The Best Fluoride-Free Toothpastes of 2026, Ranked by Heavy-Metal Tests and What Actually Rebuilds Enamel
We scored 19 fluoride-free toothpastes, tablets and powders on lead in independent lab tests, how much enamel-building hydroxyapatite they disclose, what else is in the tube, and whether the label tells the truth.
Best overall:RiseWell Mineral Toothpaste ($12, 8.9/10). A disclosed 10% micro-hydroxyapatite, a clean formula, and 26 ppb of lead in an independent test of the brand's kids paste.
Lowest lead on the exact tube:Boka Ela Mint (8.5), 32 ppb. Sensitive teeth:Elims (8.2). 10% nano-HA:Dr. Jen (8.2).
Skip: clay-based pastes and powders. A sample of Earthpaste tested at 3,500 ppb of lead and one of a Primal Life powder at 5,361.7 ppb, both over Washington's 1 ppm limit (see why).
One caveat: nearly all metals data comes from one crowd-funded tester, Lead Safe Mama, and most brands had only a kids version tested; we say which SKU every time.
Our #1 pick8.9/10
RiseWell Mineral Toothpaste
10% micro-hydroxyapatite, disclosed by the brand[18], and 26 ppb of lead in an independent lab test of its kids paste[4].
No SLS, carrageenan or titanium dioxide, and no cavity claim. The catch: a “100% Safe to Swallow” message we'd rather not see, and the adult tube itself hasn't been lab-tested.
How we score:Remineralizer 25%Heavy metals 25%Clean ingredients 20%Label honesty & track record 15%Transparency 15%Full methodology ↓
The Dr. Axe Clean Smile Score (0–10) is our editorial judgment, not a medical or safety grade. An independent result over 1,000 ppb of lead caps a product at 5.0 and keeps it out of the top 10.
Know your toothpaste
What's really in the tube, and why fluoride-free is growing
A fluoride-free paste has two jobs: help your enamel rebuild without fluoride, and not add anything you don't want, like lead. Here's what the research and the rules say, with the numbers.
Hydroxyapatite (HA)The calcium-phosphate mineral enamel is built from. In toothpaste it's used to help re-mineralize early lesions, without fluoride[60].
Lead and other metalsCome in with mineral ingredients. The tester lists bentonite clay, HA, calcium carbonate, hydrated silica and titanium dioxide as likely sources; not xylitol[1].
per 1 mg/L rise in children's urinary fluoride (13 studies). 52 of the review's 74 studies had high risk of bias, and the authors call the data uncertain below 1.5 mg/L in water.
is the drinking-water level above which a federal review had moderate confidence of lower IQ in children. It found too little data to judge 0.7 mg/L, the U.S. fluoridation level.
More than 38% used more toothpaste than a pea-sized amount (0.25 g), the most recommended at that age. Under 3, the advice is a smear the size of a rice grain.
FDA said ingestible fluoride drops and tablets shouldn't go to children under 3 or to older kids at low or moderate cavity risk, and sent enforcement notices to 4 companies.
in one advocate's lab tests (90%), fluoride pastes included; 33 had arsenic and 24 mercury. Plain hydroxyapatite powder tested at 268.7 ppb of lead and calcium carbonate at 292.
and less painful canker sores on an SLS-free paste in a 90-person crossover trial, though not fewer of them; a review of 4 trials (124 people) found fewer ulcers too. None of the pastes we scored uses SLS.
when 10% xylitol was added to fluoride toothpaste, over 2.5 to 3 years in 4,216 children. A 2024 study linked high fasting blood xylitol to heart events; the dose it tested was a drink-sized amount, far more than paste you spit out.
Cochrane, 2015; Eur Heart J, 2024
Check your water and your paste
Most fluoride exposure comes from drinking water, food and beverages[51], so start with your tap. Then look your toothpaste up in the independent lead results. Our water filter and reverse osmosis guides show which systems are certified to reduce fluoride.
Under 3, use a smear the size of a rice grain; from 3 to 6, no more than a pea (0.25 g). Nearly 4 in 10 kids 3 to 6 use more[53]. Pick a kids paste with a low lead test.
Most fluoride comes from water, food and drinks[51]. The U.S. target is 0.7 mg/L; the concern in the research starts above 1.5[52]. Check your utility, and filter if you want less.
Between teeth: in a review of 35 trials with 3,929 adults, adding floss or interdental brushes to brushing was tested mainly for gum inflammation[70]. Interdental brushes are an easy daily habit.
