Chemicals in Toothpaste and Your Toothbrush: What to Know

Here's the specific problem. 67% of 160 commercial toothpastes from 19 brands contained sodium lauryl sulfate in the most recent ingredient survey (Ucuncu et al. 2024) of commercial toothpastes contain a surfactanta compound that lowers the surface tension between two liquids, between a liquid and a gas, or between a liquid and a solid — the chemistry behind foaming, emulsifying and detergent action that strips the protective mucin layer from your gums Ucuncu et al. 2024. The white color comes from a pigment the EU banned from food in 2022 because genotoxicity couldn't be ruled out — and somehow still permits in toothpaste. And the mouthwash you use afterward may be doing something nobody expected: raising your blood pressure by killing the bacteria that regulate it.

Our guide to endocrine disruptors covers how synthetic chemicals interfere with hormonal signaling. The products inside your mouth are where that biology meets you twice a day.

Turn the tube over. Not the front, where it says 'whitening' or 'enamel defence' — the back, where the tiny print lists 10–15 ingredients. Fewer than half of them are there to clean your teeth. The active ingredient — usually fluoride — does the actual work. Everything else is formulation: surfactants for foam, humectants for texture, sweeteners for taste, pigments for color, preservatives for shelf life. Several of those formulation ingredients have research profiles worth knowing about.

SLSSodium lauryl sulfate — an anionic surfactant that lowers surface tension and creates foam in toothpastes, shampoos and detergents (sodium lauryl sulfate) is the foaming agent in two thirds of commercial toothpastes Ucuncu et al. 2024. It's a surfactant — it reduces surface tension, which is why your toothpaste lathers when you brush. The problem is that SLS also denatures mucina glycoprotein layer secreted by epithelial tissue that lubricates and protects the underlying cells — the slick coating on the inside of your gums, the glycoprotein layer that protects your oral epithelium. Strip the mucin and the underlying tissue is exposed.

You only need the foam because the packaging trained you to expect it. Foam doesn't clean your teeth. Your gums don't need foam. Nobody's gums need foam. The bristles and the fluoride do the work. The foam is theatre.

If you get canker sores, this matters beyond theatre. Herlofson and Barkvoll 1994 found that switching 10 patients with recurrent aphthous stomatitisthe clinical name for chronic recurring mouth ulcers (canker sores) — affects roughly 20% of the population to SLS-free toothpaste dropped ulcer frequency from 14.3 to 5.1 per three-month period. A systematic review pooling four crossover trials Alli et al. 2019 (n=124) confirmed it: SLS-free toothpaste significantly reduced ulcer count, duration, episodes, and pain across every study. The sample sizes are small but the direction is consistent. SLS makes your toothpaste foam. It also makes your mouth more vulnerable. Our SLS profile covers the rest of the surfactant story including its non-toothpaste appearances.

Titanium dioxide (CI 77891Color Index 77891 — the cosmetics-regulation name for titanium dioxide as a pigment, listed under Annex IV of the EU Cosmetics Regulation) is the reason your toothpaste is white. It's a pigment. It has no therapeutic function. It doesn't clean your teeth. It doesn't strengthen enamel. It's there so the paste squeezed onto your brush looks like toothpaste rather than the translucent gel it would otherwise be. That is its entire job.

In August 2022, the EU banned TiO2 from food after EFSAEuropean Food Safety Authority — the EU agency that evaluates risks in the food chain concluded that genotoxicitythe capacity of a chemical to damage DNA, potentially causing mutations and contributing to cancer risk could not be ruled out. It remains permitted in toothpaste under cosmetics regulation.

Banned from food. Still in toothpaste. Same mouth.

The regulatory logic is that food is ingested and toothpaste is spat out, so the exposure is lower. That logic would make sense if the oral mucosathe moist tissue lining the inside of the mouth — thinner than skin, densely vascularised, with very different absorption properties were impermeable. It isn't.

