{"url":"https://whatshealthyandwhy.com/toothpaste-ingredients/what-is-in-your-toothpaste","path":"/toothpaste-ingredients/what-is-in-your-toothpaste","alternates":{"json":"https://whatshealthyandwhy.com/api/articles/toothpaste-ingredients/what-is-in-your-toothpaste.json","markdown":"https://whatshealthyandwhy.com/toothpaste-ingredients/what-is-in-your-toothpaste.md"},"topic":{"slug":"toothpaste-ingredients","name":"Toothpaste Ingredients","url":"https://whatshealthyandwhy.com/toothpaste-ingredients"},"slug":"what-is-in-your-toothpaste","order":1,"title":"What Is in Your Toothpaste?","question":"What's in your toothpaste, and are 'natural' pastes as good?","answer":"Fluoride toothpaste probably prevents cavities; natural pastes without fluoride are unproven for that job, though hydroxyapatite pastes look promising.","description":"Which toothpaste ingredients do the work (fluoride), which carry trade-offs (SLS, charcoal, abrasives), where xylitol fits, and how natural pastes compare.","confidence":4,"confidenceNote":"High- and moderate-certainty Cochrane evidence supports fluoride for preventing cavities; evidence for SLS-free, xylitol and herbal pastes is weaker, and fluoride-free pastes lack long cavity trials (hydroxyapatite is the exception).","evidenceSummary":{"rctCount":1,"observationalCount":0,"metaAnalysisCount":7,"totalParticipants":"60,000+","replicated":true,"newestStudyYear":2025},"category":{"categoryTitle":"Skin & Self Care","categorySlug":"skin-and-self-care","subcategoryName":"Dental Health","subcategorySlug":"dental","url":"https://whatshealthyandwhy.com/explore/skin-and-self-care/dental"},"actions":["Choose a fluoride toothpaste of 1,000–1,500 ppm and brush twice daily: 1,000–1,250 ppm clearly beat fluoride-free in children's teeth, 1,450–1,500 ppm did slightly better, more brushing helped [1][2].","For under-6s, supervise brushing and ask a dentist about amount and strength: swallowing pea-sized amounts or more can cause mild fluorosis; 550 ppm pastes cut it versus 1,000 ppm [3][4].","For frequent mouth ulcers, try an SLS-free paste for about 8 weeks: four crossover trials found fewer or shorter ulcers and less pain, though one found only shorter ulcers [5][6]."],"cautions":["Skip charcoal pastes if you have worn enamel or exposed roots. Lab studies found they whiten less and are more abrasive than alternatives [7].","If you get cavities often, talk to a dentist before switching to a fluoride-free paste. The cavity-prevention evidence comes from fluoride [1]."],"simpleText":"Of everything in a tube of toothpaste, fluoride is the ingredient with strong proof: it reduces cavities in children and adults [1]. A few others carry trade-offs: the foaming agent SLS can aggravate mouth ulcers in some people [5], and charcoal is more abrasive than other whiteners [7]. Natural pastes without fluoride lack comparable cavity trials, though hydroxyapatite pastes matched fluoride in small trials [8].","mediumText":"How it works\n\nFluoride: the active ingredient\n\nA Cochrane review of 96 trials found that fluoride toothpaste prevents decay compared with fluoride-free paste: 1,000 to 1,250 ppm in children's permanent teeth (high-certainty), 1,000 to 1,100 ppm in adults, and 1,500 ppm in young children's baby teeth [1]. An earlier Cochrane review of 74 trials found the effect grew with higher fluoride concentration, more frequent use and supervised brushing, and was not influenced by water fluoridation [2]. The trade-off is fluorosis, a mild change in enamel from too much fluoride while teeth form. Moderate-certainty trials show lower-fluoride pastes (550 or 440 ppm) cause less of it in under-6s [4]. For the wider debate, see The Fluoride Debate.\n\nThe other ingredients\n\n- Abrasives. These polish off stains, and their strength is rated by RDA (dentin) and REA (enamel). The two numbers can diverge sharply, so a single figure can mislead [9].\n- SLS. This foaming detergent matters mainly for people prone to recurrent mouth ulcers, for whom SLS-free paste helped in small trials [5][6].\n- Charcoal. A literature review found insufficient evidence for its safety or efficacy claims [10].\n- Xylitol. Fluoride paste with 10% xylitol may cut decay by 13% versus fluoride alone, but the evidence is low-quality [11]. See Xylitol.\n\nAre \"natural\" pastes as good?