How do you read a toothpaste label?
A toothpaste label tells you most in two places: the fluoride concentration given in ppm, that is parts per million, and the ingredients list, which shows the fluoride compound and the active ingredients. The EU Cosmetic Products Regulation (EC) No 1223/2009 allows at most 0.15% fluoride in toothpastes, that is 1500 ppm, and requires the packaging to state which fluoride compound the product contains.
Toothpastes containing 0.1 to 0.15% fluoride, unless they are labelled as for adults only, must carry a warning, which in the Polish version of Commission Directive 2007/53/EC reads “U dzieci poniżej sześciu lat stosować ilość pasty wielkości ziarnka grochu pod kontrolą dorosłych, aby zminimalizować ryzyko połknięcia”, meaning that children under six should use a pea-sized amount of toothpaste under adult supervision to minimise the risk of swallowing it (legal status as of 24 October 2026).
The list helps you check quickly what to look for on the packaging.
- Fluoride concentration: 1350 to 1500 ppm for adults, and for children according to age.
- The fluoride compound in the ingredients (INCI): sodium fluoride, sodium monofluorophosphate or stannous fluoride, that is tin fluoride.
- An active ingredient suited to your need, for example potassium nitrate for sensitive teeth.
- Sodium lauryl sulfate (SLS), if you get recurrent mouth ulcers and want to avoid it.
- Claims on the front of the pack, such as “natural” or “herbal”, which on their own say nothing about protection against tooth decay.
How many ppm of fluoride should toothpaste contain for adults and children?
An adult should use toothpaste with 1350 to 1500 ppm fluoride, and a child a toothpaste whose concentration is matched to their age. The UK prevention guidance Delivering better oral health (DBOH) recommends that adults brush at least twice a day with 1350 to 1500 ppm toothpaste and spit out the foam without rinsing the mouth with water.
The guidelines of the European Academy of Paediatric Dentistry (EAPD, 2019) recommend 1000 ppm toothpaste for children up to the age of 6 and 1450 ppm after that. Polish experts (2019) recommend 1000 ppm in a rice-grain amount up to the age of 3, a pea-sized amount of 1000 ppm at ages 3 to 6, and 1450 ppm where the risk of decay is high; details of how much toothpaste to use are in the article on brushing teeth.
Concentration matters. A 2010 Cochrane review reports a 23% reduction in tooth decay for toothpastes with 1000 to 1250 ppm and 36% for those with 2400 to 2800 ppm, while toothpastes with 440 to 550 ppm or less did not differ significantly from placebo.
Fluoride or fluoride-free toothpaste?
Fluoride toothpaste protects against tooth decay better than fluoride-free toothpaste, as Cochrane reviews confirm. The 2019 update of the review (96 studies) confirmed the benefit of fluoride toothpaste compared with non-fluoride toothpaste, in adults too, and adverse effects, where they were studied, were minimal.
DBOH recommends that people who choose a fluoride-free toothpaste should be told about the loss of the protective effect against decay and about the greater need to cut down on sugar. Concerns about the safety of fluoride, including fluorosis and the IQ report, are discussed in a separate article on whether fluoride is harmful.
Hydroxyapatite toothpaste: can it replace fluoride?
Fluoride-free hydroxyapatite toothpaste has promising but still scant evidence, which is why guidelines continue to rely on fluoride. A 2022 review by Wierichs et al. concluded that the small number of clinical studies, short follow-up and high risk of bias do not allow firm conclusions, and some of the studies were funded or published by manufacturers.
In an 18-month study by Paszyńska et al. (2023), hydroxyapatite toothpaste performed no worse than 1450 ppm fluoride toothpaste. Of the 189 adults, 171 completed the study per protocol; in this analysis the DMFS index (decayed, missing or filled surfaces) did not increase in 89.3% of those using hydroxyapatite and 87.4% of those using fluoride toothpaste. Three of the authors, however, were employees of a company linked to the manufacturer. A meta-analysis by Chatzidimitriou et al. (2025) included only 4 studies and found no differences compared with fluoride toothpaste.
Commission Regulation (EU) 2024/858 allows nano-hydroxyapatite in toothpastes at concentrations of up to 10%, subject to conditions on particle shape. If you are considering a fluoride-free toothpaste, discuss it with a dentist, especially if you have active decay or the toothpaste is for a child.
Toothpaste for sensitive teeth and for the gums: which ingredients work?
Toothpaste for sensitive teeth works if it contains an ingredient with a documented effect and you use it every day for several weeks. A 2020 network meta-analysis by Martins et al. (125 studies, 12,541 patients) showed with moderate certainty an advantage over ordinary fluoride toothpaste for, among others, stannous fluoride, potassium salts, arginine and calcium sodium phosphosilicate; there is more in the article on sensitive teeth.
For gum inflammation, stannous fluoride matters. A 2006 review by Paraskevas and van der Weijden (15 publications) showed that toothpastes with stannous fluoride reduce gingivitis and plaque compared with ordinary toothpaste, and a 2019 meta-analysis by Figuero et al. recorded the weakest results for toothpastes with sanguinarine and with baking soda.
