FAQ Toothpaste Guide

SHOP TOOTHPASTE ON AMAZON

This post is collaborated with Dr. Jasmine Elmore, Board-Certified Pediatric Dentist & Owner of Optimal Kids Pediatric Dental Medicine.

Theoretically, we don’t even need toothpaste. The early 20th century records document virtually NO tooth decay in pre-contact Inuit. And guess what? They didn’t have toothpaste, much less fluoride! 

By the 2000's surveys showed 69% of Inuit preschoolers had cavities by age five. Why do you think that is? They were exposed to the West, and had a maaaaajor shift in diet change. 

Now, 99.9% of us living in the West do not eat and live like pre-contact Inuit, so can we benefit from toothpaste with remineralization properties? For sure. 

But here’s the deal. There’s no such thing as a perfect toothpaste. Most likely you’re going to have to compromise somewhere, and that’s okay! Figure out what’s most important to you for your specific oral health status, and try not to overthink it. 

⚠️Disclaimer: This guide is for educational and informational purposes only and is not intended to provide medical or dental advice. It does not replace individualized care, diagnosis, or treatment from a licensed dentist, physician, or other qualified healthcare professional. Always consult your dental provider regarding concerns about oral health, cavities, gum disease, or treatment decisions.

Fluoride in toothpaste? Good or bad? 

If fluoride was the ONLY ingredient that we knew of to help fight against cavities I would probably say use it, but we know that’s not the case. “Fluoride is bad” comes from the fact that it’s a neurotoxin at high doses, and the extensive research associating high fluoride exposure to negative neurodevelopment effects, especially related to children’s IQ levels and behaviors. In fact a 9 years long lawsuit finally came to an end last year where a federal court in CA ruled the amount of fluoride commonly added to US drinking water poses an “unreasonable risk to human health.” 

Is topical fluoride really as bad as the kind you ingest? (Like what is added to tap water)

The vast majority of fluoride studies are based on drinking water, not toothpaste. The amount of fluoride in toothpaste is much much lower, and the systemic intake isn’t going to be nearly as severe as daily drinking water. We’ll talk about this more later, but it is important to look at the context of studies when making informed decisions.

With fluoride, the amount extensively studied (in water) is vastly larger than the amount in toothpaste, and most likely (hopefully) you aren’t swallowing large quantities like you do water. So do you need to be as concerned about fluoride in toothpaste as you do water? Probably not. 

But, unlike hydroxyapatite (which we’ll also get to later), the exposure studied is still oral. And we KNOW there are other options that work just as well that aren’t neurotoxins and can actually promote remineralization and remineralize themselves with little to no known toxicity. So why not use those if you are low risk? Especially knowing what we know about fluoride. 

Why is sorbitol in toothpaste? Doesn’t it just turn into fructose and cause cavities? 

Unlike xylitol, sorbitol is used for function (ie keeping toothpaste moist), NOT cavity prevention. If it makes you uncomfortable you do not NEED it in a paste.

Listen, I used to be hesitant about sorbitol too, until I looked deeper into how it actually behaves in the mouth. In order for it to be converted into fructose it needs a specific enzyme called sorbitol dehydrogenase, which isn’t present in toothpaste and isn’t active in the oral environment.

Now some oral bacteria CAN slowly metabolize sorbitol, but it behaves very differently from real sugar. Cavity-causing bacteria strongly prefer glucose, sucrose, and fructose, and sorbitol is a poor energy source by comparison. Cavities are driven by how fast acids are produced, how low the pH drops, how long the mouth stays acidic, and low saliva flow. While some bacteria can adapt over time to use sorbitol, it’s still very slow, inefficient, produces much less acid, does not drop oral pH super aggressively, and allows saliva the time it needs to buffer acids. For most people this is not going to be an issue.

If you have low saliva flow or a higher cavity risk, you may choose to avoid it. Or if you’re more comfortable skipping it altogether, there are plenty of sorbitol-free options available.

I read somewhere some dentist saying not to use toothpaste with essential oils? Is that true?

There’s no such thing as a perfect toothpaste. You’re going to have to make a compromise somewhere. For me, my top priority is finding a toothpaste that contains nHA, not avoiding EOs.

