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Related Concept Videos

The Oral Microbiota01:27

The Oral Microbiota

The oral microbiome includes a complex ecosystem comprising over 700 microbial species, identified through genomic sequencing and culture-based analyses to date. This community includes a core microbiome, found universally among individuals, and a variable component influenced by environmental factors such as diet, lifestyle, and host genetics. Site-specific conditions, including oxygen gradients, pH levels, and nutrient availability, determine the spatial distribution of these microorganisms...
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Assessment of the Mouth

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Updated: Jun 20, 2026

Impact of Common Fruit Juices and Toothbrushing on the Discoloration of Primary Teeth
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Navigating fluoride hesitancy: mapping the evidence base for fluoride-free toothpaste alternatives.

Alexander J Wong1, Christopher C Donnell2,3

  • 1Department of Paediatric Dentistry, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, 76 Wellesley Road, Sheffield, S10 2SZ, UK.

European Journal of Pediatrics
|June 18, 2026
PubMed
Summary

Fluoride-free toothpastes show some biological effects but lack strong clinical evidence for preventing cavities in children compared to fluoride. Hydroxyapatite shows the most promise among alternatives.

Keywords:
Caries preventionFluoride hesitancyFluoride-free toothpasteHydroxyapatitePaediatric dentistryRemineralisation

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Published on: June 4, 2014

Area of Science:

  • Dental Public Health
  • Caries Prevention Research
  • Toothpaste Formulation Science

Background:

  • Fluoride toothpaste is a proven method for long-term caries prevention.
  • Fluoride-free alternatives are gaining popularity, yet their evidence base relies on surrogate or short-term outcomes.

Purpose of the Study:

  • To synthesize and interpret evidence on fluoride-free toothpaste alternatives for caries prevention.
  • To examine how these products are studied and their outcomes.
  • To inform discussions with families regarding oral hygiene choices.

Main Methods:

  • A scoping review was conducted.
  • Searches identified peer-reviewed studies from January 2020 to March 2026 evaluating fluoride-free toothpaste formulations.
  • Data were extracted and narratively synthesized, focusing on evidence generation patterns.

Main Results:

  • 122 studies were included, mostly laboratory-based, with limited direct pediatric evidence (20 studies).
  • Fluoride-free options demonstrated antimicrobial activity, biofilm modulation, and surrogate remineralization effects.
  • Clinical caries outcomes were rarely assessed, with significant heterogeneity in formulations, designs, and outcomes.

Conclusions:

  • Fluoride-free toothpastes exhibit biological effects, but evidence relies heavily on surrogate outcomes and short study durations.
  • Hydroxyapatite-based products have the most consistent data among fluoride-free options.
  • No fluoride-free category currently matches fluoride's evidence for long-term caries prevention in children.