What's the best toothpaste for people who have a high decay rate? -

OTC vs. Prescription products. | Sodium Monofluorophosphate vs. Stannous Fluoride vs. Sodium Fluoride: What concentration? Indications. Precautions. | Toothpaste brands that contain effective levels of fluoride.

Picking out an effective anticavity toothpaste really does help to reduce your risk for decay.

If you have a history of getting a lot of cavities, you'll want to make sure that the toothpaste you use is the best kind possible for preventing tooth decay.

As evidence, it's been determined that just the act of including an effective fluoride dentifrice into your brushing routine (this even includes any of the OTC products listed on this page) helps to prevent cavities on the order of 24% (vs. a placebo). (Marinho 2003) [page references]

Ingredients to look for in an anticavity toothpaste.


Fluoride was the first type of therapeutic (active) ingredient to be included in the formulation of toothpastes. And over the last 60+ years of clinical research, studies have thoroughly documented its effectiveness in helping to prevent tooth decay and lowering decay rates (Marinho 2003).

Because of this, when choosing any type of dentifrice you're selling yourself and your teeth short if it doesn't contain fluoride.

a) What fluoride compounds are used in toothpastes?

World-wide there a number of different types of fluoride compounds that are used in toothpaste formulations (in the EU there are around 20). But in the USA only three are allowed, and they cannot be used in combination. They are:

  • Stannous Fluoride (tin difluoride, SnF2) - This was the first fluoride compound added to the formulation of a commercial toothpaste as an anticavity agent (1956).
  • Sodium Fluoride (NaF)
  • Sodium Monofluorophosphate (SMFP, Na2PO3F)

b) Sodium Monofluorophosphate vs. Stannous Fluoride vs. Sodium Fluoride

No single type of fluoride compound is necessarily best.

In terms of providing cavity protection, each of the compounds listed above can be considered to be equally effective. Each one is simply a different means by which to create a product that's capable of delivering an appropriate level of fluoride ions (F-) to the oral environment when used.

Why each type of fluoride is chosen.

Interestingly enough, the specific compound chosen by a manufacturer often depends on what other ingredients are included in the product's formulation. That's because these additional agents can sometimes interfere with the fluoride's ability to deliver an effective concentration of ions. Even the type of abrasive used in a product can trigger this problem.

An advantage of stannous fluoride.

We will mention that beyond just being a source of fluoride ions, the compound stannous fluoride also has antibacterial properties. This gives toothpastes formulated with it that added benefit without the need for the inclusion of additional ingredients.

c) What's the best fluoride concentration for a toothpaste?

  • By FDA regulation (USA), any dentifrice that contains more than 1500 ppm (parts per million) of fluoride is classified as a prescription medicine. Some prescription items have a concentration as high as 5000 ppm F-.
  • OTC (over-the-counter) toothpastes typically contain between 1000 - 1500 ppm F-. The vast majority of which are targeted toward the 1000 - 1100 ppm end of the range.
Which is better, a 1000 or 5000 ppm fluoride toothpaste?

Dentifrices that make a higher concentration of fluoride ions available in the user's mouth (like prescription ones do) produce an amplified anticavity effect. So, in the case of someone who has a high decay rate, a prescription item will be more effective in helping to lower it.

5000 ppm toothpastes (prescription products).

Keep in mind that not everyone needs or should have the higher fluoride exposure that a prescription item provides. For example, this type of product wouldn't be appropriate for young children with developing teeth (see "Precautions" paragraph below) or needed by adults who haven't had a cavity in years and years.

But for people who are cavity prone or at increased risk for decay (like those who have exposed root surfaces due to gum recession), they likely will benefit from the increased level of protection provided by using a prescription product.

Since in the US you can only get high-concentration fluoride dentifrices via a prescription from your dentist, it's for them to decide if your current decay rate warrants the use of one.

1000 ppm toothpastes (OTC products).

Regular fluoride toothpastes are effective cavity preventers too. A review of dental literature performed by Walsh (2010) concluded that a dentifrice must contain a fluoride concentration of at least 1000 ppm to produce significant anticavity effects.

As reported above, most OTC toothpastes meet this standard. Their F- concentration typically lies on the range of 1000 to 1500 ppm (with the lower end of this range being the much more common).

Especially in the case where you have a history of problems with cavities but have not been using a fluoride dentifrice, just starting the use of an OTC one will help to reduce your decay rate on the order of 24% (Marinho 2003). That's a pretty big first step.

d) How to figure out the concentration of fluoride in toothpaste?

It's easy enough to determine the concentration of fluoride ions produced by a dentifrice. Here's how:

  • Look at the product's label and see what type of fluoride compound it contains and at what percentage.
  • The following percentages all equate too 1000 ppm F-.

    stannous fluoride at 0.4% | sodium fluoride at 0.22% | sodium monofluorophosphate at 0.76%

  • If your toothpaste contains a higher/lower percentage of the compound it will have a higher/lower concentration of fluoride ions. Here are some equivalents for 1100 ppm F-.

    stannous fluoride at 0.454% | sodium fluoride at 0.243% | sodium monofluorophosphate at 0.836%

  • We're only familiar with sodium fluoride being used in high-strength prescription toothpastes.