Sugar: keep free sugars under 10% of calories, ideally under 5%[72], and keep them to meals instead of sipping all day.
Five questions. If nothing fits, we say so and show the closest option.
1Who's it for?
2Hydroxyapatite a must?
3Sensitive teeth?
4Format?
5Budget?
Compare the top 10
What each toothpaste is proven to contain
Lead and arsenic in parts per billion from independent lab reports; an asterisk means a sibling (usually the kids paste) was tested.
Score = the Dr. Axe Clean Smile Score, 0–10. Over 1,000 ppb of lead caps a score at 5.0. Full methodology ↓
Clean / verified No flag, or a claim we verified.Independent lab Measured by a lab the brand didn't hire (ppb).Maker's data The brand's own disclosure.No data Nothing published.Flag Over 1,000 ppb, a claim problem, or a flagged ingredient.
*Tested on a sibling SKU, named in each review. ND = not detected. Dr. Jen's price is per fluid ounce. Davids' lead is the higher of its two tests, on a paste with the same ingredients. Shaded rows are popular pastes that missed our top 10.
Full reviews
The 10 best fluoride-free toothpastes, ranked
Each review names the exact product the lab tested and shows how the score was built. One product per brand line; kids versions and siblings appear in the guides below.
1
$12One-time price for a 3.4 oz tube; 15% off by subscription. Not a sale price.
Best overall
RiseWell Mineral Toothpaste (Wild Mint)
Paste · 10% micro-hydroxyapatite · also sold as PRO and Kids
The most complete package we found: a disclosed 10% micro-hydroxyapatite (the particle size used in the largest HA trials), a clean ingredient list with no SLS, carrageenan or titanium dioxide, and the lowest lead result in the product lines we scored (on its kids paste). The lab Lead Safe Mama used found 26 ppb of lead in RiseWell's kids paste, 8 ppb of arsenic and 9 ppb of cadmium, with no mercury detected. That's a sibling SKU, not this tube, so we cap its metals score at 8.5 until the adult paste is tested. We take a point off for “100% Safe to Swallow” messaging: swallowing toothpaste isn't the goal, and the brand's own directions still say to spit.
Best forAdults who want disclosed-percentage HA and the best lead data for the brand line
Skip ifYou want foam; this paste uses a soap, not a detergent, so it barely lathers
Remineralizer10% micro-hydroxyapatite (maker); no fluoride
Flavors & kidsWild Mint; a separate Kids paste ($12, 3.4 oz) is the one Lead Safe Mama tested
Size & cost3.4 oz for $12, about $3.53 per ounce
Foam & textureLow foam; potassium cocoate instead of SLS
SiblingRiseWell PRO ($22) adds nano-HA but carries a “prevent decay” claim; see the guides
Lead test: RiseWell Kids Mineral Toothpaste, Cake Batter · SGS North America, Jan. 2025Format: Paste
See score breakdown & sources
Remineralizer9.0
Heavy metals8.5
Clean ingredients10.0
Label honesty & track record9.0
Transparency7.5
Remineralizer: hydroxyapatite, 10% or more disclosed. Metals: 26 ppb lead in RiseWell Kids Mineral Toothpaste, Cake Batter (SGS North America, Jan. 2025), from an independent lab report we read ourselves; sibling SKU tested: max 8.5. Ingredients: nothing on our flag list. Label and track record: “safe to swallow” messaging −1. Transparency: full ingredients + HA % and type.