Vignard et al. 2023 tested what happens when food-grade titanium dioxide meets oral mucosa. TiO2Titanium dioxide — a white pigment used in toothpaste, paint and food-grade colouring; also referred to in cosmetics regulation as CI 77891 particles translocated across the buccal mucosa within 30 minutes the time TiO2 particles took to cross the buccal mucosa in a pig model after sublingual application (Vignard et al. 2023, Nanotoxicology) and reached lymph nodes in the jaw within 4 hours. In human buccal mucosathe lining of the inside of the cheeks — Vignard's TR146 cell model represents this tissue in vitro cells in vitro, the same study found genotoxicity and slight oxidative stress. The EU's Scientific Committee on Consumer Safety has been asked to reassess. Meanwhile, the ingredient is still on the back of your toothpaste, doing a cosmetic job. The ingredient that makes your toothpaste look clean is the one with the least clean safety profile.

Triclosan was once the headline concern. It was the antibacterial agent in Colgate Total at 0.3% concentration. In 2016, the FDAUnited States Food and Drug Administration — the federal agency that regulates food, drugs, cosmetics and medical devices in the US banned triclosan from consumer hand soaps over endocrine disruption and antibiotic resistance concerns — but exempted toothpaste, because Colgate had successfully argued the gingivitis benefits outweighed the risks. One company's clinical trial kept a banned chemical on the market for three more years.

The EU further restricted triclosan in 2024 — banned from mouthwash entirely, banned in toothpaste for children under three. But the story has a quieter ending than expected: Colgate voluntarily reformulated by early 2019, removing triclosan from its flagship product without fanfare. Most major brands have followed. Triclosan in toothpaste is now largely a historical concern. What replaced it in each formulation is a question most brands don't answer. Our triclosan profile covers where it still lingers in other product categories.

Most coverage of toothpaste sets up a binary: fluoride for the evidence, fluoride-free for the precaution, pick a side. The binary misses a third option that has been sold in Japan for decades and is now permitted as a cosmetic active in the EU. Hydroxyapatitethe calcium-phosphate mineral that human enamel is mostly built from. Synthetic nano-sized versions in toothpaste deposit onto the tooth surface and remineralise early lesions (HA) is the mineral your tooth enamel is already made of. Synthetic nano-hydroxyapatite in toothpaste deposits onto the enamel surface, fills micro-defects, and remineralises early lesions in the same way fluoride does — by a different chemical route, and without leaving the mouth as a swallowed dose.

This isn't a wellness claim. It's a regulated active ingredient in cosmetics in the EU, used as an anti-caries agent in Japan since the 1990s, and now backed by a small but increasingly serious set of head-to-head randomised trials against fluoride.

The strongest independent trial is Schlagenhauf and colleagues' 2019 study — a parallel non-inferiority RCTRandomised controlled trial — the gold-standard study design for testing whether an intervention causes an outcome, with participants randomly assigned to intervention or control in 150 caries-active orthodontic patients, the population most vulnerable to new decay because brackets trap food against enamel for months. Half got 1,400 ppm fluoride toothpaste, half got fluoride-free 10% hydroxyapatite. Six months later, new ICDASInternational Caries Detection and Assessment System — a standardised visual scoring system for early carious lesions on tooth surfaces≥1 caries lesions had appeared on 56.8% of HA brushers vs 60.9% of fluoride brushers. Non-inferiority confirmed in the population where fluoride should matter most Schlagenhauf et al. 2019. The trial was registered (NCT02705456); none of the authors were affiliated with HA manufacturers.

Paszynska and colleagues took the question to adults in 2023 — an 18-month, double-blind RCT with 189 participants brushing twice daily with either 10% hydroxyapatite or 1,450 ppm sodium fluoride. 89.3% of HA users had no new tooth-surface decay over 18 months — vs 87.4% of fluoride users (Paszynska 2023, n=189, per-protocol analysis) of the HA group showed no new DMFSdecayed-missing-filled tooth surfaces — the standard caries outcome measure used in dental epidemiology over 18 months, vs 87.4% of the fluoride group Paszynska et al. 2023. The HA arm was, marginally, ahead. A 2021 paediatric RCT by the same group ran the same comparison in 207 children with primary teeth — 12 months, double-blind. New ICDAS≥1 lesions in 72.7% of HA users vs 74.2% on fluoride. The non-inferiority margin held with room to spare Paszynska et al. 2021.