\n\nHerbal pastes cleaned plaque about as well as ordinary pastes in short trials, but the evidence is low-quality and measured plaque, not cavities [12]. Hydroxyapatite is the exception: four in-situ trials found no significant difference from fluoride [8]; see Nano-Hydroxyapatite.\n\nWhat to do\n\nPick a fluoride paste you will actually use every day. If you prefer a fluoride-free option, choose one with evidence, such as hydroxyapatite, and discuss your cavity risk with your dentist.","deepText":"The evidence in detail\n\nFluoride and cavities\n\nThe newer Cochrane review covered 96 studies from 1955 to 2014. In children's permanent teeth, a network meta-analysis found 1,000 to 1,250 ppm fluoride reduced caries increments versus fluoride-free paste (standardized mean difference -0.28; 95% CI -0.32 to -0.25; 55 studies, high-certainty). Pastes of 1,450 to 1,500 ppm gave -0.36 (-0.43 to -0.29; four studies) and were slightly better than 1,000 to 1,250 ppm (-0.08; -0.14 to -0.01; 10 studies, moderate-certainty). In adults, 1,000 or 1,100 ppm lowered decayed and filled surfaces by 0.53 (0.04 to 1.02; 2,162 participants, moderate-certainty). In baby teeth, one study of 998 children found 1,500 ppm reduced decay increment by 1.86 surfaces (1.21 to 2.51). Few studies reported adverse effects, and those that did found soft-tissue damage and staining minimal [1]. The older review pooled 70 trials in 42,300 children and found a 24% prevented fraction (21% to 28%) [2].\n\nThe fluorosis trade-off\n\nA Cochrane review of 43 studies found that two randomized trials (1,968 children) showed lower-fluoride paste reduced fluorosis: 550 versus 1,000 ppm gave a risk ratio of 0.75 (0.57 to 0.99), and 440 versus 1,450 ppm gave 0.72 (0.58 to 0.89). Children who brushed with 1,000 ppm or more from age one or two to five or six probably had more fluorosis, mostly mild. Evidence on amount, frequency and starting age was low or very low certainty [4]. A systematic review found fluoride paste effective for high-risk children under 6, and that pea-sized amounts or more can cause mild fluorosis [3].\n\nAbrasivity\n\nIn a bovine-tooth study, four pastes with different enamel (REA) and dentin (RDA) values were brushed for 21,600 strokes. The paste with REA 244 and RDA 12 caused the most enamel wear (9.86 micrometres) but the least dentin wear (17.0), while one with REA 4 and RDA 100 caused the most dentin wear (166.7). The authors argued that both values should be declared on every tube [9]. This is a lab model, not a measure of wear in mouths.\n\nCharcoal and SLS\n\nA literature review screened 118 potentially eligible articles on charcoal products. Thirteen studied brushing with raw charcoal or soot, none met its inclusion criteria, and three reported harm such as more decay or enamel abrasion. Advertisements made unsubstantiated claims, including \"oral detoxification\" [10]. A systematic review of 11 studies, mostly in vitro, found charcoal pastes whitened less than alternatives and were more abrasive [7]. For SLS, four double-blind crossover trials (124 participants) found SLS-free paste lowered ulcer number, duration, episodes and pain, though more trials are needed [5]. In a 90-person randomized trial with 8-week phases, SLS-free paste did not reduce ulcer number or episodes but shortened ulcers and eased pain [6]. Neither shows SLS harms people without ulcers.\n\nXylitol and herbal pastes\n\nA Cochrane review of 10 studies (5,903 participants) found that fluoride toothpaste with 10% xylitol may reduce decay by 13% (prevented fraction 0.13; 0.08 to 0.18; 4,216 children) versus fluoride alone. That result came from two studies by the same authors in the same population, so it is low-quality [11]. A meta-analysis of 24 trials (1,597 adults) found herbal toothpaste about as effective as conventional toothpaste at reducing plaque in the short term, and better than fluoride-free paste, with low-quality evidence [12]. Four small in-situ trials of hydroxyapatite versus fluoride found no significant differences in new or progressing lesions (risk ratio 0.98; 0.85 to 1.12), though lesion size and fluorescence measures did differ at six months, so the picture is not fully settled [8].