What's in Toothpaste?

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There is no doubt that your dental hygiene is important. If you’re following your dentist’s recommendations, you probably brush your teeth twice a day and floss regularly. Perhaps you also change out your germy toothbrush every three to four months, too.

These are good things! Brushing and flossing prevent plaque buildup, reduce harmful bacteria in our mouths, and protect our tooth enamel. They are the main ways that we prevent cavities and other kinds of diseases that can develop from bad oral health.

As science is discovering new information about toothcare products, it is revealing harmful ingredients in long-standing name brands. More and more people are turning to nontoxic products that use natural ingredients. In this blog post, I will share some of what I have learned to help you navigate the pros and cons of various ingredients because I want to help you make a more informed choice for yourself and your family.

The Fluoride Debate

It is a long and robust debate, and I would be foolish to skip over it. The question is whether people should use fluoride in their toothpaste or not. This discussion is important because many natural toothpastes do not include fluoride.

My post is not meant to persuade you one way or another on this issue, but only to present a summary of the arguments for and against its use. I would encourage readers to do their own research, discuss with their dentists, and make their own decisions.

How Enamel Erodes

Tooth enamel is the strongest substance in our bodies, and the main part of enamel is a calcium mineral called hydroxyapatite. It is a crystalized structure composed mainly of calcium, phosphorus, and oxygen.

When cavity-causing bacteria grow in the mouth, they produce acids that eat away at the crystal structure. Some foods also contain acids that eat away at enamel. Several ingredients in toothpastes kill bacteria or prevent microbial growth, but they do not help restore enamel after it has already been weakened by acids.

Why You Might Use Fluoride

Fluoride is the only ingredient in many toothpastes that can reverse enamel wear through remineralization. The fluoride ions bind strongly with the calcium, phosphorus, and oxygen in enamel to form fluorohydroxyapatite (FHAP). This crystalized substance is even harder than hydroxyapatite and more resistant to acids as well. The process of remineralization using fluoride is an effective way to prevent cavities.

While there are potential toxicity risks with fluoride, many believe the benefits of caries prevention outweigh the risks. Their approach is to monitor and balance the use of fluoride. They believe that when you use the right amount of fluoride, the benefits are maximized[1].

Why You Might Use Fluoride-Free

Some refuse fluoride in their toothpaste and opt for more natural pastes that avoid additional toxic ingredients. In the case of fluoride, it is found naturally in soil and water, but too much of it can cause mild to disastrous health issues.

Fluoride has been a controversial substance because of its potential toxicity in the body, especially in children.[2] A study out of Harvard concluded the “possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.”[3] High enough amounts can also worsen dental cavities and lead to fluorosis and bone disease.[4] The fact that some countries (like the United States) add regulated amounts of fluoride into municipal drinking water still causes alarm for many, as well.

Fluoride Alternatives: nHAp and Theobromine

Fluoridated toothpaste first came out in the 1890’s. Since then it has been the popular choice for toothpastes, although new research is shedding light on two other promising substances. They work the same as, or better than, fluoride without the toxicity risks.

Nano-hydroxyapatite, also called nHAp, is a synthetic version of hydroxyapatite. It closely resembles the calcium-based mineral that occurs naturally in enamel and bones, but it is a nano-particle form. A study published by the British Dental Journal concluded that hydroxyapatite performs at least as well as fluoride in remineralization of enamel[5]. Apagard, Aclaim, Boka, Chewtabs, and Bite toothpaste bits are examples of toothpaste brands that contain this compound. Chewtabs and Bite are the only ones in this group that come in tablet form. The others are packaged in plastic tubes.

Theobromine is a component in cacao beans, coffee beans, and some types of tea. Read this article to learn more about theobromine’s ability to mineralize teeth, perhaps better than fluoride.[6] Theodent is the only commercial brand I have encountered that contains theobromine in a proprietary formula called Rennou™. You can purchase it on their website, online at Amazon, or at your local Whole Foods store. Theodent is one of the more expensive types of toothpaste on the market, so some fervent DIYers choose to make their own homemade, theobromine toothpowder. Botanyculture.com provides this homemade recipe that uses cacao powder[7]

Toothpaste Ingredients

Numerous ingredients in toothpastes help remove plaque, reduce bacteria, polish teeth, freshen breath, reduce sensitivity, and whiten teeth. Toothpastes also contain foaming agents that provide that familiar bubbly feel. Many also have binding agents that hold toothpaste ingredients together in a more uniform tablet or paste. Unfortunately, some of these ingredients can be harmful to your health or the health of the planet.

Question the safety of toothpastes that contain triclosan, sodium lauryl sulfate (SLS), propylene glycol, parabens, and artificial dyes or coloring. These are merely a few ingredients that can lead unwanted side effects. They can cause canker sores, destroy oral cells, injure organs, lead to cancer, disrupt hormone function, irritate skin, cause digestive upset, etc.

Nontoxic toothpastes use natural abrasives such as calcium carbonate, silica, and kaolin clay to remove plaque and polish teeth. Sodium bicarbonate (baking soda) and activated charcoal can help to remove surface stains and whiten teeth. Natural sweeteners, including xylitol, erythritol, sorbitol, and stevia, help prevent tooth decay, and they do not produce the harmful acids that regular sugar does. Vegetable glycerin, magnesium stearate, and essential oils acts as binding agents and provide good flavors and textures. And let’s not forget coconut oil, a common toothpaste ingredient that absorbs toxins and reduces inflammation that can lead to bleeding gums.

You also might want to investigate toothpastes that use neem. Neem is an herb from the Azadirachta indica tree, which has been used for centuries in Asia to effectively combat tooth decay and restore gum health[8].

Check Your Toothpaste

We could examine many more ingredients, both good and bad, but I want to keep this post manageable. I still encourage you to research and choose toothpastes that you trust.

If you are looking for a quick solution, you can check the safety of your toothpaste brand on EWG’s website. The Environmental Working Group has a large database of ingredients used in personal care and cosmetic products. They use a scientific rating system for all sorts of products based on their toxicity levels. It doesn’t have ratings on all toothpaste products, but you might check to see if you they have the kind you use regularly. You might even find a new toothpaste you want to try instead!

Also, check the literature from the brands themselves. I would warn the reader, however, that some companies try to misdirect consumers. “Natural” does not always equate with “safe” or “effective,” so be careful about companies that make claims about their products without being transparent and factual about their ingredients.

Coming up next

This post highlights fluoride and fluoride alternatives, but it doesn’t address toothpaste packaging. If you want help sifting through your options for zero-waste dental care, go on to Part 3. Get my picks for 20 of the best toothpastes, tablets, toothbrushes, and floss for a greener dental routine.

Before you go… please leave a comment! Did anything surprise you, help you, inspire you?

[1] The American Dental Association answers common questions about the safety and efficacy of fluoride. https://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/fluoridation-faq

[2] Fluoride Action Network details the risks of fluoride in dental products. https://fluoridealert.org/issues/dental-products/toothpastes/

[3] Read the Harvard study, “Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/?report=classic

[4] Study this scientific journal article on the adverse effects of fluoride. “Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956646/

[5] Learn about tooth remineralization using hydroxyapatite versus fluoride. “Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901576/

[6] Learn more about theobromine and its efficacy in this article from the British Dental Journal https://www.nature.com/articles/sj.bdj.2013.499

[7] Get the recipe for this homemade tooth powder that contains cacao powder (theobromine). https://www.botanyculture.com/remineralizing-coconut-oil-toothpaste/

[8] Read this study on neem from 2015: “Azadirachta indica: A herbal panacea in dentistry – An update.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441161/