Just about every dental health professional agrees that brushing your teeth at least twice a day is a good thing, but what goes into that toothpaste is a wee bit more controversial. (Don’t even get us started on the whole is-flossing-really-worth-it debate of 2016.)
The source of contention? Fluoride, the naturally occurring mineral that has been added to drinking water for decades and is an ingredient in many, many adult toothpastes.
On the one hand, mainstream dentists generally embrace it as a big-time cavity fighter. The American Dental Association not only supports fluoridation of water; it won’t put its seal of approval on any toothpaste that doesn’t contain it.
And yet over the years, a smaller group of holistic dentists have raised concerns about potential neurotoxicity of fluoride in drinking water and toothpaste. After all, top medical journal The Lancet designated the mineral as a neurotoxin in 2014. And shortly after that, federal health officials—for the first time in more than 50 years— advised local governments to lower the amount of fluoride in the US water supply.
So, what tube to trust?
We asked two dentists with different opinions to weigh in on what you should squeeze onto your toothbrush every day.
The argument against fluoride
Around 15 years ago, Bruno Sharp, DDS—a fourth-generation dentist with a practice in Florida—began digging into the criticism of the old-school oral health ingredient, and he found a lot to be alarmed by.
“The effects of fluoride haven ’t been known to most dentists, therefore most dentists still believe that it’s beneficial,” Dr. Sharp says. But fluoride is a potential neurotoxin, he argues, and can accumulate in the body over time.
Indeed, mainstream medical groups like the Mayo Clinic warn about the dangerous side effects of overdosing on sodium fluoride, though it adds that taking it as a supplement or drinking it in tap water does not usually cause any of those issues. And yet, the Environmental Protection Agency has also said it’s likely some children are exposed to too much fluoride “at least occasionally.”
Which is why for Dr. Sharp, it’s just not worth the risk for anyone, especially because he’s not convinced by the science supporting fluoride’s efficacy in treating cavities.
A 2015 Cochrane review found, for example, that fluoridated water simply didn’t have any cavity-fighting benefits for adults specifically, and that a lot of the science supporting fluoridation was decades old. “Adults and children,” he says, “should be aware of the research and data available out there.”
Dr. Sharp does believe that patients with oral cancer requiring radiation do benefit from fluoride. But beyond that, he’s convinced there’s no compelling reason for it to be in toothpaste—and he’s got his own fluoride-free line that he sells through big mainstream brands, like Target and Whole Foods.
On the other hand: Here’s what it does for your teeth
New Jersey-based dentist Alexander Rubinov, DDS, is totally Team Fluoride when it comes to topical applications like toothpaste. It’s absorbed into the tooth’s enamel, he explains, and helps repair it by replenishing lost minerals. In other words, it can really help keep teeth strong.
That said, Dr. Rubinov fully acknowledges that fluoride can be dangerous in really high amounts. “I don’t want to discredit all the research that’s been done that has indicated fluoride is, indeed, toxic in a certain dose,” he notes. But you won’t get that dose from your toothpaste, which, reminder: You definitely should not be swallowing anyway.
All that said, if you generally have really good dental hygiene—you drink a lot of water, avoid sugary drinks, and you brush and floss every day—it probably doesn’t matter if you want to skip fluoride, he says.
As he explains, “It’s really most important for people who aren’t compliant with good oral health care.” In other words: Keep up a spot-on dental routine and you might not even have to worry about fluoride.
Want to dig into some other wellness controversies? Here’s how to know if six-week workout challenges are really worth it, and whether micro-dosing LSD might make you happier.