Safer Oral Care
- Alex Kelly
- Mar 30
- 6 min read
Updated: Apr 2
The Problem with Fluoride
There is evidence that fluoride offers protection against cavities (1). However, we now know it is a neurotoxin, especially effecting children (2), as well as a microbiome disruptor.
In 2016 the Fluoride Action Network (FAN), along with Moms Against Fluoridation, Food & Water Watch, the American Academy of Environmental Medicine, the International Academy of Oral Medicine and Toxicology, and the Organic Consumers Association submitted a Citizens Petition under Section 21 of the Toxic Substances Control Act (TSCA) to the Environmental Protection Agency (EPA) requesting a ban on the addition of fluoridation chemical to water. When the EPA denied their petition, they filed suit in the federal courts. Learn more about this.
This suit went on for nearly a decade, when finally in September of 2024 the federal court in California ruled in favor stating that “there is substantial and scientifically credible evidence establishing that fluoride poses a risk to human health; it is associated with a reduction in the IQ of children...” forcing the EPA to take action to strengthen regulation.
In March 2025, Utah became the first state to completely ban fluoride in public drinking water.
xylitol, erythritol, & sorbitol
When looking at non-fluoride toothpastes, there are a couple of different options. Landis Felts, a naturopathic RDH and myofunctional therapist, prefers toothpaste that contains xylitol.
Xylitol is a 5-carbon alcohol sugar that creates an alkaline environment in the mouth, in which disease cannot survive.
Xylitol inhibits the growth of Streptococcus mutant, a major bacteria responsible for tooth decay and plaque (3), it doesn’t feed bacteria like regular sugar, it helps maintain a natural pH in the mouth which prevents enamel erosion and tooth decay (4), and it remineralizes enamel (3). However, in excess it can trigger digestive issues.
Erythritol is another option. Some believe erythritol may have better efficacy in preventing cavities and plaque in certain regards. However, there is some science suggesting xylitol is more effective at inhibiting S. mutans. Erythritol does tend to have a lower potential for digestive issues.
Sorbitol is another common ingredient, but it’s not as effective as xylitol or erythritol.
hydroxyapatite
Hydroxyapatite is a naturally occurring mineral found in teeth. There is toothpastes that contains nano or micro hydroxyapatite that can help remineralize the tooth enamel, essentially filling in the tiny cracks and fissures in the enamel with hydroxyapatite particles. It strengths the enamel and prevents further decay.
Nano-Hydroxyapatite contains smaller particle sizes which allows deeper penetration into the enamel. This is typically best suited for sensitivity and early erosion.
Non-Nano Hydroxyapatite (micro) works on the surface, and can reinforce the outer layer of the enamel. This is typically best used for overall enamel maintenance and surface protection/remineralization.
There is some controversy when it comes to nano-hydroxyapatite. The European Commission Scientific Committee on Consumer Safety compiled studies on hydroxyapatite back in 2016. The following all come from that document (5).
In lab rats that were fed high amounts of N-HAP
“death of the animal occurred from 10,000mg/kg bw in both sexes as a result of cardiac and respiratory arrest.”
The above was a very high dose. Other studies with lower doses found NAHA affected lungs in similar ways: “in lungs, seven cases of bronchial associated lymphoid tissue proliferation were observed.”
NAHA was also found to create free radical damage in the liver, damage to kidney tissue, negatively affect red blood cells and platelets, and damage to DNA.
click to enlarge
safer mouth-rinse
Many mainstream mouth rinses like Listerine and Scope destroy the healthy microbiome in our mouths. When the healthy bacteria is killed, the bad bacteria takes over and you become out of balance.
STAY AWAY FROM:
fluoride
chloride/chlorite
peroxide
high levels of alcohol
artificial coloring/dye
*these apply for any oral products
flossing
One study found that people who use certain types of flosses with teflon had 22% higher levels of PFAS in their bloodstream (6). Another study from the EWG found that PFAS exposure is linked to hormone disruption, immune issues, cancer, and fertility concerns - even in very small doses.
When choosing floss choose teflon/PFAS free floss, or a water-floss. One study showed that water flossers were up 29% more effective than string floss for improving gingival health (7).
toothbrushes
Many people in the “crunchy” world tend to choose bamboo toothbrushes to avoid plastic. Personally, this is an area where I am ok choosing the plastic option. I find bamboo brushes tend to mold easily. Also electric toothbrushes remove significant more plaque than manual toothbrushes, and an 11 year study found that electric brushes resulted in 22% less gum recession (8). This is the route we choose.
tongue scraping
Landis Felts, naturopathic RDH and myofunctional therapist, compares the tongue to a shag carpet. If we aren’t cleaning the tongue, then bacteria settles and stays. Yikes! One study found that using a tongue scraper reduces volatile sulfur compounds (VSCs) by 75%, while the toothbrush only achieved a 45% reduction (9). If you want to avoid plastic, opt for stainless steel.
oral probiotics
Our mouth is directly related to our entire body, including our gut. Many people focus on GI probiotics, but if we aren’t taking care of the bad bacteria in our mouth, our gut is going to suffer.
