Does Fluoride Toothpaste Work?

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Does fluoride toothpaste really work? You might be surprised to hear that the answer is…not really. While fluoride is proven to be effective in remineralizing teeth, it doesn’t have a strong enough concentration in toothpaste in order to be effective.

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Fluoride Toothpaste is Too Weak to Be Effective

Here’s what’s misleading: the concentration of fluoride in toothpaste is too weak to have an effect. That’s because they don’t add high concentrations of fluoride to regular toothpaste.

They add an amount that is safe in case it gets swallowed by a child, but not strong enough to really do the job of remineralizing your teeth topically.

The water system contains a fluoride concentration that is supposed to strengthen teeth from the inside when you drink water. It’s about .7 parts per million (ppm). (Check out my fluoride article from the first paragraph; the science behind this is actually pretty shaky and ingestion of fluoride over time like this might be doing more harm than good.)

You’re not swallowing toothpaste; you’re applying it directly to your teeth. This is called “topical” application, and you need a higher concentration of fluoride for this to work than you’ll find in over-the-counter toothpaste—around 5,000 parts per million.

Why doesn’t toothpaste just add the higher concentration of fluoride to make it effective? That higher concentration would severely damage developing teeth if swallowed, so the FDA doesn’t allow it.

This is why you can only get fluoride paste, which contains the right concentration for topical application, by prescription only.

Where does that leave us? If you bought your toothpaste without a prescription, then it’s likely too weak of a fluoride concentration to strengthen your teeth.

Fluoride Is Absorbed Best After You’ve Brushed

If you do get a fluoride toothpaste by prescription from your dentist, then you’ll be instructed to brush first before applying the paste.

The uptake of fluoride—in other words, how your teeth absorb the fluoride—isn’t optimal when your teeth haven’t been brushed yet. 

Teeth naturally grow a covering called biofilm, and this is the stuff you remove every time you brush. You have to remove the biofilm by brushing first, and afterwards, apply fluoride paste. This has to be a two-step process.

In other words, you can’t wash and wax your car at the same time!

Prescription Fluoride Toothpaste That Works

You can get a prescription fluoride gel from your dentist that will help with remineralization. I used to recommend (and use myself) Colgate PreviDent 5000 Booster Plus every night before I went to bed.

I chose this brand to treat the areas of my teeth that are sensitive to cold and acids due to gum recession, and only after I’ve brushed to remove the biofilm. At the time, it was the best at remineralizing teeth.

The Toothpaste I Use Instead of Fluoride

I say “used to recommend” above, because I almost never prescribe fluoride anymore (or use it myself).

See, there’s a better product on the market now for most consumers. I’ve been following the research for years and I’m confident that it’s the best option for myself and my family (and yours!) to remineralize cavities.

It’s called nano-hydroxyapatite toothpaste. Hydroxyapatite (Ha) particles make up 90% of the structure of your teeth, so your teeth uptake it with ease.

NHa toothpaste is non-toxic, unlike fluoride toothpastes that require a Poison Control warning on the back. If your little one were to swallow an entire tube of it, the results would be about the same as if s/he drank a cup of bone broth!

The best part? Nano-hydroxyapatite works equally as well or better than fluoride in scientific studies!

Not a lot of these are available to buy yet. However, I now regularly use Boka’s Ela Mint Toothpaste, a nano-hydroxyapatite toothpaste that you can get as a subscription or as a one-time purchase.

Boka’s doesn’t foam much (because it has no SLS), which means it’s easier to hit that two-minute mark you need to disorganize your biofilm properly. It’s also free of other concerning ingredients in some toothpastes, like titanium dioxide, hydrogen peroxide, parabens, or synthetic flavors.

When I Still Prescribe Fluoride

There’s two notables exception to my new stance. I still write scripts for prescription-strength fluoride toothpastes to patients going through chemotherapy and radiation for cancer. I also prescribe it to those with extensive bulimia damage, for which prescription-strength fluoride can really help with tooth sensitivity.

