste. However, despite its ability to reduce cavities, many individuals remain concerned aboutfluoride’s safety.
This article will explain how fluoride works and the benefits and risks of fluoride in toothpaste. It also addresses the dangers of too much fluoride and alternatives for those who need it.
Verywell / Jessica Olah
Scientists have determined several ways fluoride strengthens teeth and helps prevent cavities. These mechanisms include:
Fluoride cannot reverse already established cavities but can slow the rate at which they develop. This is why most dentists and healthcare professionals recommend twice-daily brushing with fluoride toothpaste. The more constant the exposure to fluoride, both in toothpaste and the water supply, the greater the cavity prevention.
In addition to strengthening teeth, regular brushing with fluoride toothpaste can also help promote gum health since fluoride helps prevent harmful bacteria in the mouth.
During the late 1940s, toothpaste became the main form of dental hygiene. Before this, individuals utilized powders and other forms of dental cleaning. The addition of fluoride to toothpaste existed, but fluoridated toothpaste did not become the ADA-recommended norm untilCrest launched their versionin 1955.
Fluoride research began in 1901 when Dr. McKay, a dentist, noticed brown stains on people’s teeth in Colorado Springs, Colorado. Despite their brown appearance, Dr. McKay discovered these teeth were more resistant to cavities. After years of investigation, Dr. McKay discovered fluoride in the water as the main reason for the discoloration and theresistance to tooth decay.
Years later, Dr. Dean, a lead dentist with the National Institute of Health (NIH), furthered research on fluoride in water. He eventually led a study in 1945 in Grand Rapids, Michigan, after it became the first city to fluoridate its water. Children born after the city fluoridated their water had a 60% reduction in cavities.
Depending on your age, there are variations to optimize the beneficial effects of fluoride and minimize the risk of accidentally ingesting too much fluoride.
First tooth until 3 years of age:Toprevent cavities in kids, a caregiver should help their child brush their teeth with fluoride-containing toothpaste the size of a grain of rice twice daily from the time they see their first tooth until the child is 3 years old. This amount maximizes the benefits of fluoride while minimizing the risk of fluorosis if the child ingests the toothpaste.
3 to 6 years old:A caregiver should brush their child’s teeth with fluoride-containing toothpaste that is the size of a pea twice daily until the child is 6 years old.
Ages 6 and older:Once a child reaches age 6, they are less likely to swallow the toothpaste inadvertently and can be instructed to spit it out. By this age, the amount of toothpaste does not need to be as closely supervised as long as the child is spitting it out.
If your child has a condition that affects their ability to swallow, contact your healthcare provider for advice on how much toothpaste to use. Otherwise, children and adults aged 6 and older can use the same amounts of toothpaste.
Fluoride Concentrations in Toothpaste
A toothpaste should have a fluoride concentration of at least 1,000 parts per million (ppm) to achieve the benefits of fluoride use. Most commercial brands contain between 1,000 ppm and 1,100 ppm.
High-fluoride toothpaste generally contains fluoride in concentrations of 5,000 ppm and is only available with a prescription. Individuals with certain risk factors, such as dry mouth, diabetes, or other conditions that put them at high risk for tooth decay, may benefit from toothpaste with higher fluoride concentrations. However, it comes with a greater risk of fluorosis (spots on the teeth). If you think you need a higher concentration of toothpaste, talk to your healthcare provider for advice.
Always choose a toothpaste with the American Dental Association (ADA) Seal of Acceptance, which is a designation given to products with the recommended concentration of fluoride.
There are three different types of fluoride found in fluoride toothpaste. They are:
To receive the ADA seal, toothpaste must contain fluoride. However, the type of fluoride and other ingredients may differ depending on your needs.
For example, you will likely prefer stannous fluoride toothpaste if you havesensitive teeth. Stannous fluoride can help with tooth sensitivity due to touch and the air. For those with teeth sensitive to cold, calcium sodiumphosphosilicateis often added. Other desensitizing agents may also be found in ADA-approved toothpaste.
Other ingredients that are commonly found in toothpaste include:
Depending on the needs of your teeth, your toothpaste may have additional ingredients. Some ingredients work together with fluoride to strengthen your teeth andreduce cavities, while others work on other aspects of dental health or the shelf-life of toothpaste.
If you’re unsure of which toothpaste to use, your dental healthcare professional can recommend specific toothpaste to meet your individual needs.
