Why should you avoid high fluoride in toothpaste?

Although fluoride is effective in preventing dental caries, the fact that it is found in multiple sources, including fluoridated toothpastes, fluoride supplements (drops and lozenges), drinking water, and other natural sources, has contributed to an increase in the incidence of fluorosis and symptoms of too much fluoride. As such, one major challenge is providing the right amount of fluoride in a safe and reliable manner.

But does avoiding the use of fluoride in toothpaste help to solve this challenge?

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Why do people use a fluoridated toothpaste?

Dental professionals suggest that toothpaste is not necessary to remove dental plaque, as the mechanical action of brushing and flossing is enough to disrupt plaque that can lead to tooth decay and gum disease.

However, toothpaste can have benefits such as whitening and a fresher feeling mouth, depending on the specific ingredients used in the toothpaste you’re using.

Fluoridated toothpaste, in particular, can help reduce the demineralization process, which is the first stage of tooth decay, and aid in remineralization. It can also help disrupt dental plaque, which is a leading factor in tooth decay and gum disease.

So, if you have one person using a fluoridated toothpaste and another one using a fluoride-free one, the former (using fluoride) will have lower risk of cavities than the other.

In fact, the ADA promotes the use of fluoridated toothpaste as a requirement for optimal oral health, and even recommends its use as soon as the first baby tooth emerges.

READ: Oral hygiene instructions for special needs patients

That said, the right amount should be used to avoid risks associated with ingesting/swallowing excess fluoride.

Risks Associated with high fluoride in toothpaste

Although using toothpaste that contains higher concentrations of fluoride may provide greater protection against cavities, they can also increase the risk of dental fluorosis, a condition in which the enamel of the teeth becomes discolored and pitted due to chronic ingestion of excessive amounts of fluoride during the period of tooth formation.

Young children are particularly at risk of swallowing toothpaste, and the younger they are, the more likely they are to swallow larger amounts. Even small amounts of swallowed toothpaste can contribute to a child’s daily fluoride intake and potentially cause fluorosis.

To reduce the risk of fluorosis, it is generally recommended that children under three or six years old should be supervised when brushing their teeth with fluoride toothpaste and only use a smear or pea-sized amount of toothpaste, respectively. (how much fluoride is in toothpaste)

The frequency of toothpaste use along with the method of rinsing after toothbrushing are other factors influencing the effectiveness and safety of fluoride toothpaste. Research suggests that brushing twice a day or more, and rinsing less thoroughly after brushing can also help reduce the risk of cavities.

Keep in mind that accidental ingestion of toothpaste containing high concentrations of fluoride can be potentially life-threatening for young children. Therefore, it is recommended that these toothpastes should be kept out of the reach of children.

Is fluoride-free toothpaste better?

Fluoride-free toothpaste has become popular among consumers who prefer “natural” products or want to avoid fluoride. Some of these pastes contain baking soda or other ingredients believed to have antimicrobial properties.

READ: Does fluoride varnish have an age limit?

Proponents of non-fluoridated toothpaste argue that you don’t need to use fluoride if you can instead avoid sugar and make sure to brush regularly to remove plaque.

However, this argument is flawed because sugar is present in many foods, and regular cleaning does not prevent tooth decay mechanisms such as demineralization.

Although non-fluoride toothpaste can keep your mouth fresh and your teeth shiny, it is less effective in preventing enamel erosion, gingivitis, and tartar buildup.

That is why only fluoride toothpaste has the ADA Seal of Acceptance, and not fluoride-free toothpaste.

Alternatives to fluoride

While fluoride is one of the most effective ways to prevent mineralization and promote remineralization of tooth enamel, there are some alternative approaches that may help to some extent, and are worth considering for those who are wary of fluoride toothpaste:

Xylitol: This sugar substitute has been shown to help prevent tooth decay by reducing the amount of harmful bacteria in the mouth, increasing salivary flow, and promoting the growth of beneficial bacteria that can help to remineralize teeth.
Calcium and phosphate: These minerals are important for building strong teeth and bones, and there are toothpaste formulations that contain both calcium and phosphate to help remineralize enamel. Dairy products such as milk, cheese, and yogurt, as well as almonds and other nuts and seeds are good sources.

Nano-hydroxyapatite (n-Ha): This mineral is a natural component of teeth and bones, and toothpaste containing hydroxyapatite has been shown to help remineralize teeth and reduce sensitivity.

It’s important to note that while these alternative approaches may offer some benefits, fluoride is still considered the most effective way to prevent tooth decay and promote overall oral health.

READ: What does fluoride do for the body?

Safe use of Fluoridated toothpaste

The American Academy of Pediatrics (AAP), just like the ADA, also supports the use of fluoride toothpaste from the time of a child’s first tooth eruption.

Both organizations recommend using a children’s toothpaste with 1,000 ppm of fluoride (normal toothpaste – refer to how much fluoride is in toothpaste) instead of low-fluoride or fluoride-free toothpaste. That said, the right amount of toothpaste used varies by age:

For children under three, a small smear should be used to minimize swallowing
For children aged three to six, a pea-sized amount should be used

Even if swallowed in the recommended amounts, the concentration of fluoride is unlikely to cause harm.

Moreover, adults should avoid using high-fluoride toothpaste as their everyday brand unless they have certain medical conditions or wear fixed braces for a long period of time.

If you notice that your child has a tendency of swallowing toothpaste when brushing, your dental hygienist can recommend a less tasty brand of toothpaste to help deter them.