Independent labLead Safe Mama, LLC (Tamara Rubin). RiseWell Kids Mineral Toothpaste, Cake Batter. SGS North America report BHZ88T (Jan. 31, 2025): lead 26, arsenic 8, cadmium 9 µg/kg; mercury not detected. Open source · [4]
Maker's dataRiseWell. Hydroxyapatite (Mineral) Toothpaste page: $12, 3.4 oz; full ingredients; FAQ: “10% concentration of micro-hydroxyapatite” sourced from a mine in France; “100% Safe to Swallow.” Open source · [18]
Maker's dataRiseWell. PRO Hydroxyapatite Toothpaste page: $22, 3.4 oz; “5% NanoXIM CarePaste ... and 10% micro hydroxyapatite”; “the highest concentration of hydroxyapatite you can find on the market”; “prevent decay”; “100% Safe to Swallow.” Open source · [20]
Independent labLead Safe Mama, LLC (Tamara Rubin). Toothpaste chart: laboratory test results (chart data updated Apr. 22, 2025; list updated May 2026, 73 products). Chart header: 46 of 51 positive for lead, 33 of 51 arsenic, 24 of 51 mercury, 18 of 51 cadmium; Crest Regular 399 ppb lead, Sensodyne Extra Whitening 116, single-ingredient hydroxyapatite 268.7 (arsenic 58.9), calcium carbonate 292 (arsenic 274), Kinder Karex 72.6. Crowd-funded; the site earns advertising and affiliate income. Open source · [1]
The only paste in our top 10 where the exact product was lab-tested and landed in our best lead band. The lab Lead Safe Mama used (SGS North America) found 32 ppb of lead in Ela Mint, 21 ppb of arsenic and 10 ppb of mercury, with no cadmium detected, and a second lab found 27.4 ppb of lead in Boka's kids Orange Cream. Boka uses nano-hydroxyapatite but doesn't publish the percentage, which costs it on remineralizer and transparency. It makes no cavity claim on the product page. Note the 10 ppb of mercury: small, but Lead Safe Mama flags any mercury in a product that can be swallowed, and her article still advises against this paste for that reason.
Best forAnyone who wants the lowest measured lead on the exact tube they buy
RemineralizerNano-hydroxyapatite, % not disclosed; a little xylitol
Flavors & kidsEla Mint plus other adult flavors; kids flavors at $11.62 (Orange Cream tested at 27.4 ppb)
Size & cost4 oz for $11.62, about $2.91 per ounce
Foam & textureFoams with sodium lauroyl sarcosinate, a milder detergent than SLS
Other metalsArsenic 21 ppb, mercury 10 ppb, cadmium not detected (same test)
Lead test: Boka Ela Mint (this product) · SGS North America, Jan. 2025Format: Paste
See score breakdown & sources
Remineralizer7.0
Heavy metals10.0
Clean ingredients10.0
Label honesty & track record10.0
Transparency5.0
Remineralizer: hydroxyapatite, percentage not disclosed. Metals: 32 ppb lead in Boka Ela Mint (this product) (SGS North America, Jan. 2025), from an independent lab report we read ourselves. Ingredients: nothing on our flag list. Label and track record: no deductions. Transparency: full ingredient list only.
Independent labLead Safe Mama, LLC (Tamara Rubin). Boka Nano-Hydroxyapatite Toothpaste, Ela Mint. SGS North America report W6WYUD (reported Jan. 27, 2025): lead 32, arsenic 21, mercury 10 µg/kg; cadmium not detected (AOAC 2015.01). Includes Boka's response. Open source · [2]
The clearest label in the category: “10% Nano-Hydroxyapatite” is printed right in the ingredient list, xylitol is the second ingredient, and there's nothing on our flag list. It's made for sensitive teeth and doesn't make a cavity claim. What holds it back is data: no independent heavy-metal test yet, so it gets the class-typical metals score, and its page says the paste is “safe to swallow” (it also says to spit without rinsing, which is the right advice). If a lab test comes back low, it would move up.
Best forSensitive teeth; people who want the HA percentage printed in the ingredients
Skip ifYou want a heavy-metal test behind your paste today
Remineralizer10% nano-hydroxyapatite plus xylitol (2nd ingredient)
Flavors & kidsPineapple Orange Mint and Lavender Vanilla Mint; 1 oz travel tube $7
Size & cost4 oz for $16, about $4.00 per ounce
Foam & textureGentle foam from sodium methyl cocoyl taurate; glycerin base
MetalsNot independently tested
Lead test: Not independently testedFormat: Paste
See score breakdown & sources
Remineralizer9.0
Heavy metals6.0
Clean ingredients10.0
Label honesty & track record9.0
Transparency7.5
Remineralizer: hydroxyapatite, 10% or more disclosed. Metals: no independent test: class-typical 6. Ingredients: nothing on our flag list. Label and track record: “safe to swallow” messaging −1. Transparency: full ingredients + HA % and type.