Despite its many benefits, fluoride toothpaste can cause injury to developing teeth through fluorosis. Dental fluorosis occurs during childhood when the teeth are still coming in, causing whitish opaque patches on the surface of the teeth.
Fluorosis occurs most commonly in children eight and under whose teeth are still developing.
Other than the risk of fluorosis, fluoride in toothpaste is considered safe when used in the proper amounts. Rarely a child can get fluoride poisoning if they overeat toothpaste containing fluoride or consumemouthwashor other products containing fluoride. If your child may have consumed too much fluoride, call your local poison control (1-800-222-1222, which will connect you with the closest center) or contact a healthcare provider for advice.
Despite its benefits, some individuals are concerned fluoride causes more harm than good. Most of the controversy surrounds fluoridation in the water. In excessive amounts, fluoride has the potential to cause several health conditions, such as:
Upper limits of safe fluoride levels can vary somewhat per country or region. In the United States, the CDC recommends optimal fluoride levels greater than or equal to 0.6 mg/L and levels not exceeding 2.0 mg/L. During a five-year study period between 2016 and 2021, only 0.01% of the samples exceeded the 2.0 mg/L threshold.
Some individuals are also concerned that fluoride can contribute to cancer,particularly bone cancer. However, despite several studies, the majority indicate no link.There are also concerns that fluoride impacts cognitive ability and IQ. However, the studies examining this link have demonstrated flawed methodologies and poor evidence.
Additionally, there is a misconception that Europe does not fluoridate its water. While some parts of Europe and the United Kingdom (UK) add fluoride to the water supply, just like in the United States, other parts of Europe and elsewhere add it to the salt supply. There are even fluoridated milk programs in some European countries.
While some individuals have concerns about fluoride use, serious adverse health effects typically only occur with excessive intake, which is usually accidental. For example, a child accidentally ingesting too much of a fluoride supplement or drinking well water with excessive fluoride can cause adverse effects. Standard fluoride toothpaste and the public water supply are regulated to remain at safe levels.
Fluoride-free toothpaste has gained popularity among consumers who prefer to avoid fluoride for personal reasons. Much of the research focuses on calcium-phosphate-containing toothpastes. Toothpaste containing the calcium phosphate calledhydroxyapatitemay perform to the same standard as fluoride without the risk of fluorosis and other fluoride-associated concerns.However, the research is ongoing, and the ADA does not approve this option yet.
Gingivitis Causes and How to Treat It
Summary
21 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organization.Inadequate or excess fluoride: a major public health concern.CDC.About community water fluoridation.Community Water Fluoridation.American Dental Association.WHO emphasizes importance of fluoride in toothpastes.Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.Smithsonian Institution.Oral care.National Institute of Dental and Craniofacial Research.The story of fluoridation.American Dental Association.WHO includes three dental preparations in list of essential medicines for first time.American Dental Association.The superhero that lives inside your mouth.Thornton-Evans G.Use of toothpaste and toothbrushing patterns among children and adolescents — united states, 2013–2016.MMWR Morb Mortal Wkly Rep. 2019;68.American Dental Association.Fluoride toothpaste use for young children clinical practice guidelines (2014).Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.American Dental Association.Fluoride: topical and systemic supplements.American Dental Association.Toothpastes.Nemours Children’s Health.Fluoride.Solanki YS, Agarwal M, Gupta AB, Gupta S, Shukla P.Fluoride occurrences, health problems, detection, and remediation methods for drinking water: A comprehensive review.Sci Total Environ. 2022;807(Pt 1):150601.Boehmer TJ.Community water fluoridation levels to promote effectiveness and safety in oral health — United States, 2016–2021.MMWR Morb Mortal Wkly Rep. 2023;72.American Cancer Society.Water fluoridation and cancer risk.National Institutes of Health Office of Dietary Supplements.Fluoride.SmileSpokane.Europe and fluoridation: The facts about how Europe uses fluoride.Limeback H, Enax J, Meyer F.Improving oral health with fluoride-free calcium-phosphate-based biomimetic toothpastes: an update of the clinical evidence.Biomimetics (Basel). 2023;8(4):331.Additional ReadingAmerican Academy of Pediatrics (AAP). AAP Recommends Fluoride to Prevent Dental Caries. Itasca, Illinois; press release issued August 25, 2014.American Dental Association (ADA). ADA Uses Fluoride Toothpaste to Fight High Cavity Rate in Children. Chicago, Illinois; press release issued February 10, 2014.Slade, G.; Grider, W.; Maas, W. et al. Water Fluoridation and Dental Caries in U.S. Children and Adolescents.J Dental Res.2018:002203451877433. doi:10.1177/0022034518774331.Srinivasan, M.; Schimmel, M.; Riesen, M. et al. High-fluoride toothpaste: a multicenter randomized controlled trial in adults.Community Dent Oral Epidemiol.2014 Aug;42(4):333-40. doi:10.1111/cdoe.12090.Yeung, C. A systematic review of the efficacy and safety of fluoridation.Evid Based Dent.. 2008;9(2):39-43. doi:10.1038/sj.ebd.6400578.
