There has been some discussion in recent years about the levels of fluoride Americans are exposed to on a daily basis. Experts do agree that ingesting too much fluoride can lead to fluorosis, which can cause white flecks on teeth, or even weak bones and susceptibility to fractures. Fluorosis can be a significant health issue for babies and children whose teeth are still developing, but it's also quite rare. Experts also agree that some fluoride is important for helping a child develop strong teeth and avoid dental diseases that were common in children before the advent of fluoridated water. For most people, the ADA says the benefits of fluoride toothpaste far outweigh any risks -- for that reason, no fluoride-free toothpastes are ADA approved.
Your need, and your child's need, for fluoride will depend upon a number of factors, not the least of which is the area in the U.S. where you live, the type of water access you have, and other lifestyle issues. The best way to make an informed decision is to speak with your dental care provider and follow his or her recommendations.
However, if you do prefer a fluoride-free toothpaste you're in luck. More and more manufacturers are making toothpastes that keep fluoride out of the mix. Among those, reviewers say the best of the bunch is Tom's of Maine Fluoride-Free Toothpaste (Est. $5). It's made with zinc citrate sourced from zinc, a naturally occurring mineral, and xylitol, which is derived from birch trees or corn. This toothpaste does contain sodium lauryl sulfate (SLS), a dispersant that can cause canker sores in some sensitive individual. Tom's toothpaste comes in three different flavors: peppermint, spearmint or fennel. The product is gluten-free, cruelty-free, and halal and kosher-certified. It contains no artificial dyes, sweeteners or flavors.
Experts like Dr. David Evans recommend Tom's of Maine products for people who prefer a natural toothpaste, although like most experts, he cautions that natural toothpaste advocates generally suggest opting for a fluoride-containing toothpaste for cavity prevention. GoodGuide.com gives this Antiplaque and Whitening Fluoride-Free Toothpaste a respectable health score of 6 out of 10.
The thousands of user reviews we saw for Tom's of Maine Antiplaque and Whitening are mostly positive; however, many users are displeased about the addition of SLS to the toothpaste's formula. Otherwise, most are happy with the product's light, natural-tasting flavor and say that the paste cleans teeth effectively.
Nature's Gate (Est. $5) is another fluoride-free toothpaste earning positive feedback from people. It comes in four flavors: Crème de Anise, Crème de Cinnamon, Crème de Mint and Crème de Peppermint, none of which contain fluoride or sodium lauryl sulfate, although they do contain sodium lauroyl sarcosinate. While the two ingredients sound similar, they are not the same. The Environmental Working Group identifies sodium lauroyl sarcosinate as a surfactant and cleansing agent but gives it a "low" rating for health concerns. In addition to sodium lauroyl sarcosinate, the ingredients in Nature's Gate toothpaste consist primarily of calcium carbonate, glycerin, water, xanthan gum, and a variety of root, fruit, and leaf extracts.
Among hundreds of reviews on Amazon.com, most are positive, with reviewers saying that they like Nature's Gates foaming effect and subtle flavor, although some complain about its thin, slightly runny consistency. While there is some controversy surrounding the ingredients among reviewers, most users say it leaves their breath smelling fresh and their teeth feeling clean, and a few even say it whitens their teeth.
Both Dr. David Evans and MensHealth.com recommend The Natural Dentist (Est. $7). While both of these expert sources recommend the fluoride-containing formulation of this toothpaste, The Natural Dentist does offer a fluoride-free variety. The Natural Dentist Fluoride-Free contains peppermint oil and sage oil as primary active ingredients, and it does not contain SLS. Dozens of reviewers have mostly positive feedback for this fluoride-free toothpaste, with several users noting that using it has eliminated mouth sores and gum soreness. It doesn't create a burning sensation like other mint-flavored toothpastes, users say, and the strength of the flavor falls somewhere in the middle, appealing to both those who like a strong mint taste and those who prefer a mild flavor.