| Fluoride-free toothpaste sales have jumped ever since US Health and Human Services Secretary Robert F. Kennedy Jr. questioned the safety of fluoride. The Centers for Disease Control has called water fluoridation one of the top 10 great public health achievements in the US in the 20th century. Yet Kennedy’s claims that it causes “bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease,” have spurred Utah and Florida to ban fluoride from being added to drinking water. The concerns have spilled over into the toothpaste aisle. But are non-fluoride brands able to combat tooth decay? According to Colgate, popular ingredients in non-fluoride toothpaste include xylitol and green tea extract. Both can reduce bacteria. Other ingredients, such as papaya extract, can reduce gum inflammation, while hydrated silica polishes teeth and sodium bicarbonate, or baking soda, can polish and brighten teeth. Then there’s a fluoride alternative, hydroxyapatite, which aids in enamel remineralization to help strengthen teeth and prevent cavities. But hydroxyapatite is not as chemically binding as fluoride and may not deliver the same protection against acids that can cause cavities. Alan Baughman, a dentist in Greely, Colorado, says that the key difference between the minerals is that hydroxyapatite works on the enamel of the tooth, but fluoride can become part of the tooth. Hydroxyapatite contains calcium and phosphate, and while both are important for maintaining bone health, Baughman says they work topically and “are only effective when the breakdown of the tooth structure is confined to the enamel.” But Baughman says that when children ingest fluoride, it goes into the crystal structure of the tooth and creates fluorapatite, which makes teeth much more resistant to damaging acids. Baughman says it adds an internal layer rather than a topical shield. So while fluoride-free toothpaste has some benefits, Baughman’s advice for parents looking to strengthen their kids’ dental health is to invest in fluoride treatments while their kids are developing their adult teeth. That’s the best way to protect against future problems. That being said, the issue of fluoride — particularly for kids — is likely to remain a focus for RFK Jr. On Wednesday, HHS convened a panel that debated the benefits and risks of unapproved prescription fluoride supplements for infants and children. Speakers included well-known fluoride skeptics like Bill Osmunson and pro-fluoride scientists. — Micah Barkley | 