I’ve found that, for these patients, fluoride does the most to decrease their painful sensitivity to hot and cold.

Final Thoughts on Fluoride Toothpaste

Let’s recap.

  1. Over-the-counter fluoride toothpastes don’t contain enough fluoride to actually remineralize your teeth. Plus, they’re toxic if swallowed.
  2. Prescription-strength fluoride toothpaste can definitely remineralize your teeth, but you’re running the risk of exposing yourself to a substance that’s toxic when ingested.
  3. A new development in dental technology, nano-hydroxyapatite toothpaste, works better than fluoride to remineralize teeth.

What other questions do you have about fluoride toothpastes? You can always send me a message by using the “Submit your question” link!

Mark Burhenne DDS

Read Next: The Complete Guide to DIY Toothpaste (And The Recipe I Use)

References

  1. Vano, M., Derchi, G., Barone, A., & Covani, U. (2014). Effectiveness of nano-hydroxyapatite toothpaste in reducing dentin hypersensitivity: a double-blind randomized controlled trial. Quintessence International, 45(8). Abstract: https://www.ncbi.nlm.nih.gov/pubmed/25019114
  2. Tschoppe, P., Zandim, D. L., Martus, P., & Kielbassa, A. M. (2011). Enamel and dentine remineralization by nano-hydroxyapatite toothpastes. Journal of dentistry, 39(6), 430-437. Full text: https://www.sciencedirect.com/science/article/pii/S0300571211000832

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25 Comments

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  1. Deane Alban says:

    I’d be interested to know your thoughts about Livionex. I’ve just started using it and hope it’s all it’s made out to be. It’s supposed to be good at remineralizing teeth.

  2. I’m searching for the best (healthy, works, safest for environment) tooth powder or paste. Commercial toothpastes taste fine but have some significant environmental problems: triclosan, plastic microbeads, and the left over plastic tube and cap. Baking soda is noted by many as being too strong/abrasive for regular brushing.

    Currently the most sustainable tooth powder I’ve been able to find is the following recipe:
    4 tbsp bentonite clay
    1 tbsp activated charcoal
    6 drops peppermint (essential) oil
    1.5 tsp stevia, powdered and unprocessed
    1 tsp ground cloves (optional)
    1 tsp cinnamon (optional)

    What do you think of this formulation? How well will it work? Any downsides to this? I’ve got all the ingredients on order (should arrive in a few days). If you want to try some of what I mix up I could drop some off at your office 🙂

    • I’m not sure if they are completely free of the things you dont want but a vegan mostly organic company called Lush make these toothy tabs but forewarned they are gross

  3. By they way, I really like chewing on cocoa nibs and very dark chocolate 🙂

  4. I dont use any toothpaste to be honest…

    • I’m pretty sure that I have moderate to severe enamel erosion even though my dentist (that I see every 6 months) has said the see throughness of my teeth was normal the few times I’ve asked. I have noticed by looking at old pictures that it has gotten much worse after I had braces. I also had a problem with brushing too hard. My diet was/is (trying to be better) not great but I thought as long as I brushed, the sugar would not harm my teeth. I now know differently. What are your thoughts on regenerate, biomin f, boka, and apagard? Which one should I get to help save the enamel I have left? And I’m planning on getting either tooth mousse or mi paste to help, which one is better?

      • Mark Burhenne, DDS says:

        Boka has my favorite nHa toothpaste! It’s much more effective than fluoride and non toxic! Use the link in my store page AND my discount code ASKTHEDDS to save 10% off!

  5. Stacey Lauser says:

    My hygienist just recommended the Colgate PreviDent 5000 Booster Plus since Im mid age and have some mild to moderate recession in areas. She said it would help prevent further recession…do you believe this to be true? I do want my teeth to be healthy as we all do.