Here’s the deal with EOs. Any antibacterial ingredient used in the mouth, regardless if it’s “natural” or not has the same effects on the oral microbiome. EOs are broad-spectrum, non-selective antimicrobials, meaning they can also disrupt and kill off the GOOD bacteria. 

Another problem is the lack of research funding for EOs compared to pharmaceuticals. Because of this, most real health studies focus on whether essential oils kill pathogens or how they compare against conventional agents like chlorhexidine, and not how they affect the oral microbiome as a whole. 

EOs CAN have therapeutic uses orally, like for candida overgrowth. But the concern is that we just don’t understand yet how daily exposure affects the oral microbiome over time, and product labels often don’t disclose the exact concentrations used. But what we do know is that even a single drop can have strong antibacterial effects. 

If you’re currently using a toothpaste that contains essential oils, it doesn’t necessarily mean you need to throw it out. However, if you’re dealing with gut issues, oral dysbiosis, or other microbiome-related concerns, switching to an essential-oil-free option may be worth considering.

I’ve heard about glycerin in toothpaste coating the teeth and causing cavities?

There’s no solid clinical research showing that glycerin in toothpaste causes cavities by forming a film on teeth. This idea largely comes from a 1996 book by former chemistry professor Dr. Gerard Judd, who claimed glycerin coats teeth and blocks mineral absorption. This theory is outdated and not supported by modern dental research.

Glycerin is a water-binding ingredient and mixes easily with saliva. Because of this it typically doesn’t stick to enamel, and rinses away naturally. I know there’s people out there claiming it coats their teeth, but I would argue if that’s the case it’s most likely because they have minimal saliva flow (which is an issue in and of itself). Glycerin is thick, so I guess theoretically if the above is happening it could contribute to a film on the teeth, but it would still be pretty temporary. 

I would personally be more concerned about polysorbates and PEGs. They are stronger emulsifiers designed to bind oil and water more aggressively, which makes them more likely to leave a temporary film on the teeth. 

Let's talk about saliva for a sec

Since I’ve already mentioned it a few times...saliva often doesn’t get the spotlight it deserves. It 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).

Is xylitol or erythritol better in toothpaste?

Xylitol is one of my favorite things in the world, and not just for toothpaste! It’s one of the most well studied and effective ingredients for cavity prevention. It’s a sugar alcohol, but unlike sorbitol it has SELECTIVE anti-cavity actions. This means it only interferes with harmful bacteria like Streptococcus mutant without wiping out the beneficial bacteria. It also helps maintain a healthier oral pH, supports reminzeralization, and stimulates saliva. The only caveat is that swallowing large amounts can cause digestive issues, but hopefully you aren’t swallowing tons of toothpaste anyways.  

Erythritol is another strong option, and emerging research suggests it may be just as effective and in some cases possibly more effective than xylitol at reducing plaque and supporting cavity prevention. The thought is because of its smaller molecular size it may be able to penetrate biofilm more easily, and it generally has a lower risk of digestive issues if ingested. However, it does appear to stimulate saliva less than xylitol, and it doesn’t have the same depth of long-term research yet. 

All in all I would say both are good choices, but as of now xylitol still holds up a litter higher based on the robust research and saliva-stimulating benefits. But erythritol is a very promising alternative! But keep in mind neither promote remineralization on their own.

XYLITOL (on its own) DOES NOT REMINERALIZE!!!

This is a common misconception that I feel needs to be directly highlighted. As much as I love xylitol, it’s important to remember that on its own it does NOT actively remineralize teeth. 

Instead, it helps SUPPORT the remineralization process by creating the ideal conditions for remineralization to happen naturally - reducing acid producing bacteria, raising oral pH, and increasing saliva flow. 

If someone is prone to cavities, xylitol alone would not be ideal. If they are wanting to avoid fluoride, the next best option would be nano-hydroxyapatite.

What is hydroxyapatite? 

Ok so your enamel is made of millions of mineral crystals called hydroxyapatite, so basically hydroxyapatite is what your teeth are made of. 

When you use hydroxyapatite toothpaste you’re basically brushing with extra “tooth material” that can stick to weak spots and problem areas to fill in any microscopic holes and remineralize. Overtime this can help make the teeth stronger and less sensitive.