21 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.World Health Organization.Inadequate or excess fluoride: a major public health concern.CDC.About community water fluoridation.Community Water Fluoridation.American Dental Association.WHO emphasizes importance of fluoride in toothpastes.Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.Smithsonian Institution.Oral care.National Institute of Dental and Craniofacial Research.The story of fluoridation.American Dental Association.WHO includes three dental preparations in list of essential medicines for first time.American Dental Association.The superhero that lives inside your mouth.Thornton-Evans G.Use of toothpaste and toothbrushing patterns among children and adolescents — united states, 2013–2016.MMWR Morb Mortal Wkly Rep. 2019;68.American Dental Association.Fluoride toothpaste use for young children clinical practice guidelines (2014).Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.American Dental Association.Fluoride: topical and systemic supplements.American Dental Association.Toothpastes.Nemours Children’s Health.Fluoride.Solanki YS, Agarwal M, Gupta AB, Gupta S, Shukla P.Fluoride occurrences, health problems, detection, and remediation methods for drinking water: A comprehensive review.Sci Total Environ. 2022;807(Pt 1):150601.Boehmer TJ.Community water fluoridation levels to promote effectiveness and safety in oral health — United States, 2016–2021.MMWR Morb Mortal Wkly Rep. 2023;72.American Cancer Society.Water fluoridation and cancer risk.National Institutes of Health Office of Dietary Supplements.Fluoride.SmileSpokane.Europe and fluoridation: The facts about how Europe uses fluoride.Limeback H, Enax J, Meyer F.Improving oral health with fluoride-free calcium-phosphate-based biomimetic toothpastes: an update of the clinical evidence.Biomimetics (Basel). 2023;8(4):331.Additional ReadingAmerican Academy of Pediatrics (AAP). AAP Recommends Fluoride to Prevent Dental Caries. Itasca, Illinois; press release issued August 25, 2014.American Dental Association (ADA). ADA Uses Fluoride Toothpaste to Fight High Cavity Rate in Children. Chicago, Illinois; press release issued February 10, 2014.Slade, G.; Grider, W.; Maas, W. et al. Water Fluoridation and Dental Caries in U.S. Children and Adolescents.J Dental Res.2018:002203451877433. doi:10.1177/0022034518774331.Srinivasan, M.; Schimmel, M.; Riesen, M. et al. High-fluoride toothpaste: a multicenter randomized controlled trial in adults.Community Dent Oral Epidemiol.2014 Aug;42(4):333-40. doi:10.1111/cdoe.12090.Yeung, C. A systematic review of the efficacy and safety of fluoridation.Evid Based Dent.. 2008;9(2):39-43. doi:10.1038/sj.ebd.6400578.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
World Health Organization.Inadequate or excess fluoride: a major public health concern.CDC.About community water fluoridation.Community Water Fluoridation.American Dental Association.WHO emphasizes importance of fluoride in toothpastes.Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.Smithsonian Institution.Oral care.National Institute of Dental and Craniofacial Research.The story of fluoridation.American Dental Association.WHO includes three dental preparations in list of essential medicines for first time.American Dental Association.The superhero that lives inside your mouth.Thornton-Evans G.Use of toothpaste and toothbrushing patterns among children and adolescents — united states, 2013–2016.MMWR Morb Mortal Wkly Rep. 2019;68.American Dental Association.Fluoride toothpaste use for young children clinical practice guidelines (2014).Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.American Dental Association.Fluoride: topical and systemic supplements.American Dental Association.Toothpastes.Nemours Children’s Health.Fluoride.Solanki YS, Agarwal M, Gupta AB, Gupta S, Shukla P.Fluoride occurrences, health problems, detection, and remediation methods for drinking water: A comprehensive review.Sci Total Environ. 2022;807(Pt 1):150601.Boehmer TJ.Community water fluoridation levels to promote effectiveness and safety in oral health — United States, 2016–2021.MMWR Morb Mortal Wkly Rep. 2023;72.American Cancer Society.Water fluoridation and cancer risk.National Institutes of Health Office of Dietary Supplements.Fluoride.SmileSpokane.Europe and fluoridation: The facts about how Europe uses fluoride.Limeback H, Enax J, Meyer F.Improving oral health with fluoride-free calcium-phosphate-based biomimetic toothpastes: an update of the clinical evidence.Biomimetics (Basel). 2023;8(4):331.
