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When it comes to oral hygiene, regular brushing and flossing is only part of the process.

A toothpaste that contains fluoride is the only proven way to prevent cavities. But dental experts warn that some consumers are swapping fluoride toothpaste for fluoride-free ones.

These consumers may be turning to alternatives available online or in shops marketing “natural” products.

“I’m concerned that individuals choosing these products are missing out on the proven benefits of fluoride for cavity prevention,” Edmond Hewlett, DDS, a professor of restorative dentistry at the University of California Los Angeles School of Dentistry, told Healthline.

“As a healthcare provider, my patients’ health and wellness is of primary importance, and I want them to benefit from the best that dental science has to offer. Fluoride is a shining example.”

What is fluoride?

Fluoride is a naturally occurring mineral that can be found in most water sources like lakes, rivers, and the ocean.

For the past 70 years, fluoride has been added to most public water supplies in the United States. When added to toothpaste and dental products, this mineral helps prevent cavities by strengthening the enamel, or hard surface, of the tooth.

Studies have shown that having fluoride in public water systems has prevented tooth decay in children and adults by at least 25 percent.

Despite strong evidence supporting the benefits of fluoride for oral health, some consumers are choosing options that are marketed as being effective despite not containing fluoride.

A search on popular online shopping site Amazon revealed various fluoride-free toothpastes with advertising descriptions like “don’t choose between natural and effective.”

Comments from consumers listed under some of the products reveal some customers appear fearful of fluoride.

“Most of the bacteria eliminating toothpastes contain harmful ingredients like fluoride and triclosan and calcium chloride. We ingest a lot of poison every year just by brushing our teeth,” one customer wrote.

But Hewlett says not only is fluoride in toothpaste safe, it’s also a natural ingredient.

“Fluoride is a naturally occurring element, it’s nature’s cavity fighter. Specific fluoride compounds proven to prevent cavities and approved by the U.S. Food and Drug Administration (FDA) for cavity prevention are added to toothpaste in an FDA-approved amount,” Hewlett told Healthline.

Experts say that some consumers have a misconception about the safety of fluoride, and this may be a factor in people choosing fluoride-free products.

While fluoride-free toothpastes are marketed as being a safer and more effective way to keep your teeth healthy, Hewlett says no other ingredient comes close to the benefits of fluoride.

“Seventy years of research proves that it prevents cavities,” he said. “There is no other toothpaste ingredient with this kind of track record. For this reason, dentists have been recommending fluoride toothpaste to their patients for decades.”

What to look for in a toothpaste

When it comes to picking the right toothpaste, dentists have a simple recommendation.

“I tell all my patients to look for a toothpaste that has earned the ADA Seal of Acceptance. If a product has the ADA seal, it means that it has been tested and proven to be safe and effective,” Matthew Messina, DDS, a dentist in Ohio and spokesman for the American Dental Association (ADA), told Healthline.

In the United States, toothpastes that have been proven to be safe and effective at preventing cavities and maintaining optimal oral health all have an ADA Seal of Acceptance.

According to the ADA, only toothpastes containing fluoride will have such a label, and only after providing scientific evidence demonstrating safety and efficacy of the product.

As well as containing fluoride, ADA-accepted toothpastes must also not contain flavorings that would cause tooth decay such as sugar, And they may contain active ingredients that assist in teeth whitening, lessen tooth sensitivity, prevent enamel erosion, and reduce gingivitis and buildup of tartar.

Messina said that even if you brush your teeth well twice a day, using a toothpaste that is fluoride free isn’t a good idea, even if it is marketed as natural or safe.

“Just because something is ‘natural’ doesn’t mean it can help prevent cavities. Brushing with a toothpaste that doesn’t contain fluoride won’t help you prevent cavities,” he said.

When do cavities occur?

Cavities (tooth decay) occur when the hard outer layer of teeth is broken down.

The teeth are constantly covered in a sticky film of bacteria called plaque. When a person consumes foods or drinks containing sugar, the bacteria in plaque creates acid that then attacks the hard outer layer of the tooth, destroying it over time. Little holes called cavities then form in the tooth.

Fluoride strengthens the enamel of the tooth by helping to rebuild enamel that has been attacked by acid, reversing signs of early tooth decay.

But Hewlett says the evidence in support of the efficacy and safety of fluoride is clear.

“The best available scientific evidence shows no association between the recommended amount of fluoride used to prevent tooth decay and any harmful effects,” he said.

“Fluoride at the optimal levels in toothpaste and community water sources is safe and effective. Like any parent, I want my child to be healthy, so I made sure that he was getting the benefits of fluoride from the arrival of his first baby teeth and ever since.”