Guide
Healthy teeth: expert tips from a dentist
by Anna Sandner
Fluoride in toothpaste: protection from tooth decay or underestimated risk?
24/3/2025
Translation: Elicia Payne
Fluoride is a key component of dental care and has been used for decades to provide effective protection against tooth decay. But it’s also been a subject of debate. Read on to find out what current research says and how safe it really is to use toothpaste with fluoride.
Fluoride was first added to toothpaste back in the 1940s. At that time, Procter & Gamble was looking for an ingredient that protects tooth enamel. This lead to the company launching the first commercially successful fluoride toothpaste called Crest. Fluoride has been added to most toothpastes since 1975.
Numerous studies have proven the positive effect it has on teeth. One of which was a meta-analysis by the Cochrane Collaboration. The evaluation of 96 studies with over 65,000 participants showed that toothpaste containing fluoride significantly reduces the risk of tooth decay. Specifically, regular use can reduce tooth decay from occurring by up to 43 per cent (page in German). Fluoride strengthens tooth enamel, makes it more resistant to acids and inhibits the growth of caries.
The European Food Safety Authority (EFSA) has also confirmed that fluoride in toothpaste is safe. In the EU and Switzerland, the fluoride content is limited to a maximum of 1,500 ppm (0.15 per cent) – a concentration considered safe and effective.
Critics: justified concerns or exaggerated caution?
Despite the convincing data on the protection of tooth enamel, critics are warning of possible health risks from fluoride. Two aspects raise concerns: dental fluorosis and potential neurotoxic effects.
Dental fluorosis is identifiable by whitish spots on the teeth and can occur when children absorb too much fluoride during tooth development. It won’t occur once the enamel is fully formed. To avoid fluorosis, the following recommended amounts shouldn’t be exceeded in children (links in German):
- For children from the first milk tooth up to two years of age: twice a day a rice grain-sized amount of toothpaste with 1,000 ppm fluoride.
- For children aged two to six: a pea-sized amount of toothpaste with 1,000 ppm fluoride two to three times a day.
One study has caused heated discussions as it suggests a possible link between high fluoride intake during pregnancy and lower IQ in children (link in German). As this study examined fluoride levels in drinking water that are far above the European values, it’s not relevant over here. Plus, you can’t compare the fluoride intake of pregnant women through drinking water with our controlled use of toothpaste. In contrast to European countries, extra fluoride is added to drinking water in the USA. A comprehensive study by the Leibniz Institute at TU Dortmund University concluded that there’s no cause for concern regarding neurotoxic effects in Europe. The average fluoride concentration in European drinking water is 0.13 mg/L, so well below the limit value of 1.5 mg/L, which is considered safe.
Alternatives to fluoride: useful or superfluous?
For people who still have concerns, there are alternatives such as hydroxyapatite toothpastes. A study published in the Journal of Dentistry suggests that hydroxyapatite may have a similar remineralising effect to fluoride. However, there’s less extensive data on alternative toothpastes than for fluoride, and many experts still see fluoride toothpaste as the gold standard for preventing caries.
Verdict: fluoride – an important building block for healthy teeth
The scientific evidence clearly supports the use of fluoride in toothpaste as an effective and safe measure to prevent tooth decay. When used correctly, the benefits clearly outweigh the potential risks.
Put simply, you can trust toothpaste containing fluoride. You just need to pay attention to the correct dosage and application for children. If you’re unsure or have special requirements, it’s best to speak to your dentist.
Header image: Yuliia28/Shutterstock
Science editor and biologist. I love animals and am fascinated by plants, their abilities and everything you can do with them. That's why my favourite place is always outside - somewhere in nature, preferably in my wild garden.
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