    5000 ppm products are formulated with 1.1% NaF

Note: Precautions with fluoride use.

Fluoridated toothpaste that's swallowed by children during their tooth-forming years can lead to a type of permanent tooth staining termed "fluorosis."

For this reason it's important to both monitor the amount of toothpaste used and the brush-and-spit-out habits of children when they clean their teeth. Use this link to learn more about dental fluorosis.

The ADA Seal of Acceptance.

ADA Seal of Acceptance.

Products that display this logo are effective anticavity dentifrices.

Which are the best toothpaste brands for reducing decay?

a) OTC fluoride dentifrices.

In regard to OTC fluoride toothpastes (those types of products that you pick right off your local store's shelves), it's astoundingly easy to pick out one that's been proven effective in reducing cavities.

As candidates, just look for those whose packaging displays the logo from the American Dental Association's "Seal of Acceptance" program.

What you need to know:
  • All ADA-Accepted dentifrices have been proven to deliver a therapeutic level of fluoride (by way of their manufacturer submitting documented evidence). They must contain at least 90% of the fluoride amount found on their labeling.

    Note: Some products that have the Seal are targeted for usage by children, so by design they contain a lower concentration of fluoride than what an adult should use.

  • With the exception just noted, all OTC dentifrices that have earned the Seal can be considered to be equally effective in reducing decay.

    Note: We checked the ADA's entire toothpaste list. And although their information does contain some errors, after checking with manufacturer websites we found no approved dentifrices (intended for adult usage) that had a fluoride concentration lying outside the 1000 to 1100 ppm range.

  • As stated above, any of the three fluoride compounds used in the formulation of toothpaste in the US (stannous fluoride, sodium fluoride, sodium monofluorophosphate) can be used to create an effective product. No one is best or most effective in terms of fluoride ion release.

Which OTC fluoride toothpaste brands are best?

In terms of cavity-fighting ability, as long as a dentifrice has the ADA Seal it should be considered to be equally best in preventing decay.

At last check (June 2016), we counted over 50 individual dentifrice products that had earned the Seal. That suggest to us that it's relatively inconceivable that you could go to your local store and not find one of them.

ADA accepted toothpaste brands with fluoride.

This list includes products from these brands: Aim, AloeSense, Aquafresh, Colgate, Cool Wave, Crest, DTI, Freshmint, Hello, Sensodyne, Sheffield, Tom's of Maine, Pro-Sys, Cardinal, Oraline, Smile Central, SparkleFresh, BriteGel

Don't overlook considering a multi-care product.

Just as the ADA's Seal program evaluates cavity-fighting effectiveness, it recognizes categories for other toothpaste benefits too. So why not pick out a product that can provide multiple types of protection for your mouth and teeth?

These products are termed "multi-care" toothpastes and using one can make an excellent choice. We discuss the best ones here. Also, lower on this page we discuss the additional active ingredients they contain and how they produce an extra benefit in helping to lower a person's decay rate.

b) Prescription fluoride toothpaste brands.

The ADA Seal program no longer evaluates "professional dental products." We're assuming that this includes prescription fluoride toothpastes because we found none when reviewing their list of accepted products.

Which high-fluoride toothpaste is best?

If your dentist has a strong opinion about which brand is the best or most effective, they will no doubt indicate it on the prescription form they write. If they don't, you should ask which one you should buy.

The common concentration of these products is 5000 ppm F-, and each that does could be considered to be equally effective in providing fluoride anticavity protection. The difference between brands would have more to do with what other compounds are included in the product's formulation, once again something your dentist should pass judgment on.

Prescription toothpaste brands with fluoride (5000 ppm).

Each of these products are sodium fluoride (1.1%) dentifrices: PreviDent 5000, SF 5000 Plus, Clinpro 5000, Denta 5000 Plus

What other anticavity ingredients should you know about?

In broad terms, anything that kills bacteria and inhibits dental plaque formation should also be beneficial in helping to prevent tooth decay. And toward that goal, there are two antibacterial compounds (triclosan and stannous fluoride, both discussed below and both found in common OTC toothpastes) that you should be aware of.


As evidence, we'll mention two studies, Sentila (2011) and Tseng (1992), that determined that these compounds, at the concentration typically found in toothpaste, were effective in reducing levels of Streptococcus mutans (the type of bacteria most associated with cavity formation).

We realize that these papers are hardly the definitive word on this issue. But they do hint that dentifrices that contain one of them (like multi-care toothpastes do) are likely more effective in being able to reduce a person's decay rate than just a standard fluoride product. And for that reason probably make the best type of OTC choice for people having problems with cavities.

a) Triclosan

This is an antibacterial agent and as such helps to inhibit plaque formation. We discuss its use as an ingredient in multi-care toothpastes on this page. We're under the impression that right now only Colgate products contain this compound.

b) Stannous fluoride

You may remember our mention of stannous fluoride above as one of the three compounds used in toothpastes in the US as a source of fluoride ions.

As it turns out, stannous fluoride also has antibacterial properties and therefore also helps to inhibit plaque formation. Crest has focused on the use of this compound in their multi-care toothpastes. You can find more details here.



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