    • It won’t prevent recession directly but protects from decay and sensitivity of root structure exposed by recession. My blog post here was about over the counter toothpaste. The Prevident has an effective stronger concentration of fluoride and can remineralize tooth structure. But it will not prevent recession. Look to grinding and aggressive brushing as potential causes of recession. DrB.

  6. My dentist sells me Colgate Prevident. Why does it cost $16 when a large tube of regular toothpaste costs $3 or $4? Is fluoride that expensive?

  7. Hi my dentist recommended Prevident 5000 can I still wear my retainer after I use the paste?
    Thank you

  8. Guy Incognito says:

    I was under the impression that water fluoride was around 1ppm. Surely 1000ppm would be causing widespread fluorosis?

  9. Fredrick Davis RN says:

    I have been prescribed PreviDent by my Dentist. I also brush with hydrogen peroxide afterwards. Any suggestions on this practice.

  10. Wait… what. Are you serious about the cocao nib thing??

  11. My son is 10 and has only had one cavity. His dentist gave him prescription Clinpro 5000. They also told me to have him use it twice a day instead. Now he has what looks like plaque deposits on his teeth. Are kids supposed to be using the prescription toothpaste?

  12. The Colgate Booster word is hyperlinked to the Gel-Kam Fluoride Preventive Treatment Gel on Amazon. Is that worth trying out or is there no point using that because it is like toothpaste?

  13. Alostperson says:

    This seems to directly contradict current ADA standards and current research. Why even bother with fluoride toothpastes then? Besides tap water has 1 ppm of fluoride in it. Normal toothpaste has 1100ppm. Colgate’s prescription toothpaste has 5000ppm. I’ve read papers that around 1000ppm produces a remineralization effect. 5000ppm is for really bad cases of decay (or treatment resistant sensitivity). Something seems off about the article.

  14. Robert Hinojosa says:

    Thank you for sharing about fluoride in the toothpaste and how it works. This could help parents be more aware of the toothpaste for their kids.

  15. So with a nano-hydroxyapatite toothpaste, is there a need to brush before using the toothpaste like you would with a fluoride toothpaste, or can it just be used normally?

    • Mark Burhenne, DDS says:

      Great question, Jules!

      Not at all! There is no need to pre-brush. N-Ha is completely non-toxic and safe to even ingest!

  16. Are the fluoride mouthwashes better than the OC fluoride toothpastes?

    • Mark Burhenne, DDS says:

      Both are toxic if ingested. I recommend you read my other fluride articles too.

  17. Cynthia Wright says:

    Dr. Burhenne,
    Would the Boka toothpaste that you recommend be effective at protecting the roots below crowns that I have? My dentist is wanting me to use the prescription fluoride to help preserve my roots. Thanks for your help.

    • Mark Burhenne, DDS says:

      Hi Cynthia,

      Great thinking. Unfortunately, I’m not 100% sure if Boka claims root protection, however, they DO use nanoparticles that are effective at reaching deep into the tubules. I hope this helps.

      Dr. B.

  18. Dr. Burhenne, I actually started using Boka 2 months ago, after reading about fluoride toxicity; and having a severe reaction to a concentrated fluoride my dentist had me using. So far I am not feeling much difference, but I am not giving up (nor inclined to repeat the fluoride experience; I felt like someone had taken sandpaper to the insides of my cheeks). But I was more or less chastised at my recent cleaning for going off of fluoride; and encouraged to keep trying it. For now I’m sticking with the NHa, and starting oil pulling to see if it can help with the staining that has been a major issue in my cleanings. (It seems that the things that are great for the rest of my body are not so great for my porous roots. Matcha, herbal tea, etc. And I don’t want to give those up since they are so good for the rest of my body.)

    Can you please comment on what you have seen regarding how long it takes for NHa toothpaste to show results with remineralizing; and how effective coconut oil can be for stain removal? And, the two in tandem? (I did read your oil pulling article, which is how I found your site.) I just want some encouragement that I am not being irresponsible, as my hygienist seems to think. Thank you.

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