The dangers of fluoride in toothpaste and the evidence

Mama's Choice makes fluoride-free toothpastes, so the fair place to start is with what fluoride does well.

Fluoride protects teeth against decay. No major health body disputes that. The real questions are about dose, and about what suits you or your child at a particular stage. During pregnancy, brushing with fluoride toothpaste is normal, safe care. For young children, the key is using a tiny amount and holding the brush yourself.

What fluoride does

Fluoride is a mineral that works on the surface of the tooth. It makes enamel harder for acid to dissolve, and it helps enamel take back minerals lost in the earliest stage of decay. That happens in the mouth, while the paste sits on your teeth.

The World Health Organization counts fluoride as one of the most effective ways to reduce tooth decay across a population. Large reviews of trials involving many thousands of children show the same thing. In Malaysia, KKM has added fluoride to much of the public water supply for decades, alongside advice to brush with fluoride toothpaste.

Where the worries come from

Most of the frightening claims trace back to fluoride that is swallowed in large amounts over years. The usual source in that research is drinking water in regions where natural fluoride levels are very high, well above the levels used in public water programmes.

Studies on children's IQ come from that kind of exposure. Brushing and spitting out a small amount of toothpaste is a very different dose. The amount is what decides whether fluoride helps or harms, which is why toothpaste quantities for children are so small.

Some old claims do not hold up at all. Fluoride does not cause ADHD from normal toothpaste use, and fluoride allergy is extremely rare. Swallowing a whole tube would make a child ill, so keep toothpaste out of reach.

What is dental fluorosis?

Fluorosis is a change in how enamel looks. It happens when a child takes in too much fluoride while the adult teeth are still forming under the gums, up to about 8 years old.

The mild form shows as faint white flecks or lines. The CDC describes it as cosmetic, with no effect on how the tooth works. It does not affect adults, because adult teeth have already formed. In young children, the avoidable source is swallowed toothpaste.

How much toothpaste should children use?

Teach your child to spit out the foam and not to rinse with lots of water afterwards, so the fluoride stays on the teeth. A brush loaded end to end, as in the adverts, is far more than a child needs.

Fluoride in pregnancy

Fluoride toothpaste is safe while you are pregnant or breastfeeding. The American College of Obstetricians and Gynecologists regards it as routine care. Pregnancy actually raises the risk of decay, with morning sickness, more snacking and gums that bleed more easily.

What can get in the way is nausea. A strong mint can set off your gag reflex, and then brushing gets skipped. Brushing twice a day with something you can face is what matters most.

When fluoride-free makes sense

Several situations make a fluoride-free paste a reasonable choice.

• You are pregnant and struggling with nausea. Our Non-Fluoride Toothpaste is a light mint paste with miswak extract, formulated for pregnancy and breastfeeding and made without fluoride, SLS or triclosan. In a Mama's Choice satisfaction survey of 62 mothers in Indonesia in 2022, 93% felt comfortable using it with no nausea, and 89% felt the mint was just right.
• Your baby cannot spit yet and you would rather not ration a swallowed dose. Our Baby & Kids Toothpaste is made for babies from 6 months, with hydroxyapatite and xylitol and no fluoride. In a Mama's Choice use test with 28 mothers in Indonesia in 2022, 93% agreed their child's teeth and gums felt cleaner.
• You simply prefer it for a stage of life, and your dentist agrees.

Both are halal certified by BPJPH, Indonesia. You can buy the Non-Fluoride Toothpaste on Shopee or Lazada.

Be clear about the trade-off. A fluoride-free paste cleans teeth and freshens breath, but it does not give the decay protection fluoride does. KKM and most dental bodies recommend fluoride toothpaste for children from the first tooth. If you or your child have had decay, white spots or fillings, your dentist will usually advise more fluoride, not less. Follow that advice.

What matters more than the tube

How often sugar touches the teeth matters more than how much. A sweet drink sipped all afternoon does more harm than the same drink finished in ten minutes.

• Brush twice a day, and never skip the bedtime brush
• Clean between teeth once a day
• Keep sweet drinks and snacks to mealtimes
• Do not put your baby to bed with a bottle of milk or juice
• See a dentist during pregnancy, and take your child by their first birthday

Government dental clinics see pregnant mothers and young children, and your klinik kesihatan can refer you. Our articles on pregnancy-safe toothpaste and miswak toothpaste go into more detail.