\n\nWhere the evidence is mixed\n\nThree results cut across the headline. The SLS evidence is split: the pooled analysis says fewer ulcers, while a 90-person trial found only shorter, less painful ones [5][6]. The xylitol benefit rests on two studies by one group [11]. Herbal and hydroxyapatite pastes were compared mostly on plaque or early lesions over months, not on cavities over years [12][8]. Fluoride is the opposite: dozens of long trials, with the main trade-off being mild fluorosis in young children [1][4].\n\nBottom line\n\nConfidence 4 of 5. Fluoride's benefit is well established, and what you choose after that is mostly preference. Evidence for natural alternatives is thinner, and mostly measures plaque or early lesions rather than years of cavity prevention.","deepTruncated":false,"references":[{"id":"1","title":"Fluoride toothpastes of different concentrations for preventing dental caries","authors":"Walsh T, Worthington HV, Glenny AM, et al.","year":2019,"journal":"Cochrane Database Syst Rev","pmid":"30829399","url":"https://pubmed.ncbi.nlm.nih.gov/30829399/"},{"id":"2","title":"Fluoride toothpastes for preventing dental caries in children and adolescents","authors":"Marinho VC, Higgins JP, Sheiham A, et al.","year":2003,"journal":"Cochrane Database Syst Rev","pmid":"12535435","url":"https://pubmed.ncbi.nlm.nih.gov/12535435/"},{"id":"3","title":"Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review","authors":"Wright JT, Hanson N, Ristic H, et al.","year":2014,"journal":"J Am Dent Assoc","pmid":"24487610","url":"https://pubmed.ncbi.nlm.nih.gov/24487610/"},{"id":"4","title":"Topical fluoride as a cause of dental fluorosis in children","authors":"Wong MCM, Zhang R, Luo BW, et al.","year":2024,"journal":"Cochrane Database Syst Rev","pmid":"38899538","url":"https://pubmed.ncbi.nlm.nih.gov/38899538/"},{"id":"5","title":"Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: A systematic review","authors":"Alli BY, Erinoso OA, Olawuyi AB","year":2019,"journal":"J Oral Pathol Med","pmid":"30839136","url":"https://pubmed.ncbi.nlm.nih.gov/30839136/"},{"id":"6","title":"Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a randomized controlled clinical trial","authors":"Shim YJ, Choi JH, Ahn HJ, et al.","year":2012,"journal":"Oral Dis","pmid":"22435470","url":"https://pubmed.ncbi.nlm.nih.gov/22435470/"},{"id":"7","title":"Effectiveness and abrasiveness of activated charcoal as a whitening agent: A systematic review of in vitro studies","authors":"Tomás DBM, Pecci-Lloret MP, Guerrero-Gironés J","year":2023,"journal":"Ann Anat","pmid":"36183933","url":"https://pubmed.ncbi.nlm.nih.gov/36183933/"},{"id":"8","title":"The role of hydroxyapatite-based, fluoride-free toothpastes on the prevention and the remineralization of initial caries lesions: A systematic review and meta-analysis","authors":"Chatzidimitriou K, Theodorou K, Seremidi K, et al.","year":2025,"journal":"J Dent","pmid":"40107597","url":"https://pubmed.ncbi.nlm.nih.gov/40107597/"},{"id":"9","title":"Abrasive Enamel and Dentin Wear Resulting from Brushing with Toothpastes with Highly Discrepant Relative Enamel Abrasivity (REA) and Relative Dentin Abrasivity (RDA) Values","authors":"Dobler L, Hamza B, Attin T, et al.","year":2023,"journal":"Oral Health Prev Dent","pmid":"36727837","url":"https://pubmed.ncbi.nlm.nih.gov/36727837/"},{"id":"10","title":"Charcoal and charcoal-based dentifrices: A literature review","authors":"Brooks JK, Bashirelahi N, Reynolds MA","year":2017,"journal":"J Am Dent Assoc","pmid":"28599961","url":"https://pubmed.ncbi.nlm.nih.gov/28599961/"},{"id":"11","title":"Xylitol-containing products for preventing dental caries in children and adults","authors":"Riley P, Moore D, Ahmed F, et al.","year":2015,"journal":"Cochrane Database Syst Rev","pmid":"25809586","url":"https://pubmed.ncbi.nlm.nih.gov/25809586/"},{"id":"12","title":"Effectiveness of herbal oral care products in reducing dental plaque & gingivitis - a systematic review and meta-analysis","authors":"Janakiram C, Venkitachalam R, Fontelo P, et al.","year":2020,"journal":"BMC Complement Med Ther","pmid":"32046707","url":"https://pubmed.ncbi.nlm.nih.gov/32046707/"}],"wordCount":1058,"source":{"path":"src/content/topics/toothpaste-ingredients/what-is-in-your-toothpaste.md"},"citeAs":"“What's in your toothpaste, and are 'natural' pastes as good?.” What's Healthy and Why. https://whatshealthyandwhy.com/toothpaste-ingredients/what-is-in-your-toothpaste","notice":"General information backed by peer-reviewed research, not medical advice."}