Plus, whether or not using fluoride mouthwash is a must.
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Pop into any drugstore and you'll likely see a variety of toothpastes, including plenty of fluoride as well as fluoride-free options. But if you — like so many — have heard of dentists recommending fluoride formulas, in particular, you might be wondering why there are so many fluoride-free tubes on the market.

Here, experts explain what fluoride is and the effects it can have on your teeth so you can make an informed decision the next time you run out of the oral hygiene staple.

What Is Fluoride?

Fluoride is a naturally-occurring mineral that's commonly used to strengthen tooth enamel (the hard, protective outermost layer), explains celebrity cosmetic dentist Victoria Veytsman, D.D.S. It's released from rocks into the soil, water, and air. In fact, there is some amount of fluoride in all drinking water, and many cities across the U.S. add additional fluoride to their drinking water supplies, according to the Centers for Disease Control (CDC). But while you can (and likely do) get fluoride by sipping on H2O, dentists typically recommend using fluoride toothpaste as well, says Jeffrey Sulitzer, D.M.D., chief clinical officer at SmileDirectClub. That's because the mineral is more concentrated when found in a tube (vs. water), making it even more effective at keeping harmful bacteria at bay and preventing cavities, he explains. And on that note...

How Does Fluoride Impact Your Teeth?

In an overwhelming majority of cases, fluoride is a beneficial mineral that can repair damaged teeth (a process known as remineralization) — provided you catch the damage early on, says Veytsman. teeth (a process known as r, according to Veytsman. At its most basic, "it can make your teeth more resistant to decay and reduce the amount of acid that the bacteria on your teeth produce."

When you eat foods such as candy, crackers, or pasta, cavity-causing bacteria in your mouth start to feed on the carbohydrates in these items. This produces acids that strip your teeth of calcium and phosphate, breaking down the enamel and leaving your teeth vulnerable to decay and cavities, according to the Ameican Dental Association (ADA). Meanwhile, saliva disrupts this demineralization process by coating your teeth and adding the essential minerals back into your chompers. But it can only do so much on its own. That's where fluoride comes in. Fluoride, be it from toothpaste or drinking water, "teams up" with calcium and phosphate to create an even stronger barrier against decay called fluorapatite, according to the ADA.

As positive as this all sounds, fluoride (like everything in life) has its cons. For instance, exposure to excess fluoride can lead to a condition known as dental fluorosis in children. "This is the discoloration of the teeth, which can show up as opaque white marks, lines, or mottled enamel and poor mineralization," explains Veytsman. "Children are more at risk for it because their teeth are still forming." Even if your child is affected by dental fluorosis, it's not a huge threat to their overall health and "has more to do with cosmetic appearances," adds Sulitzer. "Most of the time, it's faint and only spotted by your dentist."

People of all ages should also steer clear of swallowing any fluoride-containing products, as high amounts of the mineral can be toxic. This doesn't necessarily mean you should head straight to the ER if you accidentally ingest a little bit of, say, fluoride mouthwash while swishing it around in your mouth. But you should be careful of downing it on the regular and keep an eye out for symptoms such as stomach pain, diarrhea, vomiting, drooling, and others if you do, in fact, swallow a large amount of fluoride, according to Mount Sinai. (FYI, studies show that children under 6 might be more prone to this toxicity, so it might be smart to go fluoride-free for your kiddos.)

Why and How to Use Fluoride Toothpaste

As mentioned above, many, if not most, dentists advise using fluoride toothpaste. Additionally, all toothpastes with the ADA Seal of Acceptance (meaning a product meets the organization's safety and efficacy requirements) must contain fluoride, according to the ADA. In other words, these approved toothpastes are formulated in such a way that they contain a safe amount of the mineral, so you shouldn't need to worry about overexposure.

