Fluoride-Free Toothpaste: Should You or Shouldn’t You?

Ten years after removing fluoride from its water, the City of Calgary officially reversed the decision.

The move—which went into effect on June 30—made headlines, with everyone from The New York Times to PBS and NPR offering their take. It’s a hot topic, especially ever since United States Secretary of Health and Human Services Robert F. Kennedy Jr. announced that he wanted fluoride—known to help strengthen teeth and prevent cavities—taken out of the country’s public drinking water, claiming potential health risks.

The fluoride conversation is certainly shifting—even when it comes to toothpaste. Brands like Tom’s and Green Beaver offer fluoride-free options, with Vancouver-based oral care brand Before launching its first-ever fluoride-free toothpaste in June. Coming in three flavours (SuperMint, Lemon Coconut and Cinnamon Orange), Before’s fluoride-free product is said to naturally strengthen tooth enamel with alternative ingredients like arginine, zinc and aloe.

“Demand for fluoride-free toothpaste is growing fast,” says Before CEO and co-founder Steve Thorp. “As more people learn about the mouth microbiome and how it impacts oral health, there’s been a clear shift toward avoiding ingredients like SLS, parabens, dyes and artificial flavours that impact the health of the microbiome. As a solution, people are looking for ingredients that support overall mouth health.”

The goal of Before, he says, “has always been to create a high-quality and clean oral care brand that has options for everyone—no matter where they stand on fluoride.”

What Is Fluoride?

Fluoride is a naturally-occurring mineral found in water, soil and many foods, including potatoes, raisins and oatmeal.

What Are the Benefits of Fluoride?

“Fluoride prevents tooth decay by strengthening the tooth enamel—the outermost surface of the tooth—and promoting the mineralization process of teeth that are vulnerable to decay,” says Salima Alibhai, an assistant professor of teaching and director of the Dental Hygiene degree program at UBC’s Faculty of Dentistry. “It is commonly used in dentistry and added to toothpaste, mouth rinses, gels and professionally-applied products.”

Are There Any Risks When Using Fluoride Toothpaste?

Alibhai says that unless someone is allergic to fluoride, which is very rare, there are no scary downsides to using a toothpaste that contains it. The only major side effect is fluorosis, which occurs when the enamel is affected by too much fluoride. Fluorosis usually shows up as white lines or brown stains on the teeth, which can be cosmetically repaired. It is not harmful, according to Alibhai, and really only happens in hotspots with high fluoride levels in groundwater.

“It is uncommon to see higher fluoride levels in over-the-counter toothpastes,” she explains, “as these products are regulated by federal guidelines before reaching consumers.”

If taken in exorbitant amounts, it is possible for fluoride to be toxic. But that, according to researchers, is virtually impossible to achieve from fluorinated toothpaste and water alone.

Are There Any Risks When Using Fluoride-Free Toothpaste?

“If an individual is susceptible to decay or at moderate to high risk of dental decay, living in a community without fluoridation and using non-fluoridated toothpaste will only raise their chances of cavities and tooth loss,” says Alibhai. “Because less than four percent of communities in British Columbia are fluoridated, this is a concern for the population as a whole.”

This is of particular issue for children, who are more prone to cavities. Seven or so years after Calgary stopped water fluoridation, 65 percent of the city’s kids suffered from tooth decay. By comparison, that number was 55 percent in Edmonton, where fluoridation remained in place.

For the unconvinced, there are promising fluoride alternatives. In 2021, the University of Toronto’s Faculty of Dentistry found that using hydroxyapatite—another naturally-occurring mineral—in toothpaste could result in benefits equivalent to fluoride.

Should You Use Fluoride-Free Toothpaste?

At the end of the day, Alibhai says that opting out of fluorinated toothpaste isn’t an automatic failing grade for your teeth.

“Fluoride-free toothpastes might not offer the same decay-fighting benefits, but they can still effectively clean the mouth,” Alibhai explains. “Some fluoride-free products include natural antimicrobials, such as xylitol, which helps prevent decay, and baking soda, a known abrasive that neutralizes the pH of saliva.”

It’s ultimately up to each individual to decide what’s right for them and their family.

“It really comes down to personal choice, and we always recommend chatting with a dental professional first on what formulation makes the most sense for your routine,” says Thorp. “Everyone’s situation is different: enamel strength, diet, microbiome health, lifestyle—it all plays a role.”