Maker's dataElims. Reflection 10% Nano-Hydroxyapatite Toothpaste, 4 oz, $16; ingredients list “10% Nano-Hydroxyapatite”; “Our toothpaste is safe to swallow so we recommend spitting without rinsing”; “brushing at least twice a day for two minutes.” Open source · [24]
Independent labLead Safe Mama, LLC (Tamara Rubin). Toothpaste chart: laboratory test results (chart data updated Apr. 22, 2025; list updated May 2026, 73 products). Chart header: 46 of 51 positive for lead, 33 of 51 arsenic, 24 of 51 mercury, 18 of 51 cadmium; Crest Regular 399 ppb lead, Sensodyne Extra Whitening 116, single-ingredient hydroxyapatite 268.7 (arsenic 58.9), calcium carbonate 292 (arsenic 274), Kinder Karex 72.6. Crowd-funded; the site earns advertising and affiliate income. Open source · [1]
A disclosed 10% nano-hydroxyapatite in a clean formula. The lab Lead Safe Mama used found 200 ppb of lead in Dr. Jen's fluoride-free Strawberry Kids paste (plus 60 ppb arsenic, 9 cadmium, 6 mercury), and Dr. Jen's published statement that a test it commissioned found 0.2 ppm matches that result. Three things cost it: the product page promises “Cavity Protection Without Fluoride” and “the same cavity protection as fluoride,” which no FDA anticavity ingredient backs; its FAQ calls it “the #1 dentist-recommended” nano-HA toothpaste, with no source; and a September 2025 Prop 65 notice alleges lead exposure from its toothpaste without a warning; no complaint or settlement is on file. Make sure you buy the fluoride-free tube: Dr. Jen's “Super Paste” adds sodium fluoride.
Best forAdults who want a disclosed 10% nano-HA and a brand that shares its own lead number
Skip ifYou want the lowest lead result, or a lower price per ounce
Remineralizer10% nano-hydroxyapatite (maker); no fluoride
Flavors & kidsCool Mint, Strawberry and Watermelon; the Strawberry kids paste was tested
Size & cost3.4 fl oz (100 mL) for $18.50, about $5.44 per fluid ounce
Foam & textureMild foam from sodium methyl cocoyl taurate
Watch the SKUThe “Super Paste” version contains 0.22% sodium fluoride
Lead test: Dr. Jen Fluoride-Free Strawberry Kids · SGS North America, Feb. 2025Format: Paste
See score breakdown & sources
Remineralizer9.0
Heavy metals7.0
Clean ingredients10.0
Label honesty & track record7.0
Transparency7.5
Remineralizer: hydroxyapatite, 10% or more disclosed. Metals: 200 ppb lead in Dr. Jen Fluoride-Free Strawberry Kids (SGS North America, Feb. 2025), from an independent lab report we read ourselves. Ingredients: nothing on our flag list. Label and track record: cavity claim without an FDA anticavity ingredient −2, unsupported superlative −0.5, Prop 65 lead notice (an allegation) −0.5. Transparency: full ingredients + HA % and type.
Independent labLead Safe Mama, LLC (Tamara Rubin). Dr. Jen Fluoride-Free Strawberry Toothpaste for Kids. SGS North America report FP2RES (Feb. 7, 2025): lead 200, arsenic 60, cadmium 9, mercury 6 µg/kg. Quotes Dr. Jen's statement: “Independent testing of our formula confirmed a lead level of only 0.2 ppm.” Open source · [6]
Maker's dataDr. Jen Natural. Fluoride-Free 10% Premium Nano-Hydroxyapatite Toothpaste page: $18.50 per tube; ingredients; “Cavity Protection Without Fluoride”; FAQ: “the #1 dentist-recommended Nanohydroxyapatite toothpaste”; “the same cavity protection as fluoride ... at the optimal 10% concentration”; package: 3.4 fl oz (100 mL). Open source · [23]
Public record / studyCalifornia Attorney General. Prop 65 60-day notice 2025-03661 (filed Sept. 16, 2025; alleged violators Dr Jen Natural, LLC; Mixt Solutions LLC; Amazon.com Services LLC; lead; toothpaste). No complaint, settlement or judgment listed as of Sept. 29, 2026. Open source · [49]
Public record / studyFDA. OTC Monograph M021, Anticaries Drug Products (posted May 2, 2023): active ingredients limited to sodium fluoride, sodium monofluorophosphate and stannous fluoride; indication “Aids in the prevention of dental cavities” (also 21 CFR 355.10 and 355.50). Open source · [45]
The best pick if you want tablets: you chew one, brush with a wet brush, and there's no tube. Bite's store names the formula “5% Nano-Hydroxyapatite,” and the ingredient list is short (erythritol, xylitol, calcium carbonate, nano-HA, baking soda, zinc citrate). The trade-offs: it costs more per brushing than a paste, about 19 cents from the jar or 13 cents on refills; no independent heavy-metal test yet; and its page lists “Helps Fight Cavities” as a benefit, a drug claim no FDA anticavity ingredient in this formula supports, and says the paste “is safe to swallow.” Bite also sells a fluoride version, so check the label.
