What should you look for in toothpaste? The best and worst ingredients, according to dentists

Allison Torres Burtka September 2022

Allison Torres Burtka is a freelance writer and editor in metro Detroit. Her writing has been published in the Guardian, espnW, Women’s Running, the Sierra Club’s Sierra magazine, Crain’s Detroit Business, and other outlets. She writes on topics

  • The most common toothpaste ingredient is fluoride, which protects against cavities. 
  • Choose a toothpaste with calcium carbonate or hydrogen peroxide if you want to whiten your teeth.
  • Avoid toothpaste with ingredients like activated charcoal, which can damage enamel.

Shopping for toothpaste can be overwhelming with the wide range of products to choose from. To start, you should look for the American Dental Association (ADA) Seal of Acceptance, which means the ADA has evaluated toothpaste for safety and efficacy. 

Beyond that, which toothpaste you choose depends on your own unique dental needs. Here are some of the best — and worst — ingredients in toothpaste. 

Fluoride

Fluoride is the main cavity-fighting ingredient in toothpaste, which helps strengthen enamel and prevent tooth decay. All tubes of toothpaste with the ADA seal contain fluoride.

There are two types of fluoride commonly found in dental products: 

  1. Sodium fluoride, prevents tooth decay and is the more common of the two.   
  2. Stannous fluoride, prevents tooth decay, and gingivitis, and reduces tooth sensitivity. While stannous fluoride stains teeth, scientists have been able to stabilize it so staining is no longer an issue. 

What the research says: A 2019 study compared adults in China who brushed with stannous fluoride toothpaste and those who brushed with sodium fluoride toothpaste. Both groups saw improvement in plaque control and gum inflammation after three and six months, but the stannous fluoride group saw greater improvement. 

Some people are wary of fluoride due to concerns about safety. Kelly Blodgett, DMD, NMD, IBDM, a holistic dentist in Portland, says whether he recommends toothpaste with fluoride depends on the patient’s risk of tooth decay. 

Some concerns about fluoride come from misinformation about the safety of fluoridated water, says Edmond Hewlett, DDS, professor and associate dean for equity, diversity, and inclusion at the UCLA School of Dentistry, and an ADA consumer advisor.

The ADA maintains that fluoride is safe in both drinking water and toothpaste, and the American Association of Pediatrics recommends fluoride in drinking water and in toothpaste in age-appropriate amounts. Children’s toothpaste typically contain less fluoride than adult toothpaste.

Potassium nitrate 

If you have sensitive teeth, you should look for toothpaste containing potassium nitrate, an ingredient that reduces tooth sensitivity. 

A small 2012 study compared the effects of potassium nitrate-containing toothpaste and mouthwash and found both significantly decreased sensitivity.

To see results, you need to use this type of toothpaste consistently. If you are brushing twice a day as recommended, it might take weeks to see any change, says Hewlett. Because the only benefit of potassium nitrate is reducing sensitivity, it isn’t something everyone needs, he says.

Zinc citrate 

Zinc citrate reduces the buildup of plaque — a sticky film covering the teeth which contain bacteria. When plaque absorbs calcium from your saliva, it turns into tartar, which needs to be scraped off, Hewlett says. Other ingredients also reduce plaque, but zinc citrate is one of the most common, he says. 

A small 2008 study compared adults who brushed with toothpaste containing zinc citrate and those who used toothpaste without the ingredient. It found after 14 days of using the zinc citrate group experienced a 24% to 52% reduction in bacteria compared to the control group.

Calcium carbonate 

Calcium carbonate is one of several abrasive agents that help clean teeth and remove stains.

You might even see stains reduced in a matter of days, Hewlett says. “Widely used abrasives like calcium carbonate are mild and can be used safely with prudent brushing,” but brushing too hard with any toothpaste can damage teeth, he says.

A small 2019 study in Japan found a toothpaste containing calcium carbonate removed greater amounts of plaque than toothpaste without it. It also found calcium carbonate did not damage gum tissue. 

Hydrogen peroxide 

Some toothpaste contains hydrogen peroxide due to its ability to reduce stains. A small 2020 study comparing toothpaste with two different concentrations of hydrogen peroxide found the higher concentration reduced stains more than the lower concentration. However, higher concentrations — like those found in a bottle of hydrogen peroxide — can damage your enamel

Toothpaste with hydrogen peroxide contains very small amounts of it, significantly lower than bottled hydrogen peroxide, so it doesn’t damage enamel, Hewlett says.

Toothpaste ingredients you should avoid 

However, not all ingredients in toothpaste are good for your teeth. Rather, some may be too abrasive which wears down the enamel. Therefore, choosing one with the ADA seal “is the safest way to screen for abrasives that might be damaging to the teeth,” Hewlett says.

Important: If you’re concerned about what’s in your toothpaste, use the Environmental Working Group (EWG) Healthy Living app or Skin Deep website, to see the EWG’s rating and a list of ingredients and potential concerns about them. The EWG’s Skin Deep website provides the same information.

  • Sodium lauryl sulfate. Some toothpaste contains sodium lauryl sulfate, which creates a foaming action to clean teeth. But for some people, it causes mouth sores, redness, swelling, and peeling. 
  • Activated charcoal. While this has become a popular ingredient in toothpaste due to its supposed whitening effects, it is very abrasive and can wear down your enamel. And there’s really no benefit to using it, Hewlett says. A 2017 review found “insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices.”   

Insider’s takeaway 

While choosing a toothpaste can be overwhelming, what’s more, important in dental hygiene is brushing and flossing regularly, Hewlett says. You should also see your dentist regularly. They can help you determine which toothpaste is best for you. Overall, look for toothpaste with the ADA seal of approval that contains fluoride

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