Oral probiotics fight the growth of bacteria the cause cavities and plaque, helping disease by reducing inflammation, reducing bad breath, strengthening overall immunity, and defend against infections.
Look for oral probiotics that contain streptococcus salivarius like StellaLife or Vital Nutrients.
saliva testing
You cannot have a healthy body with an unhealthy mouth. 80% of American adults over 35 have some form of periodontal disease. 50% of heart attacks and strokes are triggered by oral pathogens.
If you want to go the extra mile, you can do saliva testing (like SimplyPERIO) to determine and treat any pathogenic bacteria living in your mouth. Certain oral pathogens have been linked to Alzheimer’s, heart disease, pregnancy complications, strokes, diabetes, cancer, kidney disease, rheumatoid arthritis, bowel disease, fatty liver disease, and more.
mouth breathing
Mouth breathing creates a breeding ground for oral pathogens (and more), which effects the entire body.
Our nose is designed to prepare the air for the lungs by warming, filtering, accelerating, cleansing, and humidifying - leading to efficient oxygen exchange. The mouth does none of this, and actually reduces oxygen absorption (10).
Nasal breathing also produces Nitric Oxide, a potent pulmonary vasodilator. Mouth breathing decreases immunity and causes inflammation throughout the body (11-13).
Mouth breathing is never normal, and has detrimental effects across the entire body. See caption for more.
You can check your Nitric Oxide levels at home in less than 30 seconds, and supplement if needed. However if mouth-breathing, supplementation will only act as a band-aid.
Berkley Life Nitric Oxide Supplements (typically have to get through a provider)
Sources:
1 Hellwig E, Lennon AM. Systemic versus topical fluoride. Caries Res. 2004 May-Jun;38(3):258-62. doi: 10.1159/000077764. PMID: 15153698.
2 Adkins EA, Brunst KJ. Impacts of Fluoride Neurotoxicity and Mitochondrial Dysfunction on Cognition and Mental Health: A Literature Review. Int J Environ Res Public Health. 2021 Dec 7
3 Nayak PA, Nayak UA, Khandelwal V. The effect of xylitol on dental caries and oral flora. Clin Cosmet Investig Dent. 2014 Nov 10;6:89-94. doi: 10.2147/CCIDE.S55761. PMID: 25422590; PMCID: PMC4232036.
6 Jiao Y, Fu Z, Ni X. Association Between Serum Levels of Perfluoroalkyl and Polyfluoroalkyl Substances and Dental Floss Use: The Double-Edged Sword of Dental Floss Use-A Cross-Sectional Study. J Clin Periodontol. 2025 Jan 11. doi: 10.1111/jcpe.14126. Epub ahead of print. PMID: 39797715.
7 Goyal CR, Lyle DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J Clin Dent. 2013;24(2):37-42. PMID: 24282867.
8 Pitchika V, Pink C, Völzke H, Welk A, Kocher T, Holtfreter B. Long-term impact of powered toothbrush on oral health: 11-year cohort study. J Clin Periodontol. 2019 Jul;46(7):713-722. doi: 10.1111/jcpe.13126. Epub 2019 May 22. PMID: 31115952; PMCID: PMC6619286.
9 Pedrazzi V, Sato S, de Mattos Mda G, Lara EH, Panzeri H. Tongue-cleaning methods: a comparative clinical trial employing a toothbrush and a tongue scraper. J Periodontol. 2004 Jul;75(7):1009-12. doi: 10.1902/jop.2004.75.7.1009. PMID: 15341360.
10 Mouth Breathing: Understanding the Pathophysiology of an oral habit and its consequences Ramirez-Yanez German O., DDS, MDSc, MSc, PhD
11 Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiol Scand. 1996 Dec;158(4):343-7. doi: 10.1046/j.1365-201X.1996.557321000.x. PMID: 8971255.
12 Edwards DA, Chung KF. Mouth breathing, dry air, and low water permeation promote inflammation, and activate neural pathways, by osmotic stresses acting on airway lining mucus. QRB Discov. 2023 Feb 14;4:e3. doi: 10.1017/qrd.2023.1. PMID: 37529032; PMCID: PMC10392678.
13 scholarhub.ui.ac.id/cgi/viewcontent.cgi?article=1005&context=jdi#:~:text=In%20conclusion%2C%20the%20results%20of,when%20compared%20to%20nasal%20breathers.
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