Best forTravel, zero-waste homes, anyone who hates tubes
Skip ifCost per brushing matters, or you want a metals test
Remineralizer5% nano-hydroxyapatite (maker) plus xylitol and calcium carbonate
Flavors & kidsMint, Mint Charcoal and Berry Twist
Size & cost248 Bits for $48: 19¢ a brushing, or 13¢ on the $32 refill subscription
Foam & textureChew to a powder, then brush; foams with sodium cocoyl glutamate
Watch the SKUA fluoride version is sold alongside it
Lead test: Not independently testedFormat: Tablet
See score breakdown & sources
Remineralizer8.0
Heavy metals6.0
Clean ingredients10.0
Label honesty & track record7.0
Transparency7.5
Remineralizer: hydroxyapatite, 5–9% disclosed. Metals: no independent test: class-typical 6. Ingredients: nothing on our flag list. Label and track record: cavity claim without an FDA anticavity ingredient −2, “safe to swallow” messaging −1. Transparency: full ingredients + HA % and type.
Maker's dataBite. Fluoride-Free Toothpaste Bits, 4 oz: $48 for 248 Bits; ingredients; Benefits: “Helps Fight Cavities”; FAQ: nHAp “just as effective” at helping protect against cavities; “it is safe to swallow and non-irritating.” Open source · [25]
Maker's dataBite. Toothpaste Bits listing (variant named “5% Nano-Hydroxyapatite”). Open source · [26]
Public record / studyFDA. OTC Monograph M021, Anticaries Drug Products (posted May 2, 2023): active ingredients limited to sodium fluoride, sodium monofluorophosphate and stannous fluoride; indication “Aids in the prevention of dental cavities” (also 21 CFR 355.10 and 355.50). Open source · [45]
Independent labLead Safe Mama, LLC (Tamara Rubin). Toothpaste chart: laboratory test results (chart data updated Apr. 22, 2025; list updated May 2026, 73 products). Chart header: 46 of 51 positive for lead, 33 of 51 arsenic, 24 of 51 mercury, 18 of 51 cadmium; Crest Regular 399 ppb lead, Sensodyne Extra Whitening 116, single-ingredient hydroxyapatite 268.7 (arsenic 58.9), calcium carbonate 292 (arsenic 274), Kinder Karex 72.6. Crowd-funded; the site earns advertising and affiliate income. Open source · [1]
A lot of remineralizing chemistry for $11.99: nano-hydroxyapatite from Fluidinova (the nanoXIM supplier whose material the EU reviewed), plus L-arginine and calcium glycerophosphate, which are used for sensitivity. The catch is that HA sits tenth in the list, after tea tree water and a phosphate, and the percentage isn't published, so we can't tell how much you get. The lab Lead Safe Mama used found 217.5 ppb of lead in the brand's kids gel (no arsenic or cadmium detected, 8 ppb mercury). It contains cocamidopropyl betaine, a foaming agent some people react to. The label is modest: no cavity claim.
Best forBudget buyers who want HA plus sensitivity ingredients
RemineralizerNano-HA (% not disclosed) plus L-arginine and calcium glycerophosphate
Flavors & kidsFresh Mint; a separate kids gel was the one tested
Size & cost4 oz for $11.99, about $3.00 per ounce
Foam & textureFoams with cocamidopropyl betaine; glycerin and aloe base
LabelDrug-facts-style directions: brush 2 times a day, don't swallow
Lead test: Desert Essence For Kids Tutti Frutti gel · Purity Laboratories, Mar. 2025Format: Paste
See score breakdown & sources
Remineralizer7.0
Heavy metals7.0
Clean ingredients9.5
Label honesty & track record10.0
Transparency5.0
Remineralizer: hydroxyapatite, percentage not disclosed. Metals: 217.5 ppb lead in Desert Essence For Kids Tutti Frutti gel (Purity Laboratories, Mar. 2025), from an independent lab report we read ourselves. Ingredients: cocamidopropyl betaine −0.5. Label and track record: no deductions. Transparency: full ingredient list only.
