Editing Toothpaste (section)

===Fluorides===
{{main|Fluoride therapy}}

[[Fluoride]] in various forms is the most popular and effective active ingredient in toothpaste to prevent cavities.<ref name="Aspinall-2021"/> Fluoride is present in small amounts in plants, animals, and [[History of water fluoridation|some natural water sources]]. The additional fluoride in toothpaste has beneficial effects on the formation of dental enamel and bones. [[Sodium fluoride]] (NaF) is the most common source of fluoride, but [[stannous fluoride]] (SnF<sub>2</sub>), and [[sodium monofluorophosphate]] (Na<sub>2</sub>PO<sub>3</sub>F) are also used.<ref name="Aspinall-2021" />  At similar fluoride concentrations, toothpastes containing stannous fluoride have been shown to be more effective than toothpastes containing sodium fluoride for reducing the incidence of dental caries and [[Acid erosion|dental erosion]],<ref>{{cite journal | vauthors = West NX, He T, Macdonald EL, Seong J, Hellin N, Barker ML, Eversole SL | title = Erosion protection benefits of stabilized SnF<sub>2</sub> dentifrice versus an arginine-sodium monofluorophosphate dentifrice: results from in vitro and in situ clinical studies | journal = Clinical Oral Investigations | volume = 21 | issue = 2 | pages = 533–540 | date = March 2017 | pmid = 27477786 | pmc = 5318474 | doi = 10.1007/s00784-016-1905-1 }}</ref><ref>{{cite journal | vauthors = Ganss C, Lussi A, Grunau O, Klimek J, Schlueter N | title = Conventional and anti-erosion fluoride toothpastes: effect on enamel erosion and erosion-abrasion | journal = Caries Research | volume = 45 | issue = 6 | pages = 581–9 | date = 2011 | pmid = 22156703 | doi = 10.1159/000334318 | s2cid = 45156274 | url = https://boris.unibe.ch/7527/ }}</ref><ref>{{cite journal | vauthors = West NX, He T, Hellin N, Claydon N, Seong J, Macdonald E, Farrell S, Eusebio R, Wilberg A | display-authors = 6 | title = Randomized in situ clinical trial evaluating erosion protection efficacy of a 0.454% stannous fluoride dentifrice | journal = International Journal of Dental Hygiene | volume = 17 | issue = 3 | pages = 261–267 | date = August 2019 | pmid = 30556372 | pmc = 6850309 | doi = 10.1111/idh.12379 }}</ref><ref>{{cite journal | vauthors = Zhao X, He T, He Y, Chen H | title = Efficacy of a Stannous-containing Dentifrice for Protecting Against Combined Erosive and Abrasive Tooth Wear In Situ | journal = Oral Health & Preventive Dentistry | volume = 18 | issue = 1 | pages = 619–624 | date = June 2020 | pmid = 32700515 | doi = 10.3290/j.ohpd.a44926 }}</ref><ref>{{cite journal | vauthors = Stookey GK, Mau MS, Isaacs RL, Gonzalez-Gierbolini C, Bartizek RD, Biesbrock AR | title = The relative anticaries effectiveness of three fluoride-containing dentifrices in Puerto Rico | journal = Caries Research | volume = 38 | issue = 6 | pages = 542–50 | date = 2004 | pmid = 15528909 | doi = 10.1159/000080584 | s2cid = 489634 | doi-access = free }}</ref> as well as reducing [[gingivitis]].<ref name="Parkinson-2020">{{cite journal | vauthors = Parkinson CR, Milleman KR, Milleman JL | title = Gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice: a 24-week randomized controlled trial | journal = BMC Oral Health | volume = 20 | issue = 1 | pages = 89 | date = March 2020 | pmid = 32216778 | pmc = 7098169 | doi = 10.1186/s12903-020-01079-6 | doi-access = free }}</ref><ref name="Hu-2019">{{cite journal | vauthors = Hu D, Li X, Liu H, Mateo LR, Sabharwal A, Xu G, Szewczyk G, Ryan M, Zhang YP | display-authors = 6 | title = Evaluation of a stabilized stannous fluoride dentifrice on dental plaque and gingivitis in a randomized controlled trial with 6-month follow-up | journal = Journal of the American Dental Association | volume = 150 | issue = 4S | pages = S32–S37 | date = April 2019 | pmid = 30797257 | doi = 10.1016/j.adaj.2019.01.005 | s2cid = 73488958 }}</ref><ref name="Mankodi-2005">{{cite journal | vauthors = Mankodi S, Bartizek RD, Winston JL, Biesbrock AR, McClanahan SF, He T | title = Anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice | journal = Journal of Clinical Periodontology | volume = 32 | issue = 1 | pages = 75–80 | date = January 2005 | pmid = 15642062 | doi = 10.1111/j.1600-051X.2004.00639.x | doi-access = free }}</ref><ref name="Archila-2004">{{cite journal | vauthors = Archila L, Bartizek RD, Winston JL, Biesbrock AR, McClanahan SF, He T | title = The comparative efficacy of stabilized stannous fluoride/sodium hexametaphosphate dentifrice and sodium fluoride/triclosan/copolymer dentifrice for the control of gingivitis: a 6-month randomized clinical study | journal = Journal of Periodontology | volume = 75 | issue = 12 | pages = 1592–9 | date = December 2004 | pmid = 15732859 | doi = 10.1902/jop.2004.75.12.1592 }}</ref><ref name="Clark-Perry-2020">{{cite journal | vauthors = Clark-Perry D, Levin L | title = Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials | journal = International Dental Journal | volume = 70 | issue = 6 | pages = 418–426 | date = December 2020 | pmid = 32621315 | doi = 10.1111/idj.12588 | pmc = 9379195 | s2cid = 220336087 }}</ref> Some stannous fluoride-containing toothpastes also contain ingredients that allow for better stain and calculus removal.<ref>{{cite journal | vauthors = Papas A, He T, Martuscelli G, Singh M, Bartizek RD, Biesbrock AR | title = Comparative efficacy of stabilized stannous fluoride/sodium hexametaphosphate dentifrice and sodium fluoride/triclosan/copolymer dentifrice for the prevention of periodontitis in xerostomic patients: a 2-year randomized clinical trial | journal = Journal of Periodontology | volume = 78 | issue = 8 | pages = 1505–14 | date = August 2007 | pmid = 17668969 | doi = 10.1902/jop.2007.060479 | s2cid = 24785092 }}</ref> A systematic review revealed stabilised stannous fluoride-containing toothpastes had a positive effect on the reduction of plaque, gingivitis and staining, with a significant reduction in [[Calculus (dental)|calculus]] and halitosis compared to other toothpastes.<ref>{{cite journal | vauthors = Johannsen A, Emilson CG, Johannsen G, Konradsson K, Lingström P, Ramberg P | title = Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review | journal = Heliyon | volume = 5 | issue = 12 | pages = e02850 | date = December 2019 | pmid = 31872105 | pmc = 6909063 | doi = 10.1016/j.heliyon.2019.e02850 | doi-access = free | bibcode = 2019Heliy...502850J }}</ref> Furthermore, numerous clinical trials have shown gluconate chelated stannous fluoride toothpastes possess superior protection against dental erosion and [[Dentin hypersensitivity|dentine hypersensitivity]] compared to other fluoride-containing and fluoride-free toothpastes.<ref name="West-2021">{{Cite journal|last1=West|first1=Nicola X.|last2=He|first2=Tao|last3=Zou|first3=Yuanshu|last4=DiGennaro|first4=Joe|last5=Biesbrock|first5=Aaron|last6=Davies|first6=Maria|date=February 2021|title=Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion|journal=Journal of Dentistry|volume=105|pages=103566|doi=10.1016/j.jdent.2020.103566|issn=1879-176X|pmid=33383100|s2cid=229940161|doi-access=free|hdl=1983/34d78138-703d-484f-864f-ece3d3610d64|hdl-access=free}}</ref>

