Oral care sits apart from the rest of personal care, for one reason: this is the only category where the products have a large, well-established evidence base behind them, and where swapping to a gentler alternative can carry a real cost.
Tooth enamel does not regenerate. A cavity is permanent. So the sensible approach here is more conservative than elsewhere on this site — reduce the genuinely unnecessary additives, and be careful about removing the things that demonstrably work.
The short answer
Drop SLS if you get mouth ulcers, drop artificial colours and flavours freely, and be genuinely cautious about dropping fluoride — that is a decision to make with your dentist, based on your own cavity history, not based on a blog.
Fluoride: the honest version
This is the most contested item in the category, and it deserves a straight account rather than advocacy in either direction.
The evidence that topical fluoride reduces tooth decay is strong and consistent across decades of research. It works by helping remineralise enamel and making it more resistant to acid. Dental and medical bodies worldwide recommend it, and it is one of the better-evidenced interventions in routine preventive health.
The genuine, non-fringe caution is dental fluorosis in young children who swallow toothpaste during the years their permanent teeth are forming. This is why paediatric guidance specifies small amounts — a smear for under-threes, a pea-sized amount for older children — and supervision so it is spat out rather than swallowed. That is a dosing issue with a clear solution, not an argument against fluoride itself.
Concerns raised about high-level fluoride exposure generally relate to concentrations well above those in toothpaste or fluoridated water. If you choose fluoride-free anyway — and people do, for various reasons — the responsible version of that choice involves telling your dentist, so your recall interval and any additional preventive measures can account for it.
Hydroxyapatite
The one fluoride alternative with meaningful research behind it. It is the mineral enamel is largely made of, and studies — a substantial portion from Japan, where it has been used for decades — suggest it can help remineralise enamel.
The evidence base is smaller than fluoride’s but it is real, which distinguishes it from most alternatives. If you want to move away from fluoride, this is the option worth discussing with your dentist rather than simply switching to something that cleans but does not remineralise.
What is worth removing
- Sodium lauryl sulphate (SLS). The foaming agent. It contributes nothing to cleaning — the brush does that — and there is reasonable evidence it aggravates recurrent aphthous ulcers. If you get frequent mouth ulcers, this is the single most worthwhile change in your bathroom.
- Artificial colours. Purely cosmetic in a product you spit out.
- Triclosan. Largely phased out, but worth checking on older products.
- Saccharin and artificial sweeteners — harmless for most, but easy to avoid if you would rather.
- Strong “whitening” abrasives. See below, because this is where real damage happens.
Abrasion: the underrated risk
This is where DIY and “natural” oral care most often causes genuine harm, and it gets far less attention than fluoride does.
Toothpastes are measured on an abrasivity scale, and enamel loss from over-abrasive products is cumulative and permanent. Several popular natural approaches score badly here.
- Baking soda used undiluted, daily, is more abrasive than most commercial pastes and too alkaline for routine use.
- Charcoal toothpaste is the clearest example. It is abrasive, there is no good evidence it whitens beyond removing surface stain, and dental associations have repeatedly cautioned against routine use. It can also stain restorations and settle into gum margins.
- DIY salt scrubs and similar are straightforwardly damaging.
Enamel does not grow back. This is one place where the commercial product is usually the safer choice.
What actually prevents decay
Worth stating, because product choice is a much smaller variable than technique and diet.
- Brushing twice daily for two full minutes with a soft brush. Soft, not medium or hard — firmer bristles damage gums and enamel without cleaning better.
- Cleaning between the teeth daily. Floss or interdental brushes. This addresses the surfaces where decay most often starts.
- Frequency of sugar matters more than quantity. Sipping a sweet drink over an hour is considerably worse for teeth than drinking it in five minutes, because each exposure restarts an acid attack.
- Do not brush immediately after acidic food or drink. Enamel is temporarily softened; wait around thirty minutes.
- Spit, do not rinse. Rinsing with water straight after brushing washes away the concentrated toothpaste that was about to do its work.
Mouthwash and oil pulling
Mouthwash is optional for most people. High-alcohol formulas cause dryness, and a dry mouth is itself a decay risk since saliva is protective. If you use one, alcohol-free is the sensible default, and use it between brushings rather than immediately after.
Oil pulling is harmless as an adjunct and pleasant for some people. The evidence that it does anything meaningful is weak, and it is not a replacement for brushing or flossing. Do not spit oil down the sink.
Frequently asked questions
Is charcoal toothpaste safe?
Not for routine use. It is abrasive, its whitening effect is limited to surface stain removal, and dental bodies have cautioned against it. Occasional use is unlikely to be catastrophic, but daily use risks enamel wear that does not reverse.
Can I make my own toothpaste?
You can, but this is one of the few places we would gently steer you away. Homemade recipes are typically abrasive, are difficult to formulate at a safe pH, and contain nothing that remineralises enamel. The downside is permanent.
Are fluoride-free toothpastes useless?
No — they still remove plaque, and mechanical cleaning is a large part of the benefit. What they lack is the remineralising action. Hydroxyapatite formulas are the ones with actual evidence behind that function.
What about toothpaste tablets and refillable options?
Good for packaging reduction, and many now include fluoride or hydroxyapatite. Check the active ingredient rather than assuming, since some are essentially just a cleaning agent.
Keep going
This is one section of the Non-Toxic Personal Care Guide, which also covers skincare labels, deodorant, and haircare.