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High fluoride toothpaste

Does your family have a history of cavities? Perhaps you have ‘dry mouth’ or braces which both make cavities more likely. Maybe you’re just curious about the possible benefits of a high fluoride toothpaste. In any event, this article is here to help you with the essentials.

We answer the following questions:

  • Why is fluoride used in toothpaste?
  • What’s the ideal concentration of fluoride in toothpaste?
  • Who should use high fluoride toothpaste?
  • Is high fluoride toothpaste safe?
  • What is the best over the counter high fluoride toothpaste?
  • What prescription only high fluoride toothpastes are available?
  • Are there alternatives?

Why is fluoride used in toothpaste?

Tooth enamel protects your teeth. But the minerals in it can be dissolved by the acids found in plaque (a bacterial film that forms over your teeth). This process is called demineralization.

To replenish tooth enamel, it needs to be remineralized. This happens naturally through the action of saliva and the minerals it contains.

Fluoride is a natural mineral. When fluoride ions are present in your mouth the whole remineralizing process becomes far more effective. The benefits are that it:

  • Reduces the risk of developing cavities
  • Prevents existing cavities from getting worse
  • Reduces sensitivity

Research into how fluoride prevents cavities has been going on for decades. There is general agreement that even the minimum recommended amount of fluoride can reduce the number of cavities you get by at least 23%.

So how much fluoride should your toothpaste contain? This is what we look at next.

How much fluoride should toothpaste contain?

Before we answer this, it’s important to know that in the US your toothpaste may contain one of three fluoride compounds.

  • Sodium Fluoride,
  • Sodium Monofluorophosphate, or
  • Stannous Fluoride.

Stannous Fluoride has antibacterial properties which provide an added benefit. But when it comes to protection against cavities each compound is equally effective.

Which one your toothpaste contains depends on what else is in the mix. Some ingredients work better with one fluoride compound rather than another.

To gain the American Dental Association (ADA) Seal of Acceptance a toothpaste must contain at least 1000ppm (parts per million) of fluoride. It may contain up to 5000ppm, but anything over 1500pmm requires a prescription and can’t be bought over the counter.

However, fluoride content is usually expressed as a percentage. And each fluoride compound has a different potency. This makes it super tough to tell how much fluoride is in your toothpaste and whether it’s enough to do its job properly. So we’ve made this table to help:

Fluoride compound1000ppm1500ppm5000ppm*
Stannous fluoride0.4%0.6%
Sodium fluoride0.22%0.33%1.1%
Sodium monofluorophosphate0.76%1.1%

*Toothpaste containing 5000ppm only uses sodium fluoride

So what concentration is best?

The British National Health Service research suggests a minimum of 1350pmm for adults. It’s hard to find brands in the US that match or exceed this – though we have one outlined for you below.

In the case of someone who is prone to cavities, a toothpaste of at least 1500pmm is recommended. But a higher concentration prescription toothpaste will provide a much greater degree of protection.

Who should use a high fluoride toothpaste?

Why are some people more at risk of cavities and tooth decay? Risk factors include:

  • Dry Mouth (xerostomia). Saliva plays a hugely important role in remineralising teeth. Dry mouth means there’s simply not enough saliva present to do this job. It can be caused by certain medications, cancer treatments and aging
  • Orthodontic fixings such a braces which make it difficult to clean teeth
  • A history of cavities
  • Root surfaces that are exposed by gum recession
  • People who consume lots of carbohydrates and sugars.

Is high fluoride toothpaste safe?

Lots of studies have been conducted into the possibility that fluoride is harmful. The problem is, many of these have been on animals and the doses they have been given have been far higher than those present in even high fluoride toothpastes.

The current consensus is that even in high concentrations there should be no adverse side effects as long as manufacturer’s instructions are strictly followed.

Most importantly, you must spit toothpaste out and not swallow it. Also, don’t drink for 30 minutes after brushing. This is both to give the fluoride the best chance of doing its job and so that you don’t ingest it.

Children under 6 years should not use high fluoride toothpastes. This is because they are more likely to swallow the paste if it is pleasantly flavoured (which children’s toothpastes often are).

The most common side effect in children is fluorosis, which is the development of white spots on the teeth.

What is the best over the counter high fluoride toothpaste?

The highest concentration of fluoride we have found which is available over the counter is in various Sensodyne products. You can read our Sensodyne review for more information. In our view, the best of Sensodyne product for protecting enamel is:

Sensodyne Pronamel Gentle Whitening

Sensodyne Pronamel is formulated to ensure that the fluoride it contains, as well as the minerals in your saliva, are more efficiently absorbed and retained by tooth enamel.

It helps to restore natural whiteness by hardening and strengthening tooth enamel, rather than by polishing teeth to lift stains.

Pros

  • #1 dentist recommended product for strengthening & protecting tooth enamel
  • Contains 1450pmm fluoride to protect against decay
  • Helps to restore natural whiteness
  • Very low abrasivity
  • Sodium Lauryl Sulphate free

Cons

  • Disputed concerns about the use of Titanium Dioxide
  • A little more costly than regular toothpaste

Sensodyne Pronamel Gentle Whitening Ingredients

Active: Sodium Fluoride (1450 ppm Fluoride)

Inactive: Aqua, Sorbitol, Hydrated Silica, Glycerin, Potassium Nitrate, PEG-6, Cocamidopropyl Betaine, Aroma, Titanium Dioxide, Xanthan Gum, Sodium Saccharin, Sodium Fluoride, Sodium Hydroxide, Limonene, Potassium Nitrate 5% w/w.

What are the most common prescription brands?

Prescription strength toothpaste contains sodium fluoride at a concentration of over 1500ppm up to 5,000ppm.

But all toothpastes, even prescription ones, will contain other ingredients that target oral health problems such as bad breath, tartar build up and sensitivity.

So when it comes to prescription toothpaste, your dentist will select the one which best meets your individual oral health needs. She or he will also be able to advise whether you actually need a high fluoride product.

The most commonly recommended brands are:

  • Colgate Duraphat 2800
  • Clinpro 5000
  • SF 5000 plus
  • Colgate Prevident 5000, and
  • Denta 5000.

These products are used in the same way as regular toothpastes and may be prescribed for up to 3 months – longer where there is a continuing risk of cavities.

Are there alternatives?

If you are at increased risk of cavities for any reason, your dentist is highly unlikely to suggest anything other than a fluoride toothpaste.

There are a number of additional oral health products that can support you in your fight against tooth decay. These include:

There are other products that use different methods to remineralise teeth and protect them from decay. These include Xylitol toothpastes. Our article explains what Xylitol is, how it works and recommends Xylitol toothpastes which do and do not also contain fluoride. Other alternatives include products that use mineral rich ingredients like bentonite clay.

However, we at Toothsayer would always recommend you consult your dentist if you have issues with tooth decay.

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