The most recent meta-analysis pooled three RCTs and reported a 17% caries reduction with hydroxyapatite toothpaste in the Limeback 2021 meta-analysis of 3 RCTs — note both authors are employees of Dr. Kurt Wolff GmbH, a major HA manufacturer reduction in caries with HA toothpaste Limeback Enax & Meyer 2021. Both authors of that meta-analysis are senior scientists at Dr. Kurt Wolff GmbH, a major hydroxyapatite-toothpaste manufacturer. Most of the synthesis-level HA literature has at least one industry-affiliated author. The underlying RCTs are run by independent university groups; the meta-analyses that interpret them are not. Read accordingly.

Two honest caveats sit alongside the trial data. First, the evidence base for HA is small: five RCTs in the most recent meta-analysis. Fluoride's Cochrane review covers 96 RCTs in the Walsh 2019 Cochrane systematic review on fluoride toothpaste — the headline finding is high-certainty evidence in permanent dentition across seven decades and grades the headline finding high-certainty in permanent dentition. That asymmetry doesn't mean HA doesn't work. It means the bench it's sitting on isn't as long. Second, Cochrane has not yet reviewed hydroxyapatite at all. A 2025 commentary in Evidence-Based Dentistry took an independent look at the most current synthesis and concluded the evidence is now strong enough to consider HA a 'good alternative' to fluoride — independent voice, sympathetic verdict Gugnani & Gugnani 2025.

The SCCSScientific Committee on Consumer Safety — the EU body that evaluates the safety of cosmetic ingredients under Cosmetics Regulation 1223/2009 adopted a final opinion in March 2023 endorsing nano-hydroxyapatite for use in toothpaste and mouthwash within specified concentration and particle-shape limits — rod-shaped particles only, with the needle-shaped form excluded over potential toxicity concerns. In Japan, where Sangi launched the first commercial HA toothpaste decades ago, the country's medical hydroxyapatite formulation is officially designated as an anti-caries active ingredient. In the US, hydroxyapatite isn't on the FDA's OTC anti-caries monograph (21 CFR 355) — which lists only sodium fluoride, stannous fluoride, and sodium monofluorophosphate as approved actives — so HA toothpastes in the US are sold as cosmetics rather than drugs and can't make caries-prevention claims on the box.

For someone choosing between fluoride and fluoride-free, hydroxyapatite is the option the binary leaves out. The trials in adults, children, and orthodontic patients show it matching fluoride for caries prevention. The evidence base is smaller than fluoride's and the interpretive literature has commercial fingerprints — but the head-to-head trials are pre-registered, properly designed, and consistent. Switch If your reason for avoiding fluoride is the swallowing question — small children, pregnancy, a household well — hydroxyapatite is the alternative with the most evidence behind it. If you have no concern about fluoride, fluoride still has the longer scoreboard.

Here's the part that surprises most people, including most dentists. Your mouth is not supposed to be sterile. It's home to roughly 600 bacterial species — one of the most diverse microbiomes in the human body Dewhirst et al. 2010. Most of them aren't causing disease. Many of them are doing something your body can't do for itself: converting dietary nitrate from vegetables into nitrite, right there on the surface of your tongue. That nitrite gets swallowed, converted to nitric oxide in the stomach, and enters your bloodstream — where it dilates blood vessels and lowers blood pressure. The bacteria on your tongue are, in a small but measurable way, regulating your cardiovascular system.

Antiseptic mouthwash kills those bacteria. Not selectively — chlorhexidine, the clinical gold standard, is a broad-spectrum antimicrobialkills a wide range of bacterial species without distinguishing between harmful and beneficial ones — the antimicrobial equivalent of clear-cutting a forest. It doesn't distinguish between the bacteria causing your bad breath and the bacteria keeping your blood pressure down. It kills both.

Thirty-six healthy adults rinsed with 0.2% chlorhexidine mouthwash for seven days. Microbial diversity cratered, salivary pH dropped, buffering capacity fell, and — critically — salivary and plasma nitrite levels declined Bescos et al. 2020. The mouthwash didn't just change the mouth. It changed the chemistry of the blood.

