Toothpaste Explained

Toothpaste comes in many flavours and claims, but the choice is simpler than the shelf suggests. The American Dental Association says all toothpastes share the same basic ingredients, and the fluoride strength on the pack is what matters most. For how to brush, see how to brush your teeth.

What is in toothpaste?

The American Dental Association lists the basic parts of any toothpaste:

• a mild abrasive, which helps the brush remove food debris and surface stains
• humectants, which stop the paste drying out
• flavourings, which do not contain sugar and so do not cause decay
• thickeners (binders), which hold the paste together
• a detergent, which makes the foam and helps spread the paste around your mouth

Many also add active ingredients, most importantly fluoride.

Fluoride: the ingredient that matters most

The American Dental Association says fluoride strengthens tooth enamel and helps repair it in the early stages of decay. A 2019 Cochrane review (an independent summary of 96 trials) found high-certainty evidence that toothpaste with 1,000 to 1,250 ppm fluoride prevents more decay than toothpaste without fluoride, and moderate-certainty evidence that in children and teenagers, 1,450 to 1,500 ppm prevents slightly more than 1,000 to 1,250 ppm. It says the choice of strength for young children should be balanced against the risk of fluorosis, marks on developing teeth from too much fluoride.

Fluoride appears on labels as sodium fluoride, sodium monofluorophosphate or stannous fluoride. Delivering Better Oral Health, the UK government's guidance for dental teams, says there is not enough evidence to recommend one form over another: it is the strength in ppm that counts.

How strong should it be?

Guidance differs by country, especially for young children. See our fluoride guide and children's teeth for the detail. In short:

• UK: adults should use at least 1,350 ppm (NHS). Children can use family toothpaste of 1,350 to 1,500 ppm at any age; if a lower-strength children's paste is used, it should contain at least 1,000 ppm. The highest strength sold over the counter is 1,500 ppm (Delivering Better Oral Health).
• Australia: no toothpaste before 18 months, then a children's toothpaste with 500 ppm until age 6. After that, standard toothpaste of 1,000 to 1,450 ppm (Australian Dental Association).
• US: fluoride toothpaste from the first tooth. The American Dental Association says over-the-counter toothpastes generally contain 1,000 to 1,500 ppm.

Check the label

Delivering Better Oral Health reports an analysis that found almost a third (31%) of available toothpastes contained no fluoride. It warns that toothpaste bought from single-price shops, markets, websites or car boot sales may be imported or counterfeit and may contain no fluoride.

How much to use, and spit, don't rinse

• Adults and children over 3: a pea-sized amount (Australian Dental Association, healthdirect Australia).
• Younger children: a smear. Australia advises no toothpaste before 18 months.
• Spit out, do not rinse. The NHS says rinsing washes away the concentrated fluoride left on your teeth. The Australian Dental Association says not rinsing lets a layer of fluoride stay on your teeth for longer.
• Keep the tube away from small children. The NHS says not to let them lick or eat toothpaste from the tube.

The NHS advises using any mouthwash at a different time from brushing. See mouthwash.

Toothpaste for sensitive teeth

Desensitising toothpastes work in one of two ways, according to the Australian Dental Association: they soothe the nerve so it stops reacting, or they form a barrier over the sensitive area. The American Dental Association cites a 2023 review that found twice-daily use of toothpastes containing stannous (tin) compounds, potassium or arginine can be recommended to reduce sensitivity pain.

The American Dental Association says they usually need several applications, and the Australian Dental Association says they will not help if decay is the cause. See tooth sensitivity.

Whitening toothpaste

Whitening toothpastes can reduce stains on the surface of teeth using special abrasives or whitening agents, such as sodium hexametaphosphate or low levels of peroxide (healthdirect, American Dental Association). They have limits:

• The American Dental Association says over-the-counter products such as toothpastes will not make much difference to stains inside the tooth or to its natural colour. A 2020 review it cites found limited evidence that whitening toothpastes work about as well as paint-on gels but less well than whitening strips.
• healthdirect says whitening toothpaste can make teeth sensitive, and advises using it with a soft toothbrush to avoid damaging enamel.
• Charcoal: the American Dental Association says there is not enough evidence that charcoal products whiten teeth safely and effectively.

