Do You Need To Use Fluoride Toothpaste?

Gold Standards Aren’t Built on Trends

Right now, there’s a huge wave online claiming fluoride in toothpaste is inherently toxic, that hydroxyapatite can fully replace fluoride for everyone, and that “natural” automatically equals better. 

But oral health isn't always that straight-forward.

First, The Fluoride Conversation Needs More Context

Fluoride is one of the most studied tools in dentistry. There's decades of large-scale evidence showing it strengthens enamel, enhances remineralization, improves acid resistance, and lowers cavity rates over time.

I have found that a lot of the fear around fluoride lacks context. 

Yes, fluoride can absolutely be toxic at high, systemic doses (but so can water, iron, vitamin A, salt, and countless other substances). The dose matters.

Most major concerns surrounding fluoride come from chronic systemic ingestion, particularly through drinking water, where exposure is swallowed internally every single day. This evidence is overwhelming. There's no denying that. 

However, toothpaste is a completely different route of exposure.

With properly used fluoride toothpaste (meaning parent-assisted brushing, tiny amounts, supervised use, and spitting instead of swallowing) systemic exposure is dramatically lower. Not saying there's no risk, but it is nowhere near an equal comparison. 

BUT Does Everyone NEED Fluoride?

Some may disagree, but I don't think so. I used fluoride from the day I started brushing until my late 20's and had lots of cavities. It wasn't until I started learning about root cause dentistry that my cavities stopped...which funny enough, is also when I stopped using fluoride and switched to nHA. This goes to show, you don't need fluoride.

Oral health is about so much more than toothpaste. Honestly, mostly more than toothpaste. 

There are people who use prescription fluoride toothpaste, fluoride rinses, fluoride varnishes, fluoride coated floss, and still struggle with cavities and demineralization. And then there are people who use no fluoride whatsoever and never get cavities at all.

I mean, just look at the tribes Weston A. Price studied. No toothpaste, and hardly any oral decay…until they were westernized.

Why? Because cavities are multifactorial, and NOT about toothpaste. 

Root Cause Matters

Saliva quality matters. Breathing matters. Airway health matters. Diet matters. Feeding habits matter. Microbiome balance matters. Sleep matters. Bacterial load matters. Overall systemic health matters.

Toothpaste can only do so much.

More important than obsessing over ingredients is addressing why someone is cavity-prone in the first place.

• What does their nutrition look like?

• Are they constantly snacking?

• Are they mouth breathing?*

• Do they snore?

• Do they have poor saliva flow?

• Do they have airway issues?

• Do they have high pathogenic bacterial loads?

• And WHY?????

These are the questions that matter long term. Root cause, people!!! BUT…that doesn’t mean toothpaste is useless, either - especially in today's society.

A Note on Mouth Breathing* and Saliva

I want to highlight mouth breathing. This is a huge one. Mouth breathing is one of the top causes of cavities. We are designed to breath through our noses, if this isn't happening it creates a breeding ground for oral bacteria. Why? Saliva. Saliva Saliva is one of THE MOST IMPORTANT parts of oral health. It is constantly rinsing the mouth, washing away food and bacteria, buffering acids that weaken enamel and lead to cavities. It helps deliver minerals like calcium and phosphate back into the teeth and helps repair areas of damage throughout the day.

When someone’s saliva flow is healthy, it helps keep their oral environment balanced and supports a healthy oral microbiome. It keeps pH levels from becoming too acidic, and protects the gums and soft tissues. 

When someone’s saliva flow is low, problems tend to show up fast and furious like plaque buildup, sensitivity, cavities, bad breath, gum irritation. Dry mouth is a major risk factor for oral health issues!! If you are prone to cavities you should definitely be looking into your saliva flow, and getting down to the root cause (like mouth breathing, dehydration, medications, etc).

If You Keep Getting Cavities

Toothpaste is still a tool. And sometimes, especially in higher-risk situations, the right tool can provide an important extra layer of protection while you work on addressing those deeper root causes.

But if you find yourself getting cavity after cavity after cavity, whether you're using fluoride or not I would highly recommend establishing yourself with an airway dentist.