Nineteen healthy volunteers rinsed with chlorhexidine mouthwash twice a day for seven days. Systolic blood pressure rose 2–3.5 mmHg, tracking tightly with the decline in plasma nitrite Kapil et al. 2013. The increase showed up within one day and persisted throughout the week. Bondonno et al. 2015 (n=15) replicated the finding in people who already had hypertension: three days of antibacterial mouthwash raised systolic blood pressure by 2.3 mmHg.

Three days. A product sold in the oral care aisle. Two point three millimetres of mercury.

Two to three millimetres of mercury doesn't sound like much, and at the individual level it isn't. Nobody drops dead from a 2 mmHg rise. But at population scale the arithmetic doesn't forgive small numbers: the largest meta-analysis of blood pressure and vascular mortality ever assembled — one million adults in 61 prospective studies pooled by the Prospective Studies Collaboration; Lewington et al. 2002 found that across the range from 115 mmHg upward, every 20-mmHg sustained rise in systolic BP roughly doubles stroke and CHD mortality between ages 40 and 69 across 61 prospective studies — found that across the range from 115 mmHg upward, every sustained 20-mmHg rise in systolic blood pressure roughly doubles both stroke and coronary heart disease mortality between the ages of 40 and 69 Lewington et al. 2002. Then Joshipura et al. 2020 (n=540) followed actual consumers — not clinical volunteers — and found that people using over-the-counter mouthwash twice daily or more were 2.17 times more likely to develop hypertension over three years compared to non-users.

This isn't hidden. The research has been in peer-reviewed journals for more than a decade. Most of the dentists who recommend twice-daily mouthwash have never encountered the nitric oxide pathwaythe biological route by which oral bacteria convert dietary nitrate to nitrite, which is then reduced to nitric oxide — a vasodilator that lowers blood pressure in their training, and the manufacturers selling it aren't about to bring it up.

A product marketed for oral health is measurably undermining cardiovascular health. The mechanism is straightforward: kill the bacteria that produce nitric oxide, lose the nitric oxide, blood vessels constrict, pressure goes up. The bacteria aren't the problem. The mouthwash is.

Alcohol is the other concern. Original-formula Listerine contains 26.9% ethanol — approximately 54 proof, or about the strength of a supermarket vodka. McCullough and Farah 2008 reviewed the evidence and concluded it would be 'inadvisable' to recommend long-term use of alcohol-containing mouthwash. A 2020 meta-analysis Aceves Argemi et al. 2020 found no statistically significant association with oral cancer (OR 1.48, P=0.16). The cancer science is genuinely contested — that's the honest position. What isn't contested: alcohol dries the oral mucosa and further disrupts the microbiome. Which brings us back to the same conclusion by a different route. If you're using mouthwash to deal with bad breath, you're reaching for an antimicrobial solvent to solve a problem that a tongue scraper and a glass of water would handle with none of the side effects.

After the toothpaste and the mouthwash, the toothbrush is almost a relief. The chemical concerns are more modest — but 'modest' isn't 'none,' so here's where they are.

Conventional toothbrushes use nylon bristles set in a plastic handle. Nylon bristles shed microplastic fragments into your mouth during brushing. Öztürk Aytulun et al. 2025 Öztürk Aytulun et al. 2025 estimated tens of microplastic particles per day from brushing with nylon-bristle brushes; Fang et al. 2023 Fang et al. 2023 found significantly higher counts depending on bristle wear and brushing pressure, with daily release running into the thousands of particles in some conditions. The methodology for measuring microplastic shedding from oral-care products isn't yet standardised, which explains the wide range — but the direction is consistent. This is a product you put in your mouth twice a day.

Claims that BPA leaches from plastic toothbrush handles circulate in consumer health media, but published data specifically testing BPA leaching from toothbrush materials is sparse. The more direct concern is that a plastic object sits in a warm, humid bathroom for months, accumulating bacteria in a porous medium.

Boar bristle is the natural alternative to nylon: animal hair doesn't shed microplastic. The trade-off is hygiene — natural bristles are porous and need to dry thoroughly between uses. They're also not vegan, which matters to some of the audience reading this.

Most flosses you've ever used are coated with PTFEpolytetrafluoroethylene — the polymer better known as Teflon, made from the PFAS family of fluorinated chemicals — the slippery polymer better known as Teflon, from the same PFASper- and polyfluoroalkyl substances — a family of 14,000+ synthetic chemicals built around the carbon-fluorine bond, persistent in the environment and the human body family our PFAS pillar covers in detail. The same chemistry that makes Teflon non-stick is doing the work between your molars, twice a day if you're conscientious.

