Fluoride: The ultimate guide

Our clinical experts address questions around what fluoride does, if you really need to use it, and how to ensure you're keeping your teeth healthy no matter how you remineralize. Let's dive in.

Fluoride made its debut in toothpaste in the 1890s in Germany. The United States introduced it into public water sources in the 1940s and then there was an explosion of fluoride-based toothpastes starting in the 1950s. When it comes to fluoride and oral health, the two seem to always be together.

That's because fluoride is a well-known remineralizing agent. "Remineralization is like refueling your body after an intense workout," shares Wally hygienist, Iman Zayed, RDH. "Just like you need to replace electrolytes and water lost in your workout, you also need to replace the calcium and phosphorus that your teeth lose from consuming acidic food or drinks."

Your teeth lose those minerals because of the food particles that remain in your mouth. Your saliva breaks down those particles into carbohydrates and sugars, and the bacteria in your mouth from, well, being alive, eat those carbs and sugars. The byproduct (yes 💩) is acid. These acids are, well, acidic, and as they sit on your teeth they dissolve the minerals (calcium and phosphorus) on the tooth enamel.

Fluoride is often promoted as "the way" to support your enamel. But is it the only way? How effective is it? And how do you know what's right for your mouth?

Non-fluoride toothpaste - how to pick the right one

If you are looking for a fluoride-free toothpaste, how do you know which is the best option for your teeth? The key is to pick one that remineralizing your teeth.

Replacing those minerals keeps your enamel strong. Enamel is the hardest substance of the body - enamel is 96% mineral and only 4% water which makes those pearly whites more like rocks than shells. Fun fact: tooth enamel is tougher than steel, seriously.

That's because the main mineral in your enamel is, hydroxyapatite, a crystalline calcium phosphate which is pretty dang strong. Even though your enamel is strong like superman or superwoman, it still has a kryptonite: acids from bacteria. 

Fortunately, there are now plenty of toothpaste options for you to use every day - ideally twice per day 😉. The downside of so many choices is, how do you know what to pick?

We asked our dentists and hygienists for their advice for picking the right toothpaste. They said to pick whatever flavor and texture you find most enjoyable because it makes it easier to brush your teeth. And most importantly, make sure your toothpaste has one of these remineralizing ingredients:

  • Nano-hydroxyapatite
  • Recaldent

Our clinicians get into the nitty gritty of your remineralizing options. Read more to help you select a fluoride-alternative to your toothpaste 📖.

Stannous fluoride or sodium fluoride, which is for me?

You might be thinking, "wait, there is more than one type of fluoride?" You're in good company. Most people think about fluoride in their toothpaste, but there are actually two types: stannous fluoride and sodium fluoride. Okay … so which one is best for you? Or maybe neither?

Here's the too long, didn't read on stannous fluoride: 

  1. It's antimicrobial and kills bacteria that can cause gum disease and tooth decay. 
  2. It makes dental surfaces stronger and more resistant to bacterial acids. 
  3. When it makes your teeth strong, it also reduces tooth sensitivity because the extra layer on your enamel helps reduce exposure to hot, cold, and sweet foods.
  4. It helps you maintain a neutral pH in your mouth - your saliva's pH won't go down as much when you eat, and it rebounds to a neutral state more quickly 

"Stannous fluoride is a great option if you have an acidic oral environment," explains Wally hygienist, Sarah Clark, RDH. "Acidic saliva comes from cavity-causing bacteria that are thriving in your mouth. They eat food particles and give off acid waste as a by-product. Stannous fluoride targets those bacteria and helps eliminate them, which helps your mouth maintain a more neutral pH."

So what's the detail with sodium fluoride, which is found in more toothpastes? Just like stannous fluoride, sodium fluoride is great at helping you prevent cavities. "For many people, sodium fluoride is all that they need," shares Sarah Clark, RDH. "Using it twice per day, and letting it sit on your teeth after brushing goes a long way to remineralizing teeth and preventing tooth decay."

Get more details on the different types of fluoride and how to pick the right toothpaste for your mouth's personal needs 📖.

Fluoride in well water and public water sources

Most water contains naturally-occurring fluoride, but it's usually too little to prevent tooth decay. After studying the effects of fluoride on teeth health, the City of Grand Rapids in Michigan decided to give it a try and was the first city in the world to add fluoride to its drinking water in 1945. The Grand Rapids water fluoridation study turned into a 15-year project where researchers watched the rates of tooth decay of the ~30,000 schoolchildren in the area. The rate of cavities dropped more than 60% during the study.

Today most communities in the United States add fluoride to their public water supply. But how much is added? And is there any harm? The biggest drawback is risk of dental fluorosis (white marks on your teeth), which is caused by systemic fluoride when your teeth are developing.

Get the full story on fluoride in water, its connection to dental fluorosis, a bit of math, and how to choose bottled water if you want to avoid fluoride in your water 📖

High fluoride toothpaste & other fluoride treatments

If you don't see the dentist frequently enough and your at-home hygiene routine isn't optimized, this can lead to tooth decay. That means sensitivity, cavities, or cracked teeth.

The good news is if you see your dentist regularly, your clinical team can catch this early and recommend one or a combination of fluoride treatments designed to strengthen your enamel and prevent tooth decay. Your clinicians might recommend one or more of the following:

  • High fluoride toothpaste with a prescription
  • Fluoride treatment at home
  • Topical fluoride treatment at your dentist

Read more 📖 about different fluoride treatments and what you can do to avoid them in the future.

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