One of the questions I get asked most often as a dental professional is: “Which toothpaste should I use?” And it’s a fair question. With shelves full of whitening, sensitive, natural, fluoride-free and hydroxyapatite toothpastes, choosing one can feel complicated.
The good news is that you really only need to know a few things.
Start with what actually protects your teeth
The most important thing I look for in a toothpaste is an effective remineralising ingredient. The two main options are fluoride and hydroxyapatite (HAp) — and some toothpastes contain both.
Fluoride
Fluoride has decades of evidence behind it. It helps remineralise enamel, makes teeth more resistant to acid attacks and reduces the risk of cavities.
For most adults, a toothpaste containing around 1,450 ppm (parts per million) fluoride is a good everyday choice.
I also understand that some patients prefer a fluoride-free option. Fluoride remains very well established for preventing decay, but if you would rather avoid it, hydroxyapatite is the alternative I would look for.
Hydroxyapatite
Hydroxyapatite is a calcium-phosphate mineral very similar to the mineral naturally found in our teeth. It can help replenish minerals at the tooth surface and block exposed dentinal tubules, which is also why HAp toothpastes can be useful for sensitivity.
But there is one important thing to remember: don’t buy just any toothpaste because “hydroxyapatite” is written on the front.
The concentration and formulation matter. Several well-studied HAp toothpastes contain around 10%, which is why I prefer products that clearly state their concentration and have evidence behind the formulation.
Some formulations contain around 12% HAp, combining nano- and micro-hydroxyapatite. Smaller particles can interact with microscopic areas of the tooth and exposed dentinal tubules, while larger particles can help coat and remineralise the tooth surface.
You don’t necessarily need the highest percentage available — look for a meaningful concentration and a well-formulated product.
What about natural toothpaste?
There are some very good natural toothpastes, but natural doesn’t automatically mean cavity-protective. Always check the active ingredients.
Some natural toothpastes contain neither fluoride nor a meaningful amount of hydroxyapatite, so although they may have a lovely ingredient list, they might not provide enough protection against tooth decay.
High cavity risk? You may need something stronger
If you regularly develop cavities, have active decay, dry mouth or exposed root surfaces, your dentist may recommend a prescription-only high-fluoride toothpaste.
In the UK, options include Duraphat 2800 and Duraphat 5000, containing much higher levels of fluoride than standard toothpaste. Duraphat 5000, for example, contains 5,000 ppm fluoride and may be prescribed for suitable patients aged 16 and over who are at increased risk of decay.
This isn’t something I would recommend choosing yourself — your dentist should assess your individual cavity risk and prescribe it when appropriate.
So if you keep getting cavities despite brushing properly, don’t simply keep changing supermarket toothpaste. Speak to your dentist or hygienist and find out what’s causing it.
Extras worth looking for
Once you have the right fluoride or HAp protection, there are a few useful extras worth knowing about.
Xylitol is a tooth-friendly sweetener that cavity-associated bacteria cannot use in the same way as ordinary sugar. This can help reduce acid production in the mouth and support cavity prevention.
Prebiotics, probiotics and enzymes are increasingly being used in oral-care products to support the oral microbiome and the mouth’s natural defences.
Ingredients you may want to avoid
SLS — sodium lauryl sulphate — is the detergent responsible for the foaming sensation you get from many toothpastes. If you regularly suffer from mouth ulcers, dryness or irritation, trying an SLS-free toothpaste may be worthwhile.
Titanium dioxide (TiO₂) is mainly used as a white pigment to make toothpaste look brighter. It doesn’t provide a dental-health benefit, and there are ongoing questions around its safety in orally used products.
Be careful with whitening toothpaste
Whitening toothpaste mainly helps remove surface stains from things such as coffee, tea, red wine or smoking. It cannot change the natural internal colour of your teeth in the same way professionally supervised peroxide whitening can.
It is also worth considering how abrasive the toothpaste is. Toothpaste abrasivity can be measured using an RDA — Relative Dentin Abrasivity — value. Some abrasion is necessary to help remove surface deposits, but very abrasive whitening products can be less suitable if you have sensitive teeth, gum recession or enamel wear.
So, which toothpaste should you choose?
Keep it simple.
For most people: Look for around 1,450 ppm fluoride.
Prefer a fluoride-free option? Look for hydroxyapatite — but check the concentration and formulation, as not every HAp toothpaste is equal.
High cavity risk? Speak to your dentist about whether a prescription-only high-fluoride toothpaste such as Duraphat 2800 or 5000 might be appropriate.
Prone to ulcers or irritation? Consider going SLS-free.
Want a little extra? Xylitol, prebiotics, probiotics, enzymes and other microbiome-supporting ingredients can all be useful additions.
One final tip
Whichever toothpaste you choose, how you use it matters too. Brush twice a day, with the most important brush being before bed.
And when you’re finished: Spit, but don’t rinse.
Rinsing immediately with water washes away much of the active toothpaste you’ve just placed around your teeth. Leaving a small amount behind gives the protective ingredients more time to work.
If you use mouthwash, use it at a different time of day rather than immediately after brushing.
There isn’t one single “best toothpaste” for everybody. The best toothpaste is one that gives your teeth the protection they need, suits you individually and is one you’ll happily use every day.
Still unsure which toothpaste is right for you? Bring the one you are currently using to your next dental or hygiene appointment and we can have a look at it together.