A 2019 study from the Silent Spring Institute did the test that should have been run twenty years earlier. Boronow and colleagues took 18 commercial flosses — including three Oral-B Glide products and a range of competitors — and ran them through PIGEparticle-induced gamma-ray emission spectroscopy — a nuclear analytical technique that detects fluorine in materials spectroscopy, a nuclear-physics method that detects fluorine in materials. The PTFE-based flosses contained fluorine. Then they looked at serum PFAS in 178 women in their cohort and found that women who flossed with Oral-B Glide had higher serum PFAS levels than women who used non-PTFE floss Boronow et al. 2019. Two pieces of evidence from one study: the floss has fluorine, and the people who use it have more PFAS in their blood.

Procter & Gamble has stated publicly that newer Glide formulations no longer use PTFE, but no third-party laboratory has independently re-tested the reformulated product in peer-reviewed work. The cleanest answer for anyone who wants to take floss out of the equation: silk floss, or any nylon floss explicitly labelled PFAS-free. Floss is not the dominant PFAS exposure route for most people — drinking water, food packaging, and non-stick cookware contribute more — but it's the one easiest to remove from a daily routine.

This is the question that gets the most charged, so here's a direct answer instead of a hedge. Fluoride at 1,000–1,500 ppm in toothpaste has strong evidence behind it for topical cavity prevention. Swallowed fluoride — at much lower concentrations than what's in toothpaste — has associations with lower childhood IQ in some cohort studies. Same chemical, different doses, completely different verdict. The dose is the point. Our fluoride profile goes deeper on the mechanism.

For topical use, the evidence is strong — but Cochrane grades it differently for adult and primary teeth. The Walsh and colleagues 2019 systematic review Walsh et al. 2019 pooled 96 RCTs across seventy years and concluded with high-certainty evidence that toothpaste at 1,000–1,250 ppm fluoride concentration reduces caries vs non-fluoride paste in permanent dentition; for primary dentition, the evidence is moderate-certainty, and only at 1,500 ppm. The dose-response in permanent teeth is clear: higher concentration, greater protection. The WHOWorld Health Organization — the United Nations agency responsible for international public health includes fluoride toothpaste on its Essential Medicines List. The NHS, CDC, and virtually every dental association worldwide recommend it. If you spit your toothpaste out and don't swallow it, the fluoride stays on your teeth where the evidence says it works.

For systemic ingestion, the evidence is more troubling. Bashash et al. 2017 studied the ELEMENT cohort in Mexico and found that each 0.5 mg/L increase in maternal urinary fluoride was associated with a 2.5-point IQ decrease in offspring (95% CI -4.12 to -0.59) at ages 6–12. Green et al. 2019 (n=512 with complete data) found that each 1 mg/L increase in maternal urinary fluoride during pregnancy was associated with a 4.49-point lower IQ in boys — statistically significant in boys, not replicated in girls. A second measure in the same study found that each additional 1 mg/day of fluoride intake was associated with a 3.66-point IQ decrease across the combined sample.

In August 2024, the NTPNational Toxicology Program — a US government interagency programme that evaluates the toxicity of chemicals and other agents — after a multi-year systematic review — concluded with moderate confidence that fluoride exposure above 1.5 mg/L in drinking water is associated with lower IQ in children. NTP also stated explicitly that available data were insufficient to determine whether the US-recommended community fluoridation level of 0.7 mg/L the US Public Health Service's recommended community water fluoridation level since 2015 — roughly half the threshold above which NTP found a moderate-confidence IQ association — roughly half the threshold above which they found an association — has the same effect NTP 2024. A companion meta-analysis published in JAMA Pediatrics in January 2025 reanalysed 59 studies across roughly 21,000 children and reported a 1.63-point IQ decrease per 1 mg/L of urinary fluoride, with the inverse association persisting below 1.5 mg/L when the analysis was restricted to low-bias studies Taylor et al. 2025. The American Dental Association publicly reaffirmed support for community water fluoridation following NTP's release, arguing the >1.5 mg/L finding doesn't translate to the US recommendation.