For professional whitening and the legal limits in each country, see stained teeth.

Other specialist toothpastes

The American Dental Association says some toothpastes contain ingredients to reduce gingivitis (inflamed gums) or tartar, help prevent erosion (enamel loss from acid) or freshen breath.

High-fluoride prescription toothpaste

If you are at high risk of decay, a dentist may recommend a stronger toothpaste.

• UK: Delivering Better Oral Health says toothpaste above 1,500 ppm is available on prescription from a dentist. It lists 2,800 ppm for people aged 10 and over at high risk of decay, and 5,000 ppm for people aged 16 and over, including those with decay on the roots, a dry mouth, or who have had radiotherapy and chemotherapy for the head and neck. It says these should go alongside cutting down on sugar, be reviewed, and not usually be used long term.
• Australia: the Australian Dental Association says a dentist may recommend a higher-fluoride toothpaste if you have severe decay or a high risk, for example with braces, a diet high in sugar or acid, difficulty brushing, a dry mouth or no fluoridated water.
• US: the American Dental Association says prescription-strength toothpaste contains 5,000 ppm. A 2013 expert panel of the association included prescription-strength home-use fluoride paste or gel for people at raised risk of decay from age 6, a younger starting age than the UK's 16 for 5,000 ppm.

Use it exactly as your dentist and the pack instructions say. See also dry mouth.

Fluoride-free toothpaste

The American Dental Association says not all toothpastes contain fluoride, and advises always using one that does. The 2019 Cochrane review found fluoride toothpaste prevented more decay than non-fluoride toothpaste in children and in adults.

Delivering Better Oral Health notes a growing number of "natural" and eco products, including toothpaste tablets, with limited or no evidence of effectiveness, some of which contain no fluoride. It says people who choose a non-fluoride toothpaste should know they lose its decay protection and need to take more care with sugar.

Ingredients people ask about

• Sodium lauryl sulphate (SLS) is a detergent that makes toothpaste foam (American Dental Association). The NHS advises people with mouth ulcers not to use toothpaste containing it. Delivering Better Oral Health says a low-foam, SLS-free toothpaste can benefit people with a vulnerable airway, such as after a stroke, or with swallowing difficulties, a dry mouth or sensory sensitivities.
• Flavourings. The American Dental Association says essential oils such as spearmint, peppermint and cinnamon are the most common cause of irritation or allergy from toothpaste, which it says is rare, and may be listed only as "flavours". SLS and some other ingredients have also been reported.
• Children's flavours. Delivering Better Oral Health suggests starting young children on a mild mint family toothpaste, because children may eat fruit-flavoured paste. The American Dental Association cites a 2018 review that found flavouring did not increase how much toothpaste children swallowed. The two sources place the emphasis differently.
• Triclosan, an antibacterial ingredient, is no longer available in US toothpaste as of 2019 (American Dental Association).

Frequently asked questions

Sources

1. How to keep your teeth clean, NHS, accessed September 2026
2. Mouth ulcers, NHS, accessed September 2026
3. Delivering better oral health, chapter 9: fluoride, Department of Health and Social Care and NHS England, accessed September 2026
4. Tips for choosing toothpaste, Australian Dental Association, accessed September 2026
5. Brushing teeth, Australian Dental Association, accessed September 2026
6. How to brush with a manual toothbrush, Australian Dental Association, accessed September 2026
7. Sensitive teeth, Australian Dental Association, accessed September 2026
8. Dental care and teeth cleaning, healthdirect Australia, accessed September 2026
9. Teeth whitening, healthdirect Australia, accessed September 2026
10. Toothpastes, American Dental Association, accessed September 2026
11. Toothpaste, American Dental Association (MouthHealthy), accessed September 2026
12. Fluoride: topical and systemic supplements, American Dental Association, accessed September 2026
13. Whitening, American Dental Association, accessed September 2026
14. Sensitive teeth, American Dental Association (MouthHealthy), accessed September 2026
15. Fluoride toothpastes of different concentrations for preventing dental caries, Cochrane (Walsh and others, 2019), accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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