Fluoride vs fluoride-free toothpaste: What's actually better for your teeth?

India Today

5 days ago

For decades, fluoride has been at the heart of modern dental care, recommended by dentists and added to everything from toothpaste to drinking water.But in recent years, a growing wave of fluoride-free toothpaste brands has entered the mainstream, raising doubts in the minds of consumers: is fluoride truly essential, or just another chemical we've been conditioned to rely on?advertisementWHY FLUORIDE STILL HAS STRONG BACKINGFluoride has long been considered a powerful tool against cavities, and for good reason. It helps in remineralising tooth enamel, making it more resistant to acid attacks from food and bacteria.
It's particularly effective in reversing early signs of decay, something no other common toothpaste ingredient has consistently proven to do.'Fluoride has remineralising capabilities, and it inhibits the bacterial enzyme enolase, which affects and reduces bacterial activity,' says Dr. Aditi Dhaundiyal, a practising dentist based in New Delhi. In other words, it strengthens the teeth and reduces the activity of decay-causing bacteria.Germany-based dental surgeon Dr. Bibhakar Ranjan agrees, calling fluoride 'a proven agent that helps rebuild lost enamel and makes teeth more resistant to acid attacks.' He explains that fluoride forms a protective fluoroapatite layer, 'which can even reverse early stages of decay.'Many dentists still consider fluoride irreplaceable, especially for those who are more prone to cavities. Used in the correct amount, it's also considered completely safe.'Fluoride is as safe as having a multivitamin tablet,' Dr Aditi adds.Topical fluoride, like that found in toothpaste, doesn't carry the same risks as systemic fluoride (such as that found in over-fluoridated water). While very high exposure over time can lead to conditions like dental fluorosis, regular brushing with appropriate fluoride levels (about 550 ppm for kids, 1000–1500 ppm for adults) is well within safe limits.THE CASE FOR GOING FLUORIDE-FREEDespite fluoride's proven benefits, a growing number of people are opting out. Fluoride-free toothpastes, often herbal or Ayurvedic, are being marketed as safer, more natural alternatives.They appeal to people trying to avoid unnecessary chemicals and are often packed with plant-based ingredients like neem, clove, turmeric, and cinnamon.Dr Sonali Joshi Kashyap, a dental surgeon with over three decades of experience, acknowledges that fluoride may not be essential for everyone.'For someone who has a healthier oral cavity or a mouth, we can highly do without fluoride toothpaste, no doubt about it. As long as you're brushing right, brushing at the right time, and brushing after meals,' she says.advertisementIn these cases, she says, lifestyle becomes the key to cavity prevention. That includes eating a low-sugar diet, avoiding frequent snacking, and maintaining regular oral hygiene.Dr Ranjan notes that the shift towards fluoride-free options is often influenced more by online trends than science. 'To be honest, nowadays, we have too many social media influencers having more than a million followers who sometimes share or promote things which are not scientifically correct, and I feel even toothpaste brands also follows what's in the trend to boost their sales.'He adds that while some alternatives like nano-hydroxyapatite show early promise, 'fluoride remains the most well-researched and consistently effective agent against cavities. Most alternatives are not yet backed by the same level of long-term scientific validation.'Techniques like oil pulling and using natural ingredients like alum or bakul can also support oral health, though they aren't substitutes for fluoride in people at high risk of decay.That said, even Dr Sonali cautions against a one-size-fits-all approach. In areas with high natural fluoride in water, for example, the risk of fluorosis is real, and in such cases, skipping fluoride toothpaste is medically advised.But for the average person with normal fluoride exposure, she recommends a varied approach: rotate between different toothpastes, fluoride and non-fluoride, for variety and balance.advertisementWHAT'S THE RIGHT CHOICE?If your diet is clean, your brushing habits are consistent, and your cavity risk low, a fluoride-free toothpaste may be an option. But if you're unsure, or if you're caring for someone with a higher risk of cavities, like an elderly person or someone with existing dental issues, dentists often recommend fluoride as a reliable form of protection, provided it's used appropriately.Dr. Ranjan believes the fear around fluoride is often misplaced: "Fluoride in toothpaste is very safe when used as prescribed or suggested by dental professionals, just a pea-sized amount, and strictly don't swallow it."He adds, 'The fears around fluoride typically come from misunderstandings, misinformation (in the age of social media) or misapplication of high-dose fluoride.'He cites a real-world example: 'In 2011, Calgary city in Canada removed fluoride from water, and they noticed the children had more cavities than the neighbouring cities with water fluoridation, which forced the authorities in rethinking on their policy to reintroduce water fluoridation in Calgary.'The bottom line? It's less about choosing sides and more about understanding your own oral health needs. Fluoride isn't a problem, but it's also not the only solution.advertisementThe best toothpaste is one that works with your habits, not against them.At the end of the day, good oral hygiene is about consistency. No ingredient can replace brushing twice a day, limiting sugar, and visiting the dentist regularly.Whether you pick fluoride or go fluoride-free, your daily choices will matter far more than what's written on the toothpaste tube. What's essential is being informed, not influenced.-Article by Arima Singh- Ends