Deborah deMoulpied Editor’s note: If you’re in active chemo/radiation or dealing with mouth sores, dry mouth, or taste changes, check with your oncology or dental team before switching products. Some ingredients (strong flavors, high alcohol, peroxides, or very abrasive pastes) can sting or irritate healing tissues. Ask your clinician about fluoride needs, prescription‑strength pastes/rinses, and any restrictions after procedures.
Safer oral care starts with the ingredient label. Every day we use products – such as toothpaste, mouthwash, and dental floss – inside our mouths. With shelves crowded by “whitening,” “sensitive,” “charcoal,” “fluoride‑free,” and “pro‑strength” claims, it helps to know what matters most for a healthy smile.
Your mouth is an integral part of your overall health. What happens there doesn’t just stay there. For example, oral bacteria can enter the bloodstream and cause inflammation linked to heart disease, diabetes, and other chronic conditions.
LEARN MORE: Safer Oral Care Products: Toothpaste, Floss and Beyond
Of course, not all bacteria are bad. In fact, many strains are essential for a healthy oral microbiome. The goal isn’t to wipe everything out; it’s to maintain balance by boosting helpful bacteria and limiting those that are harmful. That’s why it makes sense to choose gentle, effective formulas that support both oral and overall wellness—without harsh ingredients that irritate delicate tissues.
Irritants aren’t the only problem. Many dental products contain a rogues’ gallery of harmful chemicals. A few examples:
- Some oral care products contain endocrine‑disrupting chemicals (EDCs)—ingredients that can mimic or interfere with hormones even at low doses. Several EDCs are strongly tied to hormone-related cancers. (To learn more about EDCs, please see our free eBook, Endocrine‑Disrupting Chemicals (EDCs)—What They Are & How to Reduce Your Exposures.)
- Some flosses may introduce toxic PFAS (“forever”) chemicals that have clear links to cancer.
- Microplastics can be shed from the wear and tear of many dental products, including toothbrushes, floss, aligners, and dentures. There is growing evidence linking microplastics with cancer.
So what can you do about all this? Let’s drill down (so to speak) into some common hidden risks in everyday dental products, dental care products that can contain them, and then discuss how you can minimize your exposure to the harmful chemicals they may contain.
Common additives in dental care products to be avoided include:
- Harsh surfactants such as sodium lauryl sulfate (SLS) can aggravate the mouth’s delicate lining and are associated with canker sores in susceptible people.
- Antibacterials like triclosan (banned in U.S. hand soaps) raised endocrine exposure and environmental concerns. Most U.S. companies no longer use triclosan in their dental care products; however, older or imported oral products can still contain it.
- PFAS (“forever chemicals”) are found in many everyday items—including some “easy-glide” flosses—and can build up in the body over time. Studies have shown that people who regularly use PFAS-coated floss tend to have higher PFAS blood levels, but because these chemicals are so widespread, it’s impossible to isolate floss as the sole source.
- Titanium dioxide pigments (for a bright white paste) have raised ingestion safety questions in European reviews.
- Synthetic dyes, sweeteners, and vague “flavor/fragrance” ingredients add color or taste but can irritate sensitive mouths.
- Microplastics shed from toothbrushes, floss, water pics, and so forth contribute to microplastics that are now detected in human blood and organs.
- Propylene glycol, helps keep products moist, but can cause irritation or allergic reactions in sensitive individuals and has moderate toxicity ratings on the EWG Skin Deep® Database.
- Parabens (preservatives such as methyl- or propylparaben) are used in some toothpastes and mouthwashes and are considered endocrine-disrupting chemicals. Methylparaben has been shown to reduce the efficacy of Tamoxifen, a medication commonly used to treat breast cancer.
Dental Care Products: An Oral Exam
Toothpaste: What’s in Your Tube?
Toothpaste often includes 10–20 ingredients to foam, whiten, thicken, preserve, and flavor. Many of those “extras” aren’t essential to clean teeth.
Red‑Flag Ingredients
- SLS/SLES (foaming agents): linked with irritation and mouth sores.
- Triclosan: avoid old stock; regulatory concerns persist.
- Titanium dioxide: a whitening pigment with ingestion safety questions.
- Artificial colors like Blue Dye1, Red Dye 40 and Yellow Dye 5, which have a variety of health concerns.
- Artificial Flavors can be a combination of unknown substances, some with hazardous health concerns.
What Safer Looks Like
- Short, transparent ingredient lists
- Mild (versus harsh) abrasives (hydrated silica or calcium carbonate)
- Fluoride or hydroxyapatite for enamel support
- Low‑hazard ratings (1–2) or EWG Verified on the EWG Skin Deep® Database
“Abrasivity” (or “RDA”) and Whitening Claims
You don’t need a gritty toothpaste for clean teeth. Relative Dentin Abrasivity (RDA) measures how abrasive a toothpaste is on dentin. Products with the ADA Seal must have an RDA of 250 or less, which prevents excessive wear. Lower numbers aren’t necessarily better—just stay within safe limits and follow directions.