"For the average person it is simplest to use a fluoridated toothpaste both morning and night," says Joyce Kahng, D.D.S., an Orange County, California-based dentist (whom you might know as @joycethedentist on Instagram). After all, you should be brushing at least twice a day to maintain good oral hygiene and dental health, so using fluoride toothpaste shouldn't change that.

As for fluoride mouthwash, you don't really need to add it to your oral care routine, but you can consider it if you like. "As long as you have a good oral care routine, inclusive of brushing your teeth using toothpaste with fluoride and flossing, you do not necessarily need to use mouthwash," says Sulitzer. "However, if you feel like you need a little more protection from cavities or have talked with your dentist about adding this step into your daily routine, mouthwash with fluoride can be an added benefit." (Related: Should You Floss Before or After Brushing Your Teeth?)

Not sure if you should make the switch from fluoride-free to fluoride toothpaste? It's always a good idea to talk to your dentist but also consider the state of your mouth. "A big sign of a fluoride deficiency is cavities," he says. "A lack of this mineral will result in weakened enamel, ultimately causing more tooth decay. If you notice you've been getting more cavities, it will be beneficial to start using fluoride toothpaste."

You might even benefit from taking things a step further. "For someone with a high rate of getting cavities, a prescription fluoride toothpaste morning and night can be helpful to prevent decay," says Kahng. Sound familiar? Then you should consult a dentist to determine whether an Rx product is right for you. These contain up to three times as much fluoride as a regular fluoride toothpaste, which is why they're not available over the counter, according to the Oral Health Foundation.

In some cases, you might benefit from a professional fluoride treatment, when a dentist applies a higher-strength fluoride gel, foam, rinse, or varnish to your teeth. You might be a candidate for this "if you have problems such as dry mouth, gum disease, frequent cavities, presence of crowns or braces," says Veytsman.

So Can You Ever Use Fluoride-Free Toothpaste?

There are a few reasons why you might opt for a fluoride-free toothpaste despite the aforementioned perks of using a tube with the mineral, says Kahng. For starters, some parents opt for fluoride-free toothpastes for their young children since they lack confidence that the child will spit it all out when brushing their teeth. Other people might lean toward options marketed as "clean" when choosing personal care products, thereby opting for fluoride-free toothpastes, which tend to contain more natural ingredients (and fewer preservatives, such as in the case of toothpaste tablets).

What's more, there is some evidence that extremely high levels of fluoride may cause cognitive or thyroid problems. In the vast majority of cases, though, using fluoridated toothpaste is safe for both adults and children who are able to spit it out, explains Kahng. Some people also uphold that fluoride is a dentist conspiracy to actually increase the rate of decay, adds Kahng. There is no basis for this belief. And while these folks are in the minority, their influence can be seen online and through fairly recent municipal changes to drinking water. From 2013 to 2018, for example, 74 U.S. cities voted to remove fluoride from their drinking water, according to NBC. Still, the majority of the country — over 70 percent of the U.S. population — receives fluoridated drinking water, according to the CDC.

"For patients who are anti-fluoride, I like to provide alternative actives that may help prevent decay," says Kahng. "Two promising actives that I incorporate into my own oral hygiene routine (in addition to fluoride) are nanohydroxyapatite and nanosilver."

Nanohydroxyapatite is a calcium phosphate-based agent, meaning it consists of the same minerals that make up your enamel, and because of this, it can have a remineralizing effect
"comparable to fluoride," according to research. Nanosilver, on the other hand, has been shown to have antibacterial effects, helping to keep potentially-damaging bacteria at bay.

Bottom Line

So there you have it: When it comes to choosing between fluoride or non-fluoride toothpaste, the former should be your first choice, according to experts. But if you feel uncomfortable using a fluoridated product for any reason, there are alternatives available — just be sure to look for one that contains expert-backed ingredients, such as nano-hydroxyapatite or nanosilver, as Kahng suggests. Still unsure which type of tube is best for you? Consult your dentist, who will be able to make personalized recommendations. (Up next: Should You Brush Your Teeth Before or After Breakfast?)