Analogies are always helpful to me, so think of your teeth as a brick wall. Overtime acid, sugar, bacteria, etc., wear the wall down and create chips and cracks. Brushing with hydroxyapatite toothpaste is like adding extra bricks and mortar to the wall to help make it stronger. 

Dr. Elmore has seen nHA work well in very early, microscopic cavitation. Once true cavitation forms (especially into dentin) its effectiveness is limited. nHA is great for enamel remineralization, but dentin repair is still being studied.

Is hydroxyapatite actually bad?

This is a HUGE topic in the “crunchy” world, and really grinds my gears. I have found most of the talk is around research taken wildly out of context. Concerns about the safety largely stem from early animal studies that used unrealistic exposure methods, like injections or force-feeding extremely high doses. You cannot compare that to toothpaste.

Another concern is it crossing the blood-brain barrier. Again, this is largely driven by misinterpretations of the research. Some medical studies do involve ENGINEERED nanoparticles DESIGNED to cross the blood–brain barrier for drug delivery, but these particles are purpose-built for that role and administered via injections or nasal delivery. This is fundamentally different from toothpaste use.

For something in toothpaste to reach the brain, it would first have to enter the bloodstream. That’s highly unlikely with nHA, because nHA begins dissolving at a pH of 4. Stomach acid has a pH of 1.5-3.5, meaning it would likely break down before even reaching the bloodstream.  And studies show it does not penetrate the oral epithelium either, so how else is it going to get there?

And look, I’m not saying I won’t be proven wrong someday. But until there is long-term, substantial research on toothpaste use (or similar concentrations and mode of delivery) I’m not concerned. And to me the research showing its benefits outweigh all the “talk.”

My full guide on hydroxyapatite.

Is nano or micro hydroxyapatite better to use?

Typically nano-hydroxyapatite (nHA) outperforms micro-hydroxyapatite (HA) due to its size and structure. 

Micro HA is typically just ground down calcium sources, which are usually too large to really do anything meaningful to the enamel remineralization wise, and can actually be linked to higher heavy metal contamination. It CAN offer mild benefits, but honestly it’s just an outdated technology. 

Nano HA is designed to closely match the size and shape of natural tooth minerals, which allows it to actually bond with the enamel and actively promote remineralization and tooth strength. 

For best results, skip rinsing with water after brushing. Leaving the toothpaste on your teeth allows the hydroxyapatite to stay in contact longer, promoting better remineralization.

Is 10% nano hydroxyapatite still what you recommend? I noticed you changed your blog post about it.

Yeah sorry about that guys. After a lonnnng phone call I had with Dr. Jen who founded Dr. Jen’s toothpaste, I was pretty confident in my stance that only 10% nHA provided any real benefit, but I have since had to change that because while the “talk” sounds good, I simply just cannot find the actual research to back it up. If you’re low risk I would focus more on finding a toothpaste you like that’s high quality NANO vs what the actual % is.

In fact, Dr. Mark Burhenne, founder of Fygg toothpaste, actually second guessed his 3.1% toothpaste when all this 10% chatter came about. He met with biochemists and microbiome scientists, and conducted his own peer-reviewed study that tested 8 major remineralizing toothpastes and found that it wasn’t the % that mattered but the physiochemical properties. It also found that Fygg’s toothpastes, at only 3.1% performed on par with rx strength fluoride toothpaste. 

Another study tested 2%, 5%, and 10% nHA and found that the improvements between the different %’s were similar to each other, and no one was statistically “better” then the others. 

For her patients with active cavitation who do not want fluoride, Dr. Elmore does recommend Dr. Jen’s 10% nHA, as these patients fall into a higher-risk category and she has observed meaningful benefits in practice (but the root cause still needs to be addressed).

I follow some influencers who have said ever since switching to hydroxyapatite have started getting tons of cavities and having issues.

Theoretically we don’t need toothpaste, so when I hear stories like this I am always skeptical, and have doubts that it’s due to the toothpaste. 