For whitening, most toothpastes remove surface stains rather than changing tooth color. Peroxide-based options can help, but overly abrasive or charcoal products may wear enamel and cause sensitivity if overused.
Fluoride toothpaste: thumbs up or down?
The addition of synthetic sodium fluoride – to toothpaste, mouthwash, or the water supply – has been very controversial. On the upside, sodium fluoride is one of the best‑studied and most effective ways to prevent tooth decay. It strengthens enamel and can even reverse early cavities.
As for the downside: recent studies have raised concerns about the effects of sodium fluoride at higher exposure levels. A 2019 Canadian cohort and a 2025 JAMA Pediatrics meta‑analysis found links between higher maternal fluoride intake and lower child IQ scores. However, the National Toxicology Program (2024) reported that while a certain level of fluoride may relate to lower IQ, this level is higher than what is typically found in the American population.
However, new U.S.-based evidence adds crucial context. A massive decades-long study published in Science Advances (2025) followed more than 26,000 Americans from conception through adulthood and found no evidence that exposure to recommended community-water-fluoride levels lowers cognitive skills. Participants with fluoridated-water exposure performed slightly better in high-school academic testing, possibly because better oral health reduces school absences.
Meanwhile, dental groups such as the American Dental Association (ADA) continue to support community fluoridation at a low level for its proven role in cavity prevention.
For most people, fluoride toothpaste remains a safe, effective tool. If you use a private well, test for naturally occurring calcium fluoride every few years; natural levels can vary. While calcium fluoride is less water soluble and not absorbed by the body as well, it is still recommended that the fluoride concentration should be less than .7 mg/L. If it is a lot higher, note that standard carbon filters won’t remove fluoride. If you choose to filter it out, opt for reverse osmosis or activated alumina filters.
Bottom line: Fluoride’s benefits for preventing tooth decay are well‑documented. The American Academy of Pediatrics, the Centers for Disease Control and Prevention, the American Dental Association, the American Academy of Pediatric Dentistry, and the World Health Organization recommend that everyone use fluoride toothpaste, including babies and toddlers sprouting new teeth (though in very small amounts), even if your water source is fluoride-treated – provided the water supply meets the Public Health Service’s recommendation of fluoride concentrations under .7 mg/L.
The best way to check how much fluoride is in your water is by calling your water utility and asking them about the fluoride content of the water, as even natural calcium fluoride is common in water, and levels can be quite high, whether or not the utility has actually added it.
Whether you decide to use toothpaste with sodium fluoride (some companies do offer toothpaste with calcium fluoride) or not should depend on how much you are getting from other sources, mainly your water supply. Risks appear to be mainly tied to higher-than-recommended doses, so moderation and awareness, rather than elimination, are key. Talk to your dentist, doctor, or pediatrician about any concerns you might have.
LEARN MORE: Safer Oral Care Products: Toothpaste, Floss and Beyond
Toothbrushes: Small Tools, Big Impact
Most toothbrushes are made of plastic, and given that billions are produced and discarded each year, their environmental footprint is significant. In terms of human health, research has found that as you brush, toothbrushes can release microplastics and chemical additives.
What to Know
- Manual or electric? Both can clean effectively when used correctly; some powered brushes remove more plaque in clinical studies.
- Materials matter. Toothbrush handles made from bamboo or brushes with recyclable heads can help cut waste. However, most “plant-based” or “biodegradable” bristles (such as those made from castor bean oil) can still shed bioplastic particles during use as they break down. Either way, all types of bristles harbor bacteria from usage.
- Natural bristles (such as boar hair and horse hair) are available. A study comparing five different bristles (nylon, bamboo-viscose, charcoal with nylon, bio-nylon, and pig bristles) and their microbial counts from 6 different bacteria showed pig’s bristles to have the lowest microbial count for 2 of the bacteria strains and an insignificant difference among the bristles for the other 4 bacteria strains. Horse hair has been shown to have antibacterial properties due to the melanin pigments on the hair.
- For sensitive gums or children, soft or extra-soft bristles are gentler, though the bristles themselves are still plastic.
- Consider cleaning your toothbrush head on a regular basis by soaking it in white vinegar or an alcohol-based mouthwash to reduce bacteria buildup.
- With each brushing, rinse and spit well several times to avoid swallowing microplastics.
Unfortunately, as with many things, there are trade-offs when considering certain oral care products in order to maximize oral health.
Floss: What It’s Hiding
Flossing helps remove plaque and bacteria between teeth, but some types of floss can also introduce unwanted chemicals, including:
- PTFE (Teflon-based) floss: PTFE coatings help floss glide easily but are made from the same chemical family as PFAS, or “forever chemicals,” linked to immune, liver, and developmental effects. Studies show regular users of PTFE-coated floss have higher PFAS blood levels.
- Waxes: Many flosses use petroleum-based wax. Choose beeswax or plant-based coatings instead.
- Select Materials: Conventional floss is nylon or polyester (plastic). Silk and bamboo floss offer biodegradable alternatives that don’t expose you to microplastics.
