What Is Fluoride and Why Is It in Toothpaste?

Fluoride is a naturally occurring mineral found in soil, water, and various foods. It has been widely used in dental care because of its ability to strengthen enamel and prevent cavities by promoting remineralization. Most conventional toothpastes contain active forms of fluoride such as sodium fluoride, stannous fluoride, and sodium monofluorophosphate.

However, despite its benefits, growing concerns about fluoride overexposure are prompting many consumers to switch to fluoride-free toothpaste. Let’s explore why.

Fluoride in the Environment: A Double-Edged Sword

Fluoride exists in nature, making up 0.06–0.09% of the Earth’s crust, and is found in groundwater, plants, and animals. Though essential in small amounts for bone and tooth health, excessive fluoride exposure can lead to serious health issues.

That’s why there are general guidelines for how much fluoride toothpaste should contain, based on a person’s age.

Age (years)	(ppm F)	Frequency	Size
First tooth— up to 2 years	1000	Twice daily	Grain of rice
2–6 years	1000*	Twice daily	Pea
Over 6 years	1450	Twice daily	Pea

*For children 2–6 years, 1000 + fluoride concentrations may be considered based on the individual caries risk

There are some guidelines that recommend not to use fluoride toothpaste in children under two years old.

The World Health Organization (WHO) recommends fluoride levels in drinking water to remain below 1 ppm. Above this threshold, fluoride can pose significant health risks.

Health Issues Related to Excess Fluoride:

Dental fluorosis – white spots, brown stains, and pitting on teeth
Skeletal fluorosis – pain and damage to bones and joints
Neurological effects – potential developmental issues in children
Gastrointestinal and urinary tract issues

With more than 200 million people globally at risk of fluorosis, and fluoride naturally present in many groundwater sources, the cumulative exposure—especially from fluoridated toothpaste and water—raises concerns.

Dental Fluorosis: A Visible Side Effect

Dental fluorosis occurs when children under 8 are exposed to high levels of fluoride during tooth development. In its mild form, fluorosis causes white streaks or spots. In severe cases, teeth can become stained yellow, brown, or even black, with surface pitting and structural weakness.

Fluorosis is increasingly seen in regions with fluoridated water supplies.

Research suggests many caregivers apply more than the recommended rice-sized amount for children under 2 years, leading to unintentional overexposure.

Why Are People Switching to Fluoride-Free Toothpaste?

1. Minimizing Health Risks

With fluoride exposure coming from multiple sources, using fluoride-free toothpaste can help reduce total intake—especially important for children, pregnant women, and people living in high-fluoride regions.

2. Environmental Concerns

Fluoride is a persistent environmental contaminant. As a by-product of industrial activities and dental product use, fluoride is increasingly present in groundwater and ecosystems. Over time, this can impact both human and environmental health.

3. Safer Oral Care for Children

Young children are more likely to swallow toothpaste, which contributes significantly to fluoride intake. Fluoride-free toothpastes offer peace of mind to parents concerned about dosage control.

Do Fluoride-Free Toothpastes Work?

Yes — and increasingly so, thanks to advances in dental science. While fluoride has long been the gold standard in cavity prevention, modern fluoride-free toothpastes now utilize alternative active ingredients that show comparable efficacy in protecting and strengthening teeth.

Promising Calcium-Phosphate-Based Alternatives to Fluoride

The most effective and researched fluoride-free toothpaste options are those that rely on calcium-phosphate-based molecules. These ingredients mimic the natural composition of tooth enamel and aid in remineralization, making them both safe and effective.

1. Hydroxyapatite (HAP)

Hydroxyapatite is a calcium-phosphate-based mineral and the primary component of natural tooth enamel. Clinical trials have shown that toothpaste containing HAP can:

Reduce cavities
Remineralize enamel
Protect against acid erosion
Reduce dentin hypersensitivity
Improve tooth color
Support gum health

2. Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)

Another calcium-phosphate-based compound, CPP-ACP is known for its ability to:

Reverse white spot lesions (early signs of decay)
Protect against enamel erosion
Reduce dentin hypersensitivity. However, since it contains milk-derived peptides, CPP-ACP is not suitable for individuals with dairy allergies or those following a vegan lifestyle.

3. Calcium Sodium Phosphosilicate (CSPS / Bioglass / NovaMin / BioMin)

This bioactive glass, also a calcium-phosphate-based compound, has shown potential for:

Controlling caries
Reducing white spot lesions
Although research on fluoride-free versions is still limited, early studies are promising.

Are These Ingredients Safe?

Yes. One of the key advantages of calcium-phosphate-based alternatives is their biocompatibility. If accidentally swallowed — a common concern with children — these ingredients dissociate in the stomach into calcium and phosphate ions, which are not only harmless but also beneficial as essential dietary minerals.

Bottom Line:

Calcium-phosphate-based molecules offer a safe and effective alternative to fluoride. These ingredients protect teeth from decay, remineralize enamel, and support overall oral health—especially when combined with proper brushing, flossing, and dental checkups. Whether you’re avoiding fluoride for health, environmental, or lifestyle reasons, these alternatives make fluoride-free toothpaste a powerful choice for maintaining a healthy smile.

Final Thoughts: Is Fluoride-Free Toothpaste Right for You?

The choice to go fluoride-free is personal, but it’s increasingly supported by scientific insights and health-conscious consumers. Whether you’re concerned about fluoride’s long-term health effects, trying to reduce your child’s exposure, or seeking more eco-friendly oral care, fluoride-free toothpaste offers a compelling alternative.

REFERENCE

Sudradjat H, Meyer F, Fandrich P, Wiesche E, Z–L, Enax J. (2024). Doses of fluoride toothpaste for children up to 24 months. BDJ Open, 10(7). https://doi.org/10.1038/s41405-024-00187-7
Limeback, H., Enax, J., & Meyer, F. (2023). Improving oral health with fluoride-free calcium-phosphate-based biomimetic toothpastes: An update of the clinical evidence. Biomimetics, 8(4), 331. https://doi.org/10.3390/biomimetics8040331
Toumba, K. J., Twetman, S., Splieth, C., Parnell, C., van Loveren, C., & Lygidakis, N. A. (2019). Guidelines on the use of fluoride for caries prevention in children: An updated EAPD policy document. European Archives of Paediatric Dentistry, 20(6), 507–516. https://doi.org/10.1007/s40368-019-00464-2