Is Fluoride Toothpaste Bad for You?

What is fluoride?

Fluoride is a naturally occurring mineral found in water sources such as rivers, lakes, and oceans. Fluoride is also present in small amounts in some food and beverages, including: 

• Brewed coffee

• Canned shrimp

• Raisins

• Baked russet potatoes 

• Cooked rice 

• Pork chops 

Fluoride is also in the water systems in most of the U.S. It’s estimated that fluoride in water systems helps to prevent 25% of tooth decay. As of 2020, about 73% of the population was supplied by community water systems and had access to fluoridated water.

Is fluoride toothpaste bad for you?

You might have heard that fluoride can cause bone disease, thyroid problems, and neurological problems, among other things. But is this true? And, if so, is the fluoride in your toothpaste a problem?

In high doses during childhood, fluoride can cause dental fluorosis, a condition that causes white lines or flecks and white or brown stains on teeth. Excess fluoride intake can also cause:

• Nausea and vomiting

• Abdominal pain

• Diarrhea

• Periostitis (inflammation of the connective tissue surrounding bones)

• Skeletal fluorosis (a very rare bone disease)

• Death (rarely)

But when it comes to fluoride, the important thing to remember is that these issues only occur with really high doses — far beyond what you’ll find in toothpaste or when having routine dental visits.

Do dentists support the use of fluoride in toothpaste?

Expert organizations across the board support the use of fluoride toothpaste:

• The American Dental Association (ADA) recommends brushing twice a day with fluoride toothpaste. Specifically, the ADA says to look for an option with the ADA Seal of Acceptance. 

• The National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, recommends brushing twice a day with fluoride toothpaste.

When it comes to fluoride toothpaste for small children, expert opinion for use is as follows:

• Children under age 3: The ADA and American Academy of Pediatrics (AAP) recommend an amount the size of a grain of rice as soon as children have their first tooth. The NIDC, however, cautions that children under age 2 should avoid it.

• Children ages 3 to 6: The ADA and the AAP recommend a pea-sized amount of toothpaste, followed by a thorough rinse.

Are there any alternatives to fluoride?

Fluoride is the gold standard for preventing cavities, strengthening teeth, and fighting bacteria in the mouth. But if you’re still not sure if you want to use fluoride toothpaste, you might wonder what alternatives are out there. 

Here’s what we know about two promising ingredients:

• Nano-hydroxyapatite (n-HA): This is a mineral and potential natural alternative to fluoride. Studies show that at certain concentrations, n-HA may be just as effective as fluoride.

• Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): CPP-ACP is an ingredient found in milk. One study on artificial teeth found that, in addition to n-HA, CPP-ACP may work similarly to fluoride in terms of remineralizing teeth.

And here’s what we know about two alternatives that are popular but lack scientific evidence:

• Charcoal: There’s no convincing evidence that charcoal whitens or protects teeth. In fact, it might actually wear down tooth enamel. 

• Aloe vera: There’s some evidence that aloe vera gel has antibacterial properties that benefit dental health. But the studies took place in labs, so it’s hard to know how these benefits would translate to humans. 

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Written by:

Terri Williams, BA

Terri Williams is a journalist with bylines at The Economist, American Bar Association Journal, Livestrong, Time, Yahoo, USA Today, The Balance, U.S. News & World Report, Verizon, Real Simple, and The Houston Chronicle.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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