The table sets out needs, the ingredients to look for on the label and the strength of the evidence. Toothpaste does not replace treatment: bleeding gums need tartar removal, and sensitivity in a single tooth needs an examination.
| Need | Ingredient on the label | What studies show |
|---|---|---|
| Protection against tooth decay | Sodium fluoride, sodium monofluorophosphate or stannous fluoride, 1350 to 1500 ppm | Less decay than with fluoride-free toothpaste (Cochrane) |
| Active tooth decay | Fluoride 2800 or 5000 ppm, only on a dentist’s advice | Until the decay is under control (DBOH) |
| Sensitive teeth | Potassium nitrate, stannous fluoride, arginine, calcium sodium phosphosilicate | Advantage over ordinary toothpaste, moderate certainty (Martins 2020) |
| Bleeding gums | Stannous fluoride | Less gingivitis than with ordinary toothpaste (Paraskevas 2006) |
| Enamel erosion | Fluoride, also combined with tin; a low-abrasion toothpaste | DBOH advises considering a fluoride or a fluoride and stannous toothpaste |
| Surface stains | Abrasives in whitening toothpaste | Removes more stains, but more side effects (Devila 2020) |
| Recurrent mouth ulcers | Toothpaste without sodium lauryl sulfate (SLS) | Fewer ulcers in 4 small studies (Alli 2019) |
| Fluoride-free toothpaste | Hydroxyapatite | Few studies, some co-authored by manufacturers |
Whitening toothpaste: is it bad for your teeth?
Whitening toothpaste mainly removes surface stains, but it can cause adverse effects even when used as intended; its ingredients, its abrasiveness and the condition of the teeth all play a part. A 2020 meta-analysis by Devila et al. showed that whitening toothpastes remove more stains than ordinary ones, but adverse effects occurred more often with them (relative risk 1.74), with low to moderate quality evidence.
Whitening toothpaste works mainly through abrasives, which mechanically remove stains from the tooth surface, as the American Dental Association (ADA) describes. In the European Union, products sold without the involvement of a dentist may contain at most 0.1% hydrogen peroxide, so a toothpaste will not change the natural colour of a tooth the way whitening at the dentist’s does.
The abrasiveness of a toothpaste is described by its RDA value; the ADA awards its Seal of Acceptance only to toothpastes with an RDA no higher than 250. With tooth wear, for example enamel erosion, DBOH advises avoiding highly abrasive toothpastes, and for charcoal toothpastes a 2017 review by Brooks et al. found no data confirming their safety and effectiveness.
5000 ppm toothpaste: when does a dentist recommend it?
A dentist recommends 5000 ppm fluoride toothpaste for people with active tooth decay, usually until it is under control, and it is not meant to be used on your own initiative. For adults with active decay of the crown or root, DBOH provides for 2800 ppm toothpaste from the age of 10, or 2800 or 5000 ppm from the age of 16.
Polish experts (2019) allow 5000 ppm toothpaste only on a dentist’s advice and for people over 16. Toothpaste of this concentration exceeds the EU limit of 1500 ppm for cosmetics and is registered in Poland as a medicinal product available without prescription, but its use should be agreed with a dentist.
Choosing a toothpaste and preventive care at DentalBlue
At DentalBlue in Białystok, preventive care includes hygiene treatment, fissure sealing and fluoride application, and the team includes dental hygienists. Whether an ordinary fluoride toothpaste is enough, or a higher-concentration toothpaste or one with a different active ingredient is needed, is decided by a dentist after an examination and an assessment of your risk of tooth decay. In the clinic’s price list, “Fluoryzacja” (fluoride application) costs 100 zł, and “Kompleksowa higienizacja (skaling, piaskowanie, fluoryzacja)” (comprehensive hygiene treatment: scaling, air polishing, fluoride) 350 zł. The final scope and cost are set at the visit, and prices may change.
Frequently asked questions
Is a more expensive toothpaste better?
Not necessarily. Protection against tooth decay depends on the fluoride concentration in ppm, and the effect on sensitivity or gum inflammation on a specific active ingredient. You will find both on the packaging, regardless of price and brand.
How much toothpaste should you put on the brush?
Polish experts (2019) recommend a rice-grain amount for children up to 3 years old and a pea-sized amount from 3 to 6. The EAPD (2019) puts this cut-off at 2 years and recommends 0.5 to 1 g of toothpaste for children over 6. The guidelines give no amount for adults. After brushing, spit out the foam without rinsing your mouth with water.
Is toothpaste with SLS bad for the teeth or gums?
For most people there is no reason to avoid it. In people with recurrent mouth ulcers, a 2019 review by Alli et al. (4 studies, 124 participants) described fewer ulcers, shorter episodes and less pain with SLS-free toothpaste, although the authors considered that more research is needed.
Does herbal or natural toothpaste protect against tooth decay?
Only if it contains fluoride at an appropriate concentration, which you can check in the ingredients and in ppm on the packaging. Plant additives do not replace fluoride, and in the 2019 meta-analysis by Figuero et al. toothpastes with sanguinarine, a plant extract, had the weakest effect on gum inflammation.
Is charcoal toothpaste safe?
There are no data to confirm that it is. A 2017 review by Brooks et al. found no clinical studies meeting its criteria and concluded that the data on the safety and effectiveness of charcoal toothpastes are insufficient. With sensitive teeth it is better to choose a low-abrasion toothpaste.
Sources
- OHID: Delivering better oral health, chapter 9, fluoride (2021, updated 2025)
- Cochrane: Walsh T et al., fluoride toothpastes of different concentrations, update (2019)
- Regulation (EC) No 1223/2009 on cosmetic products, Annex III, fluorine compounds (2009)
- Journal of Dental Research: Martins CC et al., toothpastes for dentine hypersensitivity, a network meta-analysis (2020)
- Journal of Clinical Periodontology: Paraskevas S, van der Weijden GA, stannous fluoride and gingivitis (2006)
- Clinical Oral Investigations: Wierichs RJ et al., nano-hydroxyapatite toothpastes for caries prevention (2022)
- Frontiers in Public Health: Paszyńska E et al., hydroxyapatite toothpaste in adults, 18 months (2023)
- Operative Dentistry: Devila A et al., whitening toothpastes, a systematic review (2020)
An informational article. It does not replace a consultation, and treatment decisions are made during a visit.