Toothpaste contains 1,000–1,500 ppm fluoride. Water fluoridation uses 0.7–1.0 ppm — roughly a thousand times lower. The neurodevelopmental concern applies primarily to systemic ingestion: swallowed toothpaste (particularly by young children who don't spit reliably), fluoridated water, and cumulative intake during pregnancy. Our tap water guide covers the regional variations in fluoridation policy.

There is also the visible mark fluoride leaves on teeth at higher exposures. Dental fluorosisWhite mottling, streaks or pitting on tooth enamel caused by fluoride exposure during enamel formation in childhood — cosmetic at the mild end, structural at severe levels affects roughly a third of US 6–11-year-olds and over 40% of 12–15-year-olds in NHANES data — almost entirely the cosmetic 'very mild' grade Beltrán-Aguilar Barker & Dye 2010. By age 16–17, more than 60% of US adolescents had at least very-mild dental fluorosis in NHANES 2011-12, up from 30% a decade earlier (Wiener et al. 2018, J Dent Hyg) now show some level of fluorosis on NHANES, up from under 30% a decade earlier Wiener et al. 2018. Skeletal fluorosisBone disease from chronic high fluoride exposure, characterised in severe form by joint pain, restricted mobility and skeletal deformity — endemic in regions with naturally fluoride-rich groundwater above ~3 mg/L — the bone-disease form — is essentially an endemic-water-supply issue (parts of India, China, the East African Rift) at concentrations above roughly 3 mg/L; the National Research Council's 2006 review concluded that crippling skeletal fluorosis is rare in the US even at the EPAUS Environmental Protection Agency — the federal agency responsible for environmental protection, including drinking water standards's then-4 mg/L enforceable maximum NRC 2006.

The precautionary position: if you're pregnant or have young children who don't yet spit reliably, an evidence-based fluoride-free toothpaste eliminates the ingestion question. That fluoride-free option is a hydroxyapatite formulation — covered above — not a generic 'natural' paste with no active ingredient at all.

Watch a toddler brush. They wave the toothbrush around their mouth, often suck the bristles, sometimes finish by chewing the head. The pea-sized stripe of paste at the start has gone somewhere by the end of two minutes — and a meaningful fraction of it has gone into them.

Bentley and colleagues actually measured this. Fifty British children with a mean age of 30 months the mean age in Bentley et al.'s 1999 toothpaste-retention study, which gravimetrically measured how much paste a toddler keeps in their mouth — about 72% retention brushed under researcher observation. The team weighed the paste dispensed onto the brush, weighed what was expectorated, and weighed brush residue. The remainder — what stayed in the mouth — averaged 0.27 grams per brush, or about 72% of dispensed toothpaste retained in the mouth by 30-month-olds in the Bentley 1999 gravimetric study (Br Dent J) of what came out of the tube. At a 1,450 ppm fluoride paste, that translates to 0.42 mg of fluoride per brushing — twice a day Bentley Ellwood & Davies 1999. Children aren't brushing their teeth so much as they are partially eating their toothpaste.

A 2023 systematic review pulled 18 studies on this question and found the swallowing fraction varied wildly — from about 11% in older preschoolers under careful supervision to over 80% in toddlers — with a pooled estimate centred near 45% Petrović et al. 2023. The variability is the headline. Different age, different supervision, different paste volume, different number.

Two things follow. First, the old advice that 'children's toothpaste should be 500 ppm fluoride' is out of date against current consensus. Both the NHSNational Health Service — the UK's public healthcare system, which publishes paediatric dental guidance for the British public and the European Academy of Paediatric Dentistry now recommend ≥1,000 ppm fluoride from the first tooth, with the dose controlled by amount — a smear (rice-grain) under three years, a pea-sized amount from three to six, and supervision until at least seven Smear under three doesn't mean smear forever — the ratio of paste to mouth changes as the child grows, and the amount goes up as supervision improves. The cavity-prevention evidence supports the higher concentration; the swallowing question is solved by the smaller volume, not the lower potency. Second, the spit-don't-rinse rule — finish brushing, spit, do not rinse with water — applies to children at least as much as adults. Rinsing washes the just-deposited fluoride straight off the enamel.

