Update from our Expert at the bottom of the post!

Which one works best for you…

Are you a savvy toothpaste shopper? Or do you reach for the same brand that you’ve always bought…or maybe settle for whatever product is on sale?

With literally dozens of toothpaste varieties on drugstore and supermarket shelves—each one touting different benefits ranging from plaque-fighting to breath-freshening and enamel-protecting—it’s tough to know which one is best for you.

You might assume that it’s all marketing hype. But the truth is, there are some ingredients that do make a difference—and a few others that you may not need.

Here are answers to the questions that will help you identify the best toothpaste for you…

Do I still need fluoride? You’re way past your cavity-prone childhood years, so you really don’t need this ingredient, right? Wrong.

Cavities occur at all ages. Your risk depends, in part, on your bacteria levels and diet (sugar provides an ideal breeding ground for bacteria that create decay-promoting acids). Using a fluoride-fortified toothpaste really does help prevent cavities. It strengthens the outer surface of teeth, making the enamel more resistant to tooth decay.

The safety question: In recent years, a growing anti-fluoride movement has asserted that fluoride is a neurotoxin. However, decades of research prove that the amount of fluoride found in toothpaste is not only safe but also necessary to guard against cavities. For general oral health, specific brands don’t matter too much—just make sure it contains fluoride.

What you may not know: If your dentist spots a cavity in the outer layer of your tooth’s enamel, you can permanently reverse it with the use of fluoride toothpaste and mouthwash.

What to do: Follow the standard advice for anyone—brush twice daily with a soft-bristle toothbrush for a full two minutes (use an electric toothbrush with a timer if necessary), then floss—but also swish with a fluoridated mouth rinse, such as ACT Anticavity Fluoride Mouthwash or Crest Pro-Health Advanced Mouthwash. Your dentist may also apply a topical fluoride varnish after a cleaning and provide a prescription for stronger fluoride toothpaste (such as Clinpro 5000 or PreviDent 5000 toothpaste).

What will relieve my dry mouth? Dry mouth is no fun at all. More than 400 medications, including blood pressure drugs and antidepressants, are known to cause dry mouth. (Be sure to tell your doctor if you take medication and have dry mouth—you may be able to switch to a different drug.) Radiation treatments in or near the mouth can also cause it. With dry mouth, you have less saliva, which is needed to help fight cavities by neutralizing acids from food.

What helps: Sip water frequently throughout the day, and try chewing sugar-free gum or sucking on sugar-free mints made with xylitol (a sugar substitute that reduces risk for cavities) between meals to stimulate saliva production.

If you have dry mouth, also consider asking your dentist to prescribe a prescription fluoride toothpaste, such as Clinpro 5000 toothpaste (mentioned earlier). It contains not only more than four times the fluoride of regular toothpaste but also calcium and phosphate to help remineralize and further strengthen your teeth.

Also helpful: Biotène makes a line of xylitol-containing rinses for dry mouth, including Dry Mouth Oral Rinse.

What if my teeth are sensitive? If you’ve lost some of your enamel due to grinding, clenching, an acidic diet or receding gums, your teeth may be hypersensitive. If that’s the case, a desensitizing toothpaste is likely to help—these products contain compounds (such as potassium nitrate) that help block transmission of pain signals from the tooth’s outer surface to the nerve.

What helps: Sensodyne Fresh Mint Toothpaste. You’ll need to use a desensitizing toothpaste daily for a few weeks before feeling the benefit—stop using it, and the sensitivity will return.

Important new finding: A 2016 study concluded that arginine, an amino acid naturally found in saliva, is superior to other desensitizing agents. Good product that contains arginine: Colgate Sensitive Pro-Relief Toothpaste.

If you have acid reflux: Don’t brush immediately after eating or during an episode of heartburn—food acids may damage tooth enamel over time. Instead: Dissolve a few teaspoons of baking soda in a bottle of water, then rinse and spit it out after eating to neutralize any acid in your mouth. Wait at least an hour, then brush with a desensitizing toothpaste.

What if I prefer a “natural” toothpaste? Most “natural” toothpastes (such as Kiss My Face and Jason) are free of sodium lauryl sulfate (SLS), a foaming agent that creates that luxurious lather during brushing.

Some people find that SLS irritates their gums, and a small study found that canker sores may be less likely to develop in people who use SLS-free toothpaste. For these individuals, an SLS-free toothpaste is a good option…just make sure it’s a product that contains fluoride, such as Tom’s of Maine Clean & Gentle with Fluoride Toothpaste, Peppermint.

To Swish? Or Not to Swish?

Not all mouthwashes are created equal. Some, such as Scope, temporarily freshen your breath, but they don’t contain the fluoride that is needed to prevent or control tooth decay. To keep your enamel strong: Stick with a fluoridated rinse such as ACT Anticavity Fluoride Mouthwash.

An antibacterial rinse, such as Listerine, can reduce the bacterial count in your mouth to help prevent gingivitis, and it even has a new fluoride-enhanced formulation—just be aware that some versions contain alcohol, which can exacerbate dry mouth. If this is an issue for you, consider an alcohol-free antibacterial mouthwash, such as Listerine Total Care Zero or Crest Pro-Health Advanced (alcohol-free) Mouthwash.

Update: Thanks very much for your comments on this article. We reached out to our expert source, Dr. Natalie Hastings, DMD, for her thoughts, which are summarized below.

As the article states, decades of research prove that the amount of fluoride found in toothpaste is not only safe but also necessary to guard against cavities.

Fluoride has a direct remineralization effect on teeth. Fluoride is incorporated in the surface of the tooth structure to strengthen it and more resistant to future acid attacks that would result in break down of the tooth—demineralization. Xylitol is an antibacterial. It inhibits the growth of the bacteria that causes cavities. It does not directly remineralizes tooth structure. If used, it is recommended to use xylitol mints or gums 3-5 times daily for a total of 5 mg for optimal results.

Fluoride is also naturally found in groundwater and in the oceans—all waters in various amounts. Water fluoridation is the adjustment of fluoride to a recommended level for preventing tooth decay while minimizing the risk of fluorosis in the general population. The US Department of Health and Human Services announced a recommendation that community water systems adjust the amount of fluoride 0.7 parts per million. Before water fluoridation, children had about 3 times as many cavities. For generations, millions of people have lived in areas where fluoride is found naturally in drinking water in concentrations as high or higher than those recommended to prevent dental decay. Research conducted among these persons confirms the safety of fluoride in the water supply.

PS: Because Bottom Line Health is committed to reviewing all significant new medical research, we will report if there are new relevant findings on fluoride. Thanks again for writing!
—The editors of Bottom Line Health