Toothpaste and brushing guide

How does toothpaste work?

The ADA says toothpastes share the same core ingredients. Fluoride helps prevent decay and supports early remineralization; abrasives such as calcium carbonate and silicas clean teeth and can remove surface stains; and detergents such as sodium lauryl sulfate create foam that helps loosen plaque during brushing. Humectants such as glycerol, propylene glycol and sorbitol keep the paste from drying out, thickeners stabilize it and flavors and non-caloric sweeteners are common.

Is there sugar in toothpaste? Is there alcohol?

The ADA says sugar and other cariogenic ingredients are not allowed in ADA-accepted toothpastes, and that flavors and non-caloric sweeteners are common. The ADA page lists humectants and sweeteners but does not discuss alcohol in toothpaste, and the sources we read do not either, so check the ingredient list if you want to avoid it.

What the ADA Seal means

Manufacturers earn the Seal by submitting data to the ADA Council on Scientific Affairs, which evaluates safety and efficacy. The ADA says all toothpastes with a claim of cavity protection with the Seal must contain fluoride, and that sealed toothpastes must have a relative dentin abrasivity of 250 or less. The ADA notes that the FDA sets requirements but does not test toothpastes for compliance, so Seal holders supply the data that verifies it.

Whitening and sensitivity toothpastes

The ADA says abrasives can remove surface stains and hydrogen and carbamide peroxides can lighten deeper stains. For dentin hypersensitivity, which it says affects about 11.5 percent of patients, a 2023 systematic review found that twice-daily use of stannous, potassium (with or without stannous) or arginine toothpastes can reduce sensitivity pain. Cleveland Clinic advises avoiding toothpastes with a lot of baking soda, which is abrasive, while Healthline reports the ADA considers baking soda safe for enamel and dentin, so fluoride toothpaste remains the sensible default.

How much toothpaste for children

The ADA says to use a rice-sized smear of fluoride toothpaste from the first tooth until age 3, then a pea-sized amount from ages 3 to 6, and to supervise brushing so children spit rather than swallow. Excess fluoride during permanent tooth development can cause fluorosis, ranging from mild white flecks to severe enamel pitting. The ADA also says a 2018 meta-analysis found flavoring does not increase children's toothpaste ingestion, and that caregivers often use up to twice the recommended amount.

How to brush

Cleveland Clinic says to angle the brush at about 45 degrees to the gum line, use short, overlapping strokes with gentle pressure, clean every surface, brush twice a day for at least two minutes at one session and floss as well. The ADA gives the same angle and two-minute guideline. Our guide on how to choose a toothbrush covers brushes, replacement and cleaning.

Toothpaste tablets and non-gel toothpaste

The sources we read do not cover toothpaste tablets or what non-gel toothpaste is, so we cannot advise on them. The ADA's key rule is that cavity-protection claims with the ADA Seal require fluoride, so check that any alternative lists fluoride and carries the Seal.

Should you clean your tongue?

The sources we read for this guide do not address tongue cleaning, and Cleveland Clinic's brushing guide does not address it either. Ask your dentist if you have persistent bad breath, which can have other causes.

Reading labels

The ADA says to look for the ADA Seal, to confirm fluoride is listed if you want cavity protection, and to check labels for essential oils such as spearmint, peppermint and cinnamon, which can cause irritation or allergic reactions and may appear under generic flavors.

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