Independent labLead Safe Mama, LLC (Tamara Rubin). Desert Essence For Kids Fluoride-Free Tutti Frutti gel. Purity Laboratories case 2503160 (Mar. 14, 2025): lead 217.5 ppb, mercury 8.0; arsenic <10, cadmium <5. Open source · [7]
Maker's dataDesert Essence. Nano-Hydroxyapatite Sensitive + Whitening Toothpaste page: $11.99; complete ingredients; directions “at least 2 times a day” and “do not swallow”; “Certified B Corporation”; package: 4 oz (113 g). Open source · [27]
Redmond's newer paste swaps Earthpaste's clay base for micro-hydroxyapatite, listed fifth after sorbitol, xylitol, silica and water, and it carries no Prop 65 warning, unlike Earthpaste. It still contains a small amount of Redmond bentonite clay (eighth in the list), the ingredient most tied to high lead in toothpaste tests, and it hasn't been independently tested, so we score its metals as class-typical. No cavity claim and nothing on our flag list. We'd like to see a lead test before ranking it higher.
Best forEarthpaste fans who want HA and a lower clay load
Skip ifYou want tested lead numbers or a disclosed HA percentage
RemineralizerMicro-hydroxyapatite (% not disclosed) plus xylitol
Flavors & kidsOrange Vanilla, Citrus Rosemary, Wild Mint
Size & cost4 oz for $12.99, about $3.25 per ounce
Foam & textureNo foaming agent listed
ClayBentonite, 8th ingredient
Lead test: Not independently testedFormat: Paste
See score breakdown & sources
Remineralizer7.0
Heavy metals6.0
Clean ingredients10.0
Label honesty & track record10.0
Transparency5.0
Remineralizer: hydroxyapatite, percentage not disclosed. Metals: no independent test: class-typical 6. Ingredients: nothing on our flag list. Label and track record: no deductions. Transparency: full ingredient list only.
A glycerin-free paste built on calcium carbonate, baking soda, xylitol and micro-hydroxyapatite, with nothing on our ingredient flag list. The lab Lead Safe Mama used found 273 ppb of lead and 133 ppb of arsenic in Wellnesse's children's strawberry paste, a sibling, so it lands in our middle lead band. Its page lists “Correct cavities” among the paste's benefits, which is a drug claim; no FDA anticavity ingredient is in the formula, and a toothpaste can't reverse a cavity. The HA percentage isn't published.
RemineralizerMicro-hydroxyapatite (% not disclosed) plus xylitol and calcium carbonate
Flavors & kidsFresh Mint; a children's strawberry paste is the one tested
Size & cost4 oz for $15, about $3.75 per ounce
Foam & textureLight foam from sodium cocoyl glutamate; glycerin-free
Other metalsKids paste: arsenic 133, cadmium 8 ppb, mercury not detected
Lead test: Wellnesse Children's Strawberry · SGS North America, Jan. 2025Format: Paste
See score breakdown & sources
Remineralizer7.0
Heavy metals7.0
Clean ingredients10.0
Label honesty & track record8.0
Transparency5.0
Remineralizer: hydroxyapatite, percentage not disclosed. Metals: 273 ppb lead in Wellnesse Children's Strawberry (SGS North America, Jan. 2025), from an independent lab report we read ourselves. Ingredients: nothing on our flag list. Label and track record: cavity claim without an FDA anticavity ingredient −2. Transparency: full ingredient list only.
Independent labLead Safe Mama, LLC (Tamara Rubin). Wellnesse Fluoride Free Children's Toothpaste, Strawberry. SGS North America report 5AFLDQ (Jan. 6, 2025): lead 273, arsenic 133, cadmium 8 µg/kg; mercury not detected. Open source · [8]
Maker's dataWellnesse. Whitening Toothpaste Fresh Mint page: $15; ingredients; “Natural micro-hydroxyapatite”; benefit list includes “Correct cavities”; “B-corp Certified”; package: 4 oz (113 g). Open source · [29]
Certifier databaseB Lab directory listing, Wellnesse PBC, Certified B Corporation (found Sept. 29, 2026). Open source · [17]
Public record / studyFDA. OTC Monograph M021, Anticaries Drug Products (posted May 2, 2023): active ingredients limited to sodium fluoride, sodium monofluorophosphate and stannous fluoride; indication “Aids in the prevention of dental cavities” (also 21 CFR 355.10 and 355.50). Open source · [45]
Two separate labs have tested Davids pastes, and both results landed in our fourth lead band: 457 ppb of lead (202 ppb arsenic) in the Sensitive + Whitening peppermint paste, which lists the same ingredients as this Hydroxi tube, and 422.5 ppb (185.4 ppb arsenic) in Hydroxi Orange Vanilla in September 2025. That's still well under Washington's 1 ppm limit. It uses rod-shaped nano-HA, the form the EU allows, but doesn't publish the percentage, and it contains carrageenan. A July 2025 Prop 65 notice alleges lead exposure from Davids toothpaste, including Hydroxi, without a warning; no complaint or settlement is on file. EWG's database lists Davids' Sensitive + Whitening hydroxyapatite paste, which has the same ingredients, as EWG Verified; the mark doesn't cover heavy-metal limits.