World Health Organization.Inadequate or excess fluoride: a major public health concern.
CDC.About community water fluoridation.Community Water Fluoridation.
American Dental Association.WHO emphasizes importance of fluoride in toothpastes.
Mankar N, Kumbhare S, Nikhade P, Mahapatra J, Agrawal P.Role of fluoride in dentistry: a narrative review.Cureus. 15(12):e50884.
Smithsonian Institution.Oral care.
National Institute of Dental and Craniofacial Research.The story of fluoridation.
American Dental Association.WHO includes three dental preparations in list of essential medicines for first time.
American Dental Association.The superhero that lives inside your mouth.
Thornton-Evans G.Use of toothpaste and toothbrushing patterns among children and adolescents — united states, 2013–2016.MMWR Morb Mortal Wkly Rep. 2019;68.
American Dental Association.Fluoride toothpaste use for young children clinical practice guidelines (2014).
American Dental Association.Fluoride: topical and systemic supplements.
American Dental Association.Toothpastes.
Nemours Children’s Health.Fluoride.
Solanki YS, Agarwal M, Gupta AB, Gupta S, Shukla P.Fluoride occurrences, health problems, detection, and remediation methods for drinking water: A comprehensive review.Sci Total Environ. 2022;807(Pt 1):150601.
Boehmer TJ.Community water fluoridation levels to promote effectiveness and safety in oral health — United States, 2016–2021.MMWR Morb Mortal Wkly Rep. 2023;72.
American Cancer Society.Water fluoridation and cancer risk.
National Institutes of Health Office of Dietary Supplements.Fluoride.
SmileSpokane.Europe and fluoridation: The facts about how Europe uses fluoride.
Limeback H, Enax J, Meyer F.Improving oral health with fluoride-free calcium-phosphate-based biomimetic toothpastes: an update of the clinical evidence.Biomimetics (Basel). 2023;8(4):331.
American Academy of Pediatrics (AAP). AAP Recommends Fluoride to Prevent Dental Caries. Itasca, Illinois; press release issued August 25, 2014.American Dental Association (ADA). ADA Uses Fluoride Toothpaste to Fight High Cavity Rate in Children. Chicago, Illinois; press release issued February 10, 2014.Slade, G.; Grider, W.; Maas, W. et al. Water Fluoridation and Dental Caries in U.S. Children and Adolescents.J Dental Res.2018:002203451877433. doi:10.1177/0022034518774331.Srinivasan, M.; Schimmel, M.; Riesen, M. et al. High-fluoride toothpaste: a multicenter randomized controlled trial in adults.Community Dent Oral Epidemiol.2014 Aug;42(4):333-40. doi:10.1111/cdoe.12090.Yeung, C. A systematic review of the efficacy and safety of fluoridation.Evid Based Dent.. 2008;9(2):39-43. doi:10.1038/sj.ebd.6400578.
American Academy of Pediatrics (AAP). AAP Recommends Fluoride to Prevent Dental Caries. Itasca, Illinois; press release issued August 25, 2014.
American Dental Association (ADA). ADA Uses Fluoride Toothpaste to Fight High Cavity Rate in Children. Chicago, Illinois; press release issued February 10, 2014.
Slade, G.; Grider, W.; Maas, W. et al. Water Fluoridation and Dental Caries in U.S. Children and Adolescents.J Dental Res.2018:002203451877433. doi:10.1177/0022034518774331.
Srinivasan, M.; Schimmel, M.; Riesen, M. et al. High-fluoride toothpaste: a multicenter randomized controlled trial in adults.Community Dent Oral Epidemiol.2014 Aug;42(4):333-40. doi:10.1111/cdoe.12090.
Yeung, C. A systematic review of the efficacy and safety of fluoridation.Evid Based Dent.. 2008;9(2):39-43. doi:10.1038/sj.ebd.6400578.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