Much of the toothpaste sold in the United States has 1,000 to 1,100 parts per million fluoride. In European countries, such as the UK or Greece, the fluoride content is often higher; a sodium fluoride content of 0.312% w/w (1,450 [[Parts per million|ppm]] fluoride) or stannous fluoride content of 0.454% w/w (1,100 ppm fluoride) is common. All of these concentrations are likely to prevent [[tooth decay]], according to a 2019 [[Cochrane review]].<ref name="Walsh-2019" /> Concentrations below 1,000 ppm are not likely to be preventive, and the preventive effect increases with concentration.<ref name="Walsh-2019" /> Clinical trials support the use of high fluoride (5,000 ppm fluoride) dentifrices, for prevention of root caries in elderly adults by reducing the amount of plaque accumulated, decreasing the number of [[Streptococcus mutans|mutans streptococci]] and [[Lactobacillus|lactobacilli]] and possibly promoting calcium fluoride deposits to a higher degree than after the use of traditional fluoride containing dentifrices.<ref name="Walsh-2019" />

Most toothpaste products have a shelf life of about two years, after which the fluoride and antibacterial properties may become less effective.{{cn|date=January 2025}} While expired toothpaste is generally safe to use, regulatory bodies like the FDA require expiration dates on fluoride-containing toothpaste to ensure optimal effectiveness.{{cn|date=January 2025}}