The most common question I get at the office is “What toothpaste should I be using?” So, here’s the Cliff Notes on everything you need to know about your toothpaste.

We recommend any toothpaste with an active fluoride system. With all the emphasis on natural and organic products these days, some people are concerned about fluoridation and whether or not it is of any real benefit. And is it potentially harmful?

Fluorine is a common element that’s frequently found in our water and foods as naturally-occurring fluoride. Some towns don’t need to fluoridate their drinking water because enough fluoride is present in the groundwater naturally to prevent tooth decay. In communities where there is not adequate fluoride naturally, a fluoride compound is added to the water during purification. Dozens of studies have shown that there is a marked reduction in tooth decay after the fluoridation of a community’s water supply. So, it is of great benefit, particularly in reducing the incidence of decay in children.

If you are on a well, there may be enough fluoride in your water. To find out, call the water lab at the State Board of Health at (317)921-5874 and ask for a fluoride test kit. For ten bucks and $6.50 S&H, they will send you a collection bottle and instructions on submitting your water for analysis. The results will be returned to you in 30 days or less. A copy may also be sent to your dentist.

Sometimes people ask, “But isn’t fluoride a poison?” Well, yes, it is, but only if it’s in a high concentration. Table salt is also poisonous if you eat enough of it. The amount of fluoride added to water is miniscule, compared to toxic levels. With fluoridated water, we are talking about 0.8 to 2 ppm (parts per million.) 1 part per million is the equivalent of one teaspoon for every 1,302 gallons of water. That’s not much, but it’s all you need to reduce tooth decay.

By the way, reverse-osmosis water filtration systems remove fluoride, so if you have an RO system, fluoride in your toothpaste is doubly important.

So, look for the toothpaste that’s labeled “cavity preventive”. It’ll be on the bottom shelf near either end of the display, where it’s hard to see. It’ll be less expensive than the ones with all the whiteners and breath fresheners. That’s why they put it where it’s easily missed!

So, what else is in toothpaste? There will be a detergent as a cleaning agent, an abrasive as a scrubbing agent, flavoring, coloring, and a surfactant. What the heck is a surfactant? That’s what makes stuff foamy. Anything that makes thick suds, like toothpaste, shampoo, or dish detergent, will have a surfactant to enhance foaming, usually something called sodium lauryl sulfate.

The detergent is not a problem. It works to clean better than a bare brush would. The abrasive is another story. Most toothpastes use a form of silica as an abrasive, the equivalent of ground quartz or fine sand. Some pastes are too abrasive for frequent use, the ones who tout their polishing ability, like Close-Up and Ultrabrite. Occasional use is okay, but daily use, particularly if you really like to scrub, has the potential for visible loss of tooth material. Use highly-abrasive pastes wisely.

Now, let’s talk about sodium lauryl sulfate. If you have frequent outbreaks of cold sores or fever blisters, you may be sensitive to SLS. Use a paste with no SLS and see if that helps. Non-SLS pastes are not always easy to find. The most commonly available one is Sensodyne, pink formula. Sensodyne has several other formulas, but most have SLS. The old-fashioned pink does not. You’ll be able to find non-SLS pastes in most health-food stores, too, but you’ll have to spend a lot more for them there.

What about those whiteners and germ killers that so many pastes have now? It’s mostly marketing. If there were enough of those ingredients for a truly therapeutic benefit, they’d be prescription items.

Often, when I ask patients what toothpaste they use, they answer, “Whatever is on sale.” Which is fine, as long as there’s fluoride in it. Check the box for this statement from the American Dental Association: “Crest (substitute any other name) has been shown to be an effective decay-preventive dentifrice…” There will also be the shield of the ADA Council on Dental Therapeutics. There are some good pastes that don’t have the endorsement of the ADA, but the ones that do have proven in clinical studies that they’re effective against decay.

One more thing…if you have acid reflux or other chronic stomach problems, you may be regurgitating acid at night, which can lead to decay or tooth sensitivity. It helps to use a paste high in baking soda at bedtime. Brush well and spit, but don’t rinse, so that a film of baking soda remains on your teeth. It will help neutralize any stomach acid that you burp up while you’re sleeping.

Next time, we take on mouthwashes!


  1. People should know that the fluoride that’s added to water supplies is not pharmaceutical grade. Fluoridation chemicals (silicofluorides) are captured from the smokestacks of phosphate fertilizer industries and are allowed to contain trace amounts of lead, arsenic, mercury and other toxins.

    This fluoride has never been safety tested on humans or animals. The Florida producer of silicofluorides is one of the worst environmental polluters in the state – one of the reasons is their fluoride emissions.

    Ingesting fluoride does not reduce tooth decay, according to the Centers for Disease Control

    for more info http://www.fluorideaction.net

    • You are correct that fluoride ingestion does not reduce tooth decay. All those fluoride-laced vitamins that pediatricians have been prescribing for years and years are effective only while the child is chewing them up–the fluoride in the vitamin becomes a topical application while the stuff is in the mouth. As far as your info on the source of fluoride that’s used as a water additive, I will check out. Thanks for responding!

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