When someone experiences recurrent cavities, it’s often driven by underlying systemic or oral-environment factors, not toothpaste. It could very well be that overall systemic issues are finally catching up with them, and whatever toothpaste they were using prior was just compensating for the risk factors. There are soooo many things I would want to know. Did they switch to microHA or nanoHA? Are they mouth breathers? Do they have low saliva flow? What’s their diet like? Do they have airway or hormonal issues? Have they had a saliva test done to make sure their mouth isn’t being overrun by pathogenic bacteria? Who’s their dentist and how are they taking and interpreting x-rays?

Additionally (and unfortunately), many times cavities are simply missed. Dr. Elmore has seen this from outside x-rays and intraoral sent to her, which poses the question could part of the rise in cavity rates be due to changes in how dentists approach, define, and diagnose cavities?

I’m not trying to disregard someone’s lived experience, but most people just aren’t aware of the actual root causes of deteriorating oral health...and it’s not usually toothpaste.

I read somewhere hydroxyapatite only coats the surfaces of the tooth and can make x-rays look like there’s no cavities when there really is.

This is just simply inaccurate. It’s also often directed at micro-hydroxyapatite, not nano-hydroxyapatite, which wouldn’t be my top choice anyway (but don’t quote me on that). 

This is also a complete misunderstanding of how X-rays work. For a change to appear on an X-ray, there must be an actual change in mineral density, either demineralization or remineralization. X-rays don’t show surface “coatings.” They work based on how easily light passes through tissue, so lighter or darker areas reflect real differences in density. If something were merely coating a tooth, it would not show up radiographically at all. Logically, the idea that hydroxyapatite could “mask” decay on an X-ray doesn’t hold up.

X-rays also don’t reliably detect very early enamel changes in general, regardless of whether fluoride or hydroxyapatite is used. Once a cavity is truly cavitated (meaning there is an actual hole) no toothpaste can reverse it, and it requires a filling. If early repair does occur, a tooth may look better on X-ray because the enamel is genuinely getting stronger, not because decay is being covered up.

There’s also a growing divide in dentistry between more traditional and more holistic approaches, including differences in how cavities are defined, diagnosed, and treated. In some cases, decay is simply missed until it’s “too late” due to interpretation differences or poor-quality X-rays, not toothpaste. This happens more often than people realize, especially in high-volume, corporate dental settings.

Top toothpaste recs for cavity prone kids

If you want to avoid fluoride, then anything with NANO-hydroxyapatite (Dr. Elmore would recommed 10% Dr. Jen).

But ultimately you need to get to the root cause of why your child is cavity prone. Toothpaste can only do so much, and it can’t fix systemic issues. What is your child’s diet like? What’s their dental hygiene look like - are they brushing properly 2x a day AND flossing? Do they have low saliva flow? You can consider giving xylitol lollipops or mints after snacks and meals. Do they mouth breathe? Do they snore?

I would also highly advise getting established with an airway dentist. 

What toothpaste is safe for a baby to use with their first teeth? And at what age should I stop using training toothpaste?

You don’t technically need training toothpaste. Training toothpastes are designed for kids who can’t spit yet aka no fluorides, are typically non or low-abrasive, and don’t contain harsh surfactants like SLS, strong EOs, dyes, or intense flavors…all of which we should be staying away from anyways. 

So it’s actually very easy to find a toothpaste safe for the whole family…baby through adults! Yes, even if it’s not labeled “babies” or “training.”

Young babies with their first teeth you can also just use a wet rag to wipe the teeth. Which brings us to our next point...

Let's talk about PARENT ASSISTED BRUSHING

Toothpaste is only effective if it actually reaches the teeth, and is left there long enough to work. Most young children simply don’t have the motor skills to brush thoroughly on their own. Even some 8-year-olds still need hands-on help, as Dr. Elmore often sees in practice.

When parents assist with brushing, they ensure the toothpaste is properly applied to all tooth surfaces, allowing it to do its job. And once brushing is done, DO NOT RINSE!!! Let the toothpaste remain on the teeth to help maximize its protective benefits.

Now let's talk about the AMOUNT OF TOOTHPASTE

Most people use wildly too much toothpaste. Even in commercials, the amount typically shown is way too much. If you are using the correct amount by age then the risk of systemic effect is really low, and therefore any toothpaste (outside of fluoride) is typically fine to use for any age. 

0-6mo: wipe with water and cloth 

Under 3yr: grain of rice

3yr - adult: pea sized amount