Is it acceptable for dentists to use non-fluoride toothpaste?

Fluoride is a common ingredient in almost every toothpaste brand, as it is known to protect against tooth decay. But why would anyone choose a fluoride-free toothpaste? And would a dentist opt for it? Let's find out.

Fluoride ranks as the 13th most abundant element in the Earth's crust. It naturally occurs in certain soils and water sources. In the 1940s, scientists discovered that fluoride helps prevent tooth decay, leading to its addition to the public water supply in many cities. This led to a reduction in tooth decay rates by 50 to 60 percent [source: American Dental Hygienists' Association]. Today, over 60 percent of Americans drink water that is fluoridated [source: Kids Health]. The Centers for Disease Control (CDC) regards community water fluoridation as one of the 10 greatest public health accomplishments of the 20th century. Fluoride toothpaste became commonplace in the 1950s.

So, how does fluoride function? It's simple: fluoride works with saliva to protect the tooth enamel from damage caused by bacteria and acids in your mouth. Additionally, it helps remineralize your teeth, which can make them stronger if there's mild decay. However, there's a catch.

Excessive fluoride can lead to fluorosis, which causes spotted discoloration of the teeth. Children under 6 are typically at risk [source: Danoff]. Fortunately, most cases of fluorosis are considered "very mild to mild" [source: Kids Health]. However, critics of fluoride point to a CDC study showing that 41 percent of children aged 12 to 15 today have mild fluorosis, up from 23 percent in 1986. The Department of Health and Human Services is considering reducing the level of community water fluoridation, as people now get fluoride from other sources like toothpaste, sodas, juices, and dental treatments [source: DHHS].

Beyond fluorosis, the primary danger of fluoride is overdose. The lethal dose of fluoride is approximately 5 mg per 2.2 lbs. (1 kilogram) of body weight. Swallowing a small amount won't harm you, but one tube of toothpaste contains enough fluoride to be fatal for a 60-pound (30-kilogram) child if the entire tube is ingested [source: Fluoride Action Network]. That's why children should use only a pea-sized amount of toothpaste and be supervised to ensure they spit out, rather than swallow, after brushing. If your child appears unwell and you suspect they swallowed a large amount of toothpaste, immediately contact poison control.

Fluoride allergies do exist, though they are extremely rare. Only about one percent of people are hypersensitive to fluoride. They may experience skin rashes, headaches, weakness, joint pain, blurred vision, fatigue, or canker sores when exposed to approximately 1 mg per liter of water [source: Fluoride Action Network]. These individuals can recover from fluoride exposure but should avoid it when possible.

If you're worried about too much fluoride, what steps should you take when visiting the dentist?

Fluoride Use in Dental Offices

Dentists allow you to skip fluoride treatments if you prefer, but they will explain the reasons behind the treatment so that you're fully informed. It's important to note that they do not use regular toothpaste during cleanings. Instead, during the polishing stage, they apply prophy paste, a pumice-based gel containing a tiny amount of fluoride. The fluoride content is so minimal that typically no alternative is offered.

Some dentists are part of a fluoride-free movement and opt not to use fluoride treatments at all. They simply skip this step during routine cleanings or may substitute it with ingredients like synthetic hydroxyapatite as a replacement for fluoride [source: BioSafeDentistry]. To locate a fluoride-free dentist, visit websites like fluoridefreedentist.com or biosafedentistry.com.

Other ways to reduce your fluoride exposure include drinking bottled water and using fluoride-free toothpaste. However, be aware that fluoride-free toothpastes can be expensive, and they lack the remineralizing benefits that fluoride provides.