Best forPlastic-free bathrooms on a budget
Skip ifLead is your top concern, or you avoid carrageenan
Size & cost4 oz for $10.95, about $2.74 per ounce; 1.75 oz travel $6.95
Foam & textureSodium cocoyl glutamate; carrageenan as a binder
Other metalsArsenic 202 ppb (Feb. 2025) and 185.4 ppb (Sept. 2025)
Lead test: Davids Premium Sensitive + Whitening, Peppermint (same ingredients) · SGS North America, Feb. 2025Format: Paste
See score breakdown & sources
Remineralizer7.0
Heavy metals5.5
Clean ingredients8.5
Label honesty & track record9.5
Transparency5.0
Remineralizer: hydroxyapatite, percentage not disclosed. Metals: 457 ppb lead in Davids Premium Sensitive + Whitening, Peppermint (same ingredients) (SGS North America, Feb. 2025), from an independent lab report we read ourselves. Ingredients: carrageenan −1.5. Label and track record: Prop 65 lead notice (an allegation) −0.5. Transparency: full ingredient list only.
Independent labLead Safe Mama, LLC (Tamara Rubin). Davids Premium Toothpaste Sensitive + Whitening, Natural Peppermint. SGS North America report WASKRO (Feb. 27, 2025): lead 0.457, arsenic 0.202 mg/kg; cadmium and mercury not detected (<0.025). Open source · [9]
Public record / studyCalifornia Attorney General. Prop 65 60-day notice 2025-02758 (filed July 31, 2025; alleged violator Davids Natural Toothpaste; lead). No complaint, settlement or judgment listed as of Sept. 29, 2026. Open source · [48]
A plain, honest paste: glycerin, aloe, silica, calcium carbonate, baking soda and a coconut soap, with no cavity claim (it says only that it helps reduce plaque and whiten). The lab Lead Safe Mama used tested this exact tube and found 160 ppb of lead, 23 ppb arsenic and 6 ppb mercury, with no cadmium. It has no hydroxyapatite and no xylitol, so it scores the minimum on remineralizing; it's a cleaner, not an enamel builder. At $1.60 an ounce it's the least expensive paste in our top 10.
Best forA simple, low-cost paste for people who get their minerals elsewhere
Other metalsArsenic 23 ppb, mercury 6 ppb, cadmium not detected
Lead test: Dr. Bronner's Peppermint All-One (this product) · SGS North America, Feb. 2025Format: Paste
See score breakdown & sources
Remineralizer3.0
Heavy metals7.0
Clean ingredients10.0
Label honesty & track record10.0
Transparency5.0
Remineralizer: no remineralizing ingredient. Metals: 160 ppb lead in Dr. Bronner's Peppermint All-One (this product) (SGS North America, Feb. 2025), from an independent lab report we read ourselves. Ingredients: nothing on our flag list. Label and track record: no deductions. Transparency: full ingredient list only.
Independent labLead Safe Mama, LLC (Tamara Rubin). Dr. Bronner's Peppermint All-One Toothpaste. SGS North America report 3ZM5M4 (Feb. 26, 2025): lead 0.16, arsenic 0.023, mercury 0.006 mg/kg; cadmium not detected. Open source · [5]
Official-site prices for one unit on Sept. 29, 2026, divided by the net amount on the page or package. For scale, a child's pea-sized dab is 0.25 g[53], and a 4 oz tube holds about 113 g.
