What Chemicals are Safe in Toothpaste?

Besides the mechanics of brushing your teeth, do you know what's actually in your toothpaste, and whether it's really protecting you? There are many chemicals that go into making toothpaste, but the two most studied are fluoride and nanohydroxyapatite. Both work to strengthen the outer layer of our teeth and protect against cavities [1].

What Are Cavities?

Cavities form when the bacteria in plaque (the sticky film that builds up on your teeth) breaks down the sugar you eat to produce acid on your teeth. That acid buildup gradually eats away at your teeth. Cavities are the most common disease in the world, affecting almost 100% of adults [2]. Dental cavities are more concentrated in communities with lower incomes, and despite being preventable, the number of cases has not decreased in the past three decades [2].

Benefits of Fluoride

For about three decades, fluoride has been approved and recommended by the World Health Organization for use in oral hygiene [3]. Fluoride works in several ways, including rebuilding enamel (the hard outer layer of your tooth that protects it from damage), stopping further mineral loss, and fighting the bacteria that cause cavities [4].

A study with children found that those who used fluoride mouth rinse were about 10 percentage points more likely to be cavity-free compared to those who did not use the fluoride mouth rinse [5]. Dental offices also provide fluoride varnishes, which are pastes that coat your teeth in active ingredients that help protect and repair teeth. The first generation of fluoride treatments typically contained 5% sodium fluoride (NaF), while newer versions include not just fluoride but also minerals that help rebuild teeth [6].

Benefits of Nanohydroxyapatite

For those who would rather avoid fluoride, a less common but equally effective alternative is nanohydroxyapatite. Nanohydroxyapatite is a fluoride-free ingredient that also helps in cavity prevention [7].

Hydroxyapatite is one of the most researched materials in both medicine and dentistry because of how well the body tolerates it and its positive effects on bone. Nanohydroxyapatite takes those same strengths further, because it dissolves better and is gentler on the body. It works by filling in the tiny gaps and weak spots in enamel and forming a protective coating over it [8]. One study found that people who used a nanohydroxyapatite lotion after brushing rebuilt significantly more enamel than those who used a lotion with no active ingredients [9].

What to Look For When Buying Toothpaste

With so many options on the shelf, choosing a toothpaste does not have to be complicated. Here is what actually matters:

• Look for fluoride or nanohydroxyapatite on the ingredient label → these are the two ingredients with strong evidence behind them

• Check for the ADA Seal of Acceptance (American Dental Association), which means the product has been tested and meets safety and effectiveness standards [10]

• If you have sensitive teeth, whitening toothpastes may cause irritation since they rely on abrasive ingredients to remove surface stains. A basic fluoride or nanohydroxyapatite toothpaste will still protect your teeth without the added abrasion [10]

• Flavor, color, and foam have no effect on how well a toothpaste protects your teeth → a basic store-brand toothpaste with fluoride works just as well as an expensive one

The most important thing is that you are brushing consistently, twice a day, for two minutes. The best toothpaste is the one you will actually use.

Key Takeaways

A minty flavor might make brushing feel refreshing, but the flavor has nothing to do with whether your toothpaste is actually protecting your teeth. Choosing a toothpaste with fluoride or nanohydroxyapatite does not just protect your enamel, it helps rebuild it. Left untreated, cavities can spread deeper into the tooth and lead to serious infections that affect the rest of the body.

Where to Get Dental Care in LA/OC

Routine dental care is one of the most commonly skipped forms of preventive health, often because of cost. If you or someone in your family needs dental care but does not have insurance or cannot afford it, these resources can help:

• Community health centers and Federally Qualified Health Centers (FQHCs) in LA and OC offer dental care on a sliding scale fee based on income

• UCLA Dental Group and USC Herman Ostrow School of Dentistry offer lower-cost care provided by supervised dental students

• Denti-Cal, California's Medi-Cal dental program, covers basic dental services for qualifying adults and children, including cleanings, fillings, and extractions

• Use this tool to find a low-cost dental provider near you: findahealthcenter.hrsa.gov 

Sources

1. Chatzidimitriou, K., Theodorou, K., Seremidi, K., Kloukos, D., Gizani, S., & Papaioannou, W. (2025). The role of hydroxyapatite-based, fluoride-free toothpastes on the prevention and the remineralization of initial caries lesions: A systematic review and meta-analysis. Journal of dentistry, 156, 105691. https://doi.org/10.1016/j.jdent.2025.105691 

2. Rathee, M., & Sapra, A. (2023, June 21). Dental caries. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551699/ 

3. O'Mullane, D. M., Baez, R. J., Jones, S., Lennon, M. A., Petersen, P. E., Rugg-Gunn, A. J., Whelton, H., & Whitford, G. M. (2016). Fluoride and Oral Health. Community dental health, 33(2), 69–99.https://pubmed.ncbi.nlm.nih.gov/27352462/ 

4. Yeh, C. H., Wang, Y. L., Vo, T. T. T., Lee, Y. C., & Lee, I. T. (2025). Fluoride in Dental Caries Prevention and Treatment: Mechanisms, Clinical Evidence, and Public Health Perspectives. Healthcare (Basel, Switzerland), 13(17), 2246. https://doi.org/10.3390/healthcare13172246 

5. de Sousa, M.daL., Wagner, M., & Sheiham, A. (2002). Caries reductions related to the use of fluorides: a retrospective cohort study. International dental journal, 52(5), 315–320. https://doi.org/10.1002/j.1875-595x.2002.tb00877.x 

6. Piesiak-Pańczyszyn, D., Zakrzewski, W., Piszko, A., Piszko, P. J., & Dobrzyński, M. (2023). Review on fluoride varnishes currently recommended in dental prophylaxis. Polimery w medycynie, 53(2), 141–151. https://doi.org/10.17219/pim/174016 

7. O'Hagan-Wong, K., Enax, J., Meyer, F., & Ganss, B. (2022). The use of hydroxyapatite toothpaste to prevent dental caries. Odontology, 110(2), 223–230. https://doi.org/10.1007/s10266-021-00675-4 

8. Pushpalatha, C., Gayathri, V. S., Sowmya, S. V., Augustine, D., Alamoudi, A., Zidane, B., Albar, N. H. M., & Bhandi, S. (2023). Nanohydroxyapatite in dentistry: A comprehensive review. The Saudi Dental Journal, 35(6), 741–752. https://doi.org/10.1016/j.sdentj.2023.05.018 

9. Amaechi, B. T., Alshareif, D. O., Azees, P. A. A., Shehata, M. A., Lima, P. P., Abdollahi, A., Kalkhorani, P. S., Evans, V., Bagheri, A., & Okoye, L. O. (2021). Anti-caries evaluation of a nano-hydroxyapatite dental lotion for use after toothbrushing: An in situ study. Journal of dentistry, 115, 103863. https://doi.org/10.1016/j.jdent.2021.103863 

10. American Dental Association. (n.d.). Toothpastes. https://www.ada.org/resources/ada-library/oral-health-topics/toothpastes