Safer Options
- PFAS-free silk or bamboo floss (often in refillable glass vials)
- Water flossers (a good choice if string floss feels uncomfortable)
Mouthwash: To rinse or not to rinse?
Mouthwash can play a role in oral hygiene, but it’s not essential for everyone. Some rinses are cosmetic, designed mainly to freshen breath, while others are therapeutic, targeting plaque, bacteria, or gingivitis.
That said, most mouthwashes, especially those containing broad-spectrum antimicrobials or high alcohol levels don’t distinguish between harmful and beneficial bacteria. Overuse can disrupt the mouth’s microbiome, upsetting the balance that helps protect against disease.
Proceed with caution:
- Alcohol (20–25%)—can be drying and irritating to tissues
- Artificial dyes and flavors—additives without health benefits
- Chlorhexidine (CHX)—a prescription antimicrobial rinse sometimes used for gum infections or after dental procedures. It is not for everyday use. Most dentists limit it to about two weeks, since it can stain teeth, alter taste, and disrupt the mouth’s natural balance.
Consider using:
- Essential‑oil‑based formulas (thymol, menthol, eucalyptol). Evidence comparing alcohol‑free vs alcohol‑containing essential oils is mixed.
- Cetylpyridinium chloride (CPC): This antimicrobial, commonly found in mouthwashes and toothpastes, tends to show a small but significant plaque/gingivitis reduction when used alongside regular brushing and flossing. It is a well-tolerated alternative to alcohol based mouthwashes. However, it has been shown to cause staining of teeth, irritation, and allergic reactions. Like other antiseptics, overuse of CPC could potentially contribute to bacterial drug resistance, but it is generally considered safe when used as directed.
Another kind of mouthwash is the Ayurvedic practice of Oil pulling, which involves swishing edible oil (eg coconut, sesame, or olive) in the mouth for 10-20 minutes before spitting it out. Oil pulling may slightly lower bacteria and plaque from teeth and gums. However, there is limited scientific evidence to support these claims.
The bottom line: Mouthwash can be helpful in certain situations, but it’s not a replacement for good brushing and flossing. Use it as needed, but not as an everyday habit, especially if you’re using antibacterial formulas, which can upset the mouth’s natural balance of good and bad bacteria. Think of it as an occasional adjunct to good oral care, not the foundation of it.
Smarter Shopping Tools
The good news: by reading labels and using some free apps, you can reduce exposure to these chemicals without sacrificing clean teeth or fresh breath.
- EWG Skin Deep® Database – Search for products or ingredients for toothpaste, teeth whiteners, and mouthwash, which gives you ratings for selecting better products.
- EWG Healthy Living App – Scan a product’s barcode or search by name to get a rating. The app also provides healthier alternative suggestions.
- Clearya app – An online extension that alerts you to potentially harmful ingredients when shopping on Amazon, Target, Walmart, iHerb, or Sephora. You can also take a photo or video of the ingredients when shopping in person for ratings and warnings concerning ingredients.
- Yuka App – Analyzes products and provides a score between 1-100. Yuka will suggest healthier alternatives in the event of a poor score.
- Think Dirty – By scanning barcodes, a rating of 0-10 will appear. Details about the health impacts of the chemicals listed are provided while suggesting safer products.
- INCI Beauty (Europe) – Lets you search products or scan barcodes to reveal an ingredient list and a score of 0-20. Allows users to rate products and share opinions.
- CDC: Community Water Fluoridation – The CDC’s information landing page on fluoridation.
Each platform scores products a little differently. Use them as guides, and always read the full ingredient list. When in doubt, favor short, specific ingredient lists over vague claims.
Nine Easy Tips for Better Dental Health
1 – Brush in the morning; brush and floss at night. Be sure to replace your toothbrush every 3-4 months, and ideally more frequently if you are using natural bristles. If you are using plastic bristles, keep in mind that the older the plastic is, the more it sheds.
2– Reduce plastics where you can. For example, some flosses are in plastic-free packaging and offer plastic-free refills. With toothbrushes, bamboo handles help reduce landfill waste. (Note that to avoid plastic bristles, the only truly non-plastic options are made from boar and horse hair.)
3 – Choose toothpastes with good ingredients, avoiding those containing the “red flag” ingredients listed above. Choose high ratings from 3rd-party websites and apps.
4 – Choose natural dental flosses. Avoid single-use floss picks to reduce plastic waste, and avoid “easy-glide” floss. Look for natural silk or biodegradable options instead.
5 – If you want to scrape your tongue, use stainless steel.
6 – If you choose to use mouthwash, select safer options that suit your needs. Larger bottles will shed less plastic (less surface area relative to volume).
7 – Avoid sugary sticky foods, tobacco, and sodas.
8 – Eat a healthy diet.
9 – See your dentist regularly.
We all want strong teeth, healthy gums, and fewer unnecessary exposures. When you shift to simpler, well‑labeled formulas and steer clear of the usual chemical suspects, you support your oral microbiome and your long‑term health.
LEARN MORE: Safer Oral Care Products: Toothpaste, Floss and Beyond