Toothpaste is rarely the dominant fluoride source for school-age children even when ingested. The Iowa Fluoride Study, which has followed a cohort of children for over two decades, found that fluoridated drinking water typically contributes more than half of total fluoride intake, with dentifrice contributing a smaller share that declines with age as children get better at spitting Bhagavatula et al. 2022. The systemic-exposure question is mostly a water question. The toothpaste question is mostly a not-letting-them-eat-it question.

There is a separate concern with children's oral-health products that has nothing to do with fluoride. Teething gels containing benzocainea topical local anaesthetic used in some over-the-counter teething products — the FDA has issued repeated warnings against use in children under two due to risk of methemoglobinemia, a blood disorder that reduces the oxygen-carrying capacity of red blood cells can cause methemoglobinemia — a blood disorder that reduces oxygen-carrying capacity — in infants. The US FDA has issued repeated warnings (2011 and 2018) against using benzocaine teething products in children under two, citing cases dating back decades. If your child is teething, the practical advice is older than chemistry: a clean, cool teething ring, not a tube of numbing gel.

The honest paediatric position: the question isn't fluoride or no-fluoride for children. It's the right amount of the right paste for their age, supervised brushing, finishing with a spit and no rinse, and not flavouring the paste like dessert. OK

Tongue scraping reduces the volatile sulfur compounds responsible for bad breath. The Cochrane systematic review on the question pooled two trials of 40 participants total and reported VSC reductions of 40–75% with scrapers vs 33–45% with brushing the tongue with a toothbrush — a small but statistically significant difference Outhouse et al. 2006. The effect is short-lived — Cochrane noted VSC levels could not be detected for more than 30 minutes after the intervention in any of the groups — but the mechanical removal of tongue biofilm is the most direct approach to breath that doesn't involve killing your oral bacteria. Seemann et al. 2001 (n=30) found similar effect sizes in earlier work.

Copper is the interesting material choice. Young et al. 2001 tested metal salts against oral volatile sulfur compound production and found copper outperformed both zinc and tin in inhibiting VSC. The mechanism isn't just antimicrobial: copper has a chemical affinity for sulfur, binding the compounds that cause the smell. No published trial directly compares copper versus stainless-steel tongue scrapers in a clinical setting, so the material advantage is inferred from solution chemistry rather than directly demonstrated in a controlled trial. The chemistry is sound, and the EPA registered copper as an antimicrobial surface material in 2008.

The EU and UK require cosmetics (including toothpaste) to list all ingredients using INCIInternational Nomenclature of Cosmetic Ingredients — the EU/global naming convention used on cosmetic labels, designed for cross-language consistency rather than consumer readability names. INCI was designed for consistency across languages, not readability. So the titanium dioxide in your toothpaste appears as CI 77891. SLS appears as sodium laureth sulfate or sodium lauryl sulfate depending on the variant. Fluoride compounds appear as sodium fluoride, sodium monofluorophosphate, or stannous fluoride.

The practical translation: if you see CI 77891 on the label, that's the pigment the EU banned from food. If you see sodium lauryl sulfate or sodium laureth sulfate near the top of the list, that's the foaming agent that strips mucin. Hydroxyapatite usually appears as 'hydroxyapatite' or sometimes 'nano-hydroxyapatite' or 'mHAP'. Ingredients are listed in descending order by weight. The first five ingredients make up the bulk of the formula. Anything listed near the bottom is present in trace amounts.

The front of the pack claims. The back of the pack tells you what's in it. Read the back.

The oral-care wellness aisle has its own set of products that promise more than they deliver. Three are worth taking apart: charcoal toothpaste (the loudest claim), oil pulling (the oldest), and toothpaste tablets (the newest). The honest reads run from 'skip' to 'harmless ritual' to 'no evidence either way.'

