Fluoride-Free Toothpaste: What the Research Shows

Fluoride-free toothpaste has not been shown to lower cavity risk the way fluoride toothpaste has. The best evidence, a Cochrane review, compared fluoride with non-fluoride paste, and fluoride came out ahead. This guide covers what was measured, what the risks are and who might still choose fluoride-free.

We sell two fluoride-free toothpastes, including the Naturapeutic Sensitive, so read this with that in mind. Where our own listings say more than the sources do, this page says so. For another everyday swap, see our bamboo toothbrush guide.

Does Fluoride-Free Toothpaste Work?

It has not been shown to work as well at lowering cavity risk. The trials that showed toothpaste reducing decay compared fluoride paste with non-fluoride paste, and fluoride made the difference.

• What the review found: A 2019 Cochrane review found high-certainty evidence that toothpaste with 1,000 to 1,250 ppm fluoride reduces new decay in children and adolescents compared with non-fluoride toothpaste (55 studies). Its plain-language summary says 1,000 or 1,100 ppm paste also reduced decay in adults of all ages.
• Young children: In baby teeth, the review found 1,500 ppm fluoride toothpaste reduced new decay compared with non-fluoride toothpaste, from one study with moderate-certainty evidence.
• What Health Canada says: Health Canada says brushing with fluoridated toothpaste helps prevent tooth decay, and that fluoride strengthens enamel, lowers the amount of acid in your mouth and helps rebuild minerals that make teeth stronger.
• What is not tested: The review compared fluoride with non-fluoride toothpaste in general. It did not test any natural brand, including ours.

Is Fluoride Toothpaste Safe?

Used as directed, the sources we read say yes. Health Canada says the only health risks proven to be related to fluoride are dental fluorosis and skeletal fluorosis.

• Dental fluorosis: Health Canada says small white lines or flecks can appear on adult teeth only if a young child swallowed too much fluoride while those teeth were forming, and that in its mild form it is only cosmetic. In a Canadian survey, 59.8% of children had normal teeth, 16% had very mild or mild fluorosis and under 0.3% had moderate or severe fluorosis.
• Skeletal fluorosis: Health Canada says it needs very high fluoride intake every day for a long time and is extremely rare in Canada.
• Swallowing: Health Canada notes toothpaste contains high amounts of fluoride and very young children may swallow it, which is why recommended amounts depend on age.
• Claims we did not assess: Some people choose fluoride-free paste because of other concerns about fluoride. We did not review that research for this guide, and Health Canada says no other health risks have been proven. Raise any specific concern with your dentist.

Can Xylitol or Other Natural Ingredients Replace Fluoride?

Not on the evidence we read. A 2015 Cochrane review of xylitol products found little to support xylitol on its own.

• The one clear result: Over 2.5 to 3 years, a fluoride toothpaste containing 10% xylitol may reduce cavities by 13% compared with a fluoride-only toothpaste (4,216 children, low-quality evidence). That is xylitol added to fluoride, not xylitol instead of it.
• Everything else: The review says the remaining evidence came from small single studies with risk of bias and was insufficient to determine a benefit, and that there is no compelling evidence to support the use of xylitol products.
• Other ingredients: One of our toothpastes lists silica, xylitol and green tea extract. We did not look for studies on silica or green tea extract, so we make no claim about them.

Who Might Choose Fluoride-Free Toothpaste?

Mainly people whose dentist has assessed their risk and agreed, and parents of children under three who are not at risk of decay. The sources we read do not recommend it as a general replacement.

• Children under three: The Canadian Dental Association (CDA) says to consult a health professional to assess your child's risk of decay. If your child is not at risk, use a toothbrush moistened only with water; if at risk, use a tiny amount, the size of a grain of rice, of fluoridated toothpaste.
• Your own risk: The CDA position on fluoride recommends consulting your dentist for an assessment of your risk of cavities and for advice about daily products with fluoride.
• What to look for: The same CDA position says to look for the CDA Seal when buying daily oral care products. Our two fluoride-free listings do not mention it.

How Much Toothpaste Should Children Use?

It depends on age, and the amounts apply to fluoridated paste. Health Canada asks an adult to help children under 6 brush. No source we read gives a separate amount for fluoride-free paste.

1. Under 3 years (0 to 36 months). Consult a health professional about your child's risk of decay. If at risk, an adult brushes with a minimal, rice-grain-sized amount of fluoridated toothpaste.
2. Ages 3 to 6. An adult helps and uses only a small, green pea-sized amount (5 mm at most) of fluoridated toothpaste.
3. Encourage spitting. The CDA says to supervise young children, encourage spitting out the paste and make sure brushing is thorough, because young children often swallow toothpaste.
4. Age 6 and older. Once your child can spit out toothpaste, supervised brushing with fluoridated toothpaste can begin.

What Is in Our Fluoride-Free Toothpastes?

Two Green Beaver toothpastes, both listed as fluoride-free. Neither listing says it lowers cavity risk, and we do not claim that either.

• Naturapeutic Sensitive, Fresh Mint: The listing says it is free from fluoride, SLS, parabens, potassium nitrate and artificial ingredients, and that it is made in Canada and ECOCERT certified. It also says it soothes tooth sensitivity; we found no source for that, so treat it as unproven.
• Natural Toothpaste: The listing says it is a fluoride-free formula with silica, xylitol and green tea extract, free from artificial colours and flavours, SLS, parabens and triclosan, and certified by ECOCERT and the Natural Products Association.
• Where they fit: If your dentist recommends a fluoride toothpaste, these are not a substitute for it.

When Should You See a Dentist About Your Toothpaste?

Before switching, if you or your child are prone to cavities, and whenever your dentist's advice differs from what you read online. This guide is information, not medical advice.

The CDA recommends that children see a dentist no later than 12 months of age or within 6 months of getting their first tooth. It also recommends a cavity-risk assessment from your dentist, who can advise on daily products with fluoride that meet your needs.

Frequently Asked Questions

Is fluoride-free toothpaste as good as fluoride toothpaste?

Not on the evidence we read. A Cochrane review found high-certainty evidence that 1,000 to 1,250 ppm fluoride toothpaste reduces decay compared with non-fluoride toothpaste.

Does fluoride-free toothpaste stop cavities?

We found no trial showing it does. Neither of our fluoride-free listings claims to lower cavity risk.

Is fluoride toothpaste safe for kids?

Used in the right amount, Health Canada says yes. The proven risk is dental fluorosis from swallowing too much while teeth form, so use a rice-grain amount under 3 if at risk and a pea-sized amount from 3 to 6.

Can xylitol replace fluoride in toothpaste?

Not on the evidence we read. A Cochrane review found only low-quality evidence that xylitol added to a fluoride toothpaste may cut cavities by 13%, and found no compelling evidence for xylitol products otherwise.

Can toddlers use fluoride-free toothpaste?

The CDA says a child under 3 who is not at risk of decay can use a toothbrush moistened with water only. Ask a health professional to assess your child's risk first.

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