Interviewer: Natural toothpaste, you know the kind that doesn't have fluoride? Does it work? We're going to find out next on The Scope.
Dr. David Okano is a periodontist with over 30 years of experience and is currently an assistant professor at the University of Utah School of Dentistry. It seems like when you go down the toothpaste aisle now, you're starting to see more and more natural options and a lot of those have no fluoride in them. Are those toothpastes effective?
Effectiveness of Fluoride-Free Toothpaste
Dr. Okano: In terms of prevention of tooth decay, no. The only benefit that you'll gain is a fresher mouth with natural toothpaste, but you will not receive any benefit against tooth decay if it doesn't have fluoride within it.
Interviewer: So the act of just cleaning your teeth at the end of the day, scrubbing them with a brush, that doesn't prevent tooth decay? Do you need to have fluoride?
Dr. Okano: You certainly need to brush your teeth. The question is, do you need toothpaste to clean your teeth?
Interviewer: Okay.
Dr. Okano: You really do not need toothpaste to remove the dental plaque from your teeth. Purely the mechanical action of the toothbrush bristles and your dental floss disrupts the dental plaque that ultimately leads to tooth decay and gum disease. So you really don't need toothpaste. Now, toothpaste does have some benefits. Some will have some whitening agents for those who want whiter teeth with associated concerns, though, with abrasiveness, and sensitivity considerations. You would also have a fresher-looking mouth. But as far as removing the causative factors for tooth decay and gum disease, the toothpaste itself is not as important as purely the mechanical action of your toothbrush and your dental floss.
The Role of Fluoride in Preventing Tooth Decay
Interviewer: Okay. And then how does fluoride help prevent tooth decay, then? Because it sounded like you just said that the mechanical action of your brush could do a lot of that.
Dr. Okano: Sure. The benefit that you would have with fluoride in your toothpaste is that the fluoride will help reduce the demineralization process, which is the first stage of tooth decay. Also, if you have the demineralization but not yet a full-blown cavity in the tooth, the fluoride can be taken up into that demineralized area to help it remineralize. Also, fluoride does help disrupt dental plaque, which is what we just talked about as the causative factor in tooth decay and gum disease.
Interviewer: So if two patients identical in every way came in and one was using natural toothpaste and one was using a fluoride toothpaste, what would the differences be?
Dr. Okano: All things being equal, you would see less potential for tooth decay in the individual who was using the fluoride-containing toothpaste.
Recommendations for Fluoride Toothpaste Usage
Interviewer: Is that something that you would really need to use every day or if somebody was concerned about fluoride, they just use the fluoride once a week?
Dr. Okano: No, you should use it with your toothpaste to get the benefits on a daily basis. It would be recommended that you brush your teeth at least twice a day and with a pea-sized amount of toothpaste on your toothbrush.
Interviewer: Oh, I use a lot more than that.
Dr. Okano: Yes, most people will. And I'm sure the toothpaste companies love you for using that full 1 inch of toothpaste on the toothbrush. But, in reality, a pea-sized amount would be the amount necessary, particularly if you're a child. We know that if a child ingests fluoride-containing toothpaste, it could be too much fluoride to the developing tooth, causing fluorosis, which means white spots on teeth and dark spots, even.
Interviewer: So you can use too much?
Dr. Okano: Yes.
Interviewer: Especially for a young child. And I have heard that the recommendation there is a rice-sized bit of toothpaste for very young children.
Dr. Okano: Between a rice-size and a pea-size.
Interviewer: All right. And you've got to have that fluoride if you really want to maximize the chance that you're going to have good, healthy teeth for a long time.
Dr. Okano: That is correct. It's very important to do proper home care with your brushing and flossing at home. The use of fluoridated toothpaste is very beneficial for tooth decay, but it's all part of total dental health, and seeing your dentist regularly as he or she would recommend, would be very important to maintaining good dental health.
updated: August 18, 2023
originally published: August 10, 2016
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