Charcoal toothpaste is the cleanest 'skip.' A 2017 literature review in the Journal of the American Dental Association screened 118 papers, found no acceptable RCTs supporting safety or whitening efficacy, then walked into Amazon, ordered the first 50 charcoal dentifrices that came up, and audited what they were claiming on the label Brooks Bashirelahi & Reynolds 2017. The dentifrices made antibacterial, 'detoxification' and whitening claims with no evidence behind them, and the majority contained no fluoride at all. A 2019 in vitro study testing six whitening pastes against tea-stained enamel found that activated charcoala form of carbon processed to have small low-volume pores that increase surface area for adsorption — used in water filtration, medical poisoning treatment, and wellness-marketed dentifrices showed no whitening effect, while blue covarine and microbeads outperformed it Vaz et al. 2019. The American Dental Association has never granted a Seal of Acceptance to a charcoal toothpaste. The product trades a measurable abrasive for a marketing story.

Oil pulling — swishing coconut or sesame oil for 10–20 minutes — is older. Its evidence base is small Indian dental-school RCTs of 10–20 adolescents over 7–14 days, with mixed results. A 2016 systematic review of five RCTs found that oil pulling did not significantly reduce plaque compared with control in three of five trials (p=0.28, 0.94, 0.38), and did not differ from chlorhexidine in two trials measuring gingival index Gbinigie et al. 2016. A more recent 2020 review of four coconut-oil RCTs reported some signal for plaque reduction but described its own evidence base as high-bias and 'insufficient for conclusive findings' Woolley et al. 2020. There is no Cochrane systematic review on oil pulling, despite frequent claims to the contrary. The honest position: harmless if done after — not instead of — brushing, with no documented benefit beyond what brushing alone provides.

Toothpaste tablets are newest and the easiest to summarise. No clinical trial has compared tablet-form toothpaste to conventional paste for caries prevention. Most popular brands are also fluoride-free, which removes the one ingredient with the strongest RCT evidence in conventional paste. The plastic-free packaging is real. The dental-evidence base is empty. As a travel solution they're sensible; as a daily replacement for fluoridated paste, the swap is currently a leap of faith with no data on either side. If a hydroxyapatite tablet with proper RCT data ever appears, this paragraph changes.

One more aisle-claim worth puncturing: 'SLS-free' doesn't automatically mean 'gentler.' The most common SLS replacement, cocamidopropyl betainea coconut-oil-derived surfactant used as the most common SLS replacement in 'gentle' toothpastes — named ACDS Allergen of the Year 2004, with sensitisation rates of 3-7% attributed to manufacturing impurities (DMAPA and amidoamine) (CAPB), was named the American Contact Dermatitis Society's Allergen of the Year in 2004, with population sensitisation rates between 3% and 7% — the sensitisers being amidoamine and DMAPA manufacturing impurities rather than CAPB itself Jacob & Amini 2008. If SLS irritates you, switching may help. Or you may be swapping one irritant for another. The label 'SLS-free' doesn't tell you which.

The short version: regulators have moved on triclosan and TiO2 in food, endorsed hydroxyapatite as a cosmetic active in the EU, and reaffirmed fluoride after the NTP review — but oral care products still occupy a specific blind spot. Cosmetics regulation is separate from food regulation, and toothpaste benefits from the assumption that you spit it out. That assumption hasn't kept pace with the absorption research.

Here's what the research points toward. Not a perfect routine — some trade-offs are genuine — but one where each product choice is informed by what the studies actually say, not by what the packaging claims. Our eso-friendly framework covers how to apply this lens to anything else in your bathroom.

The total cost of switching is modest. An SLS-free toothpaste runs about the same price as a conventional one. A bamboo toothbrush costs £2–4. A copper tongue scraper is a one-time purchase of £4–6 that lasts years. Skipping mouthwash saves money. Silk floss costs marginally more than the cheapest PTFE-coated rolls but lasts longer per metre. The eso-friendly oral care routine isn't more expensive than the conventional one. In most cases, it's cheaper — because the most evidence-based change is removing a product entirely.

None of this is a case for panic about any single ingredient. The point is simpler: the surfactant that makes your toothpaste foam also strips the layer that protects your gums. The pigment that makes it white crosses your oral mucosa in thirty minutes. The mouthwash that freshens your breath kills the bacteria your cardiovascular system depends on. The floss that glides between your teeth was made from the same fluoropolymer family as Teflon. All of it is in published journals. None of it is on the back of the tube.

The alternatives exist, they cost about the same, and they work. The only thing they don't do is foam.