Dental Care Basics

Does Fluoride Toothpaste Work?

Regular toothpaste doesn't contain enough fluoride to effectively strengthen teeth. That's because the concentration of fluoride in the water system and in toothpaste are two very different things.

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Does Fluoride Toothpaste Work?
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Does fluoride toothpaste really work? You might be surprised to hear that the answer is, no. 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.

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 that much more fluoride to regular toothpaste than what’s in the water.

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—as opposed to ingestion of fluoride when your teeth are developing.

The water system contains a fluoride concentration that strengthens teeth by getting absorbed by your body when you drink water. It’s about 1 part per million.

But you’re not swallowing toothpaste; you’re applying it directly to your teeth. This is a very different from swallowing fluoridated water; this is called “topical” application, and you need a higher concentration of fluoride for this to work; around 5,000 parts per million.

Why doesn’t toothpaste just add the higher concentration of fluoride then 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.

So, brushing with non-prescription fluoride toothpaste is just about the same as brushing with regular tap water that has had fluoride added to it.

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!

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. (I’m not affiliated with Colgate in any way. I used it because, it was the best at remineralizing teeth.)

A natural alternative that is just as effective as fluoride, or perhaps even more (depending on the study) would be chewing on cacao nibs or very dark (90%+) chocolate.

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. 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. Nano-hydroxyapatite (NHa) particles are the exact structure your teeth are made of to begin with, so your teeth uptake it very normally.

NHa toothpaste is non-toxic, unlike fluoride toothpastes that require a Poison Control warning ont he 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 better than fluoride! (1, 2)

Not a lot of these are available to buy yet. However, I started using 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.

when i still prescribe fluoride

There’s one notable exception to my new stance. I still write scripts for prescription-strength fluoride toothpastes to patients going through chemotherapy and radiation for cancer.

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

final thoughts on fluoride toothpaste

Let’s recap.

Over-the-counter fluoride toothpastes don’t contain enough fluoride to actually remineralize your teeth.

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.

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)


  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:
  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:

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