Our top 10Other products we scoredShorter bar = lower price per ounce
hello Fluoride-Free$6.99 for 5 oz$1.40per oz
Dr. Bronner's All-One#10 · $7.99 for 5 oz$1.60per oz
Burst Natural$7.99 for 4.7 oz$1.70per oz
Tom's of Maine FF$7.99 for 4.5 oz$1.78per oz
Earthpaste$9.89 for 4 oz$2.47per oz
Lumineux 10% Nano-HA$19.99 for two (sold out) for 7.5 oz$2.67per oz
Davids Hydroxi#9 · $10.95 for 4 oz$2.74per oz
Boka Ela Mint#2 · $11.62 for 4 oz$2.91per oz
Desert Essence Nano-HA#6 · $11.99 for 4 oz$3.00per oz
Redmond Leaf#7 · $12.99 for 4 oz$3.25per oz
Uncle Harry's$10 for 3 oz$3.33per oz
RiseWell Mineral#1 · $12 for 3.4 oz$3.53per oz
Wellnesse Whitening#8 · $15 for 4 oz$3.75per oz
Elims Reflection#3 · $16 for 4 oz$4.00per oz
Dr. Jen Fluoride-Free#4 · $18.50 for 3.4 fl oz$5.44per fl oz
RiseWell PRO$22 for 3.4 oz$6.47per oz
Primal Life tooth powder$25.99 for 1 oz$25.99per oz
Tablets: Bite's 4 oz jar of 248 Bits costs $48, or $12.00 per ounce. At 2 a day, that's about $11.61 a month from the jar, or $7.74 a month on the $32 refill subscription [our calculation][25]. Primal Life's powder is $25.99 for a 1 oz jar[39]. Lumineux's price is for two 3.75 oz tubes[32]. Arm & Hammer isn't sold on its own site, so its price varies by retailer[40].
Heavy metals
Lead in tested toothpastes, from the lab reports
Every value below was read from the lab report in each Lead Safe Mama article or from her April 2025 chart, not from a summary. The scale is logarithmic: each step is 10 times the one before. Most toothpastes tested, fluoride ones included, show some lead[1].
#10Dr. Bronner's All-One[5]This product160ppb lead
#4Dr. Jen (kids paste)[6]Fluoride-Free Strawberry Kids200ppb lead
#6Desert Essence (kids gel)[7]For Kids Tutti Frutti gel217.5ppb lead
#8Wellnesse (children's paste)[8]Children's Strawberry273ppb lead
#9Davids Hydroxi Orange Vanilla[10]Hydroxi, Sept. 2025422.5ppb lead
#9Davids Sensitive + Whitening[9]Same ingredients as our pick457ppb lead
Other products we scored
Tom's of Maine (kids FF)[11]Kid's Natural FF, Silly Strawberry240ppb lead
hello (kids FF gel)[12]Fresh Watermelon493ppb lead
Earthpaste Lemon Twist[13]Silver Earthpaste3,500ppb lead
Primal Life powder + nano-HA[14]Polished Peppermint5,361.7ppb lead
Fluoride pastes, for comparison
Sensodyne Extra Whitening[1]Fluoride paste, for comparison116ppb lead
Crest Regular[1]Fluoride paste, for comparison399ppb lead
Raw ingredients
Plain hydroxyapatite powder[1]Single ingredient268.7ppb lead
Plain calcium carbonate[1]Single ingredient292ppb lead
Washington bans selling cosmetics with 1 ppm (1,000 ppb) of lead or more from Jan. 1, 2025[46]; fluoride pastes are OTC drugs under FDA's anticavity monograph[45], so fluoride-free pastes are generally sold as cosmetics. FDA's 10 ppm figure is draft guidance for lip products and externally applied cosmetics; it doesn't name toothpaste, so treat it as context, not a toothpaste limit[47]. Labs: SGS North America or Purity Laboratories, named on each report. These are single samples; lots vary, as the two Davids tests show[9][10].
Remineralizer
How much hydroxyapatite is in the tube?
The percentage is the first thing to look for on an HA paste. Only five of the brands we scored publish it; the hatched bars mean the brand uses HA but doesn't say how much.
Disclosed hydroxyapatite, % of the formula
Nano-HAMicro-HAHA, amount not disclosedEU limit for nano-HA, 10%
Lumineux 10% Nano-HA[32]$19.99 for two (sold out)10% nano10%disclosed
RiseWell PRO[20]$2210% micro + about 0.78% nano≈10.8%our calculation
The EU allows nano-HA in toothpaste below 10%, as uncoated rods only[64]; in June 2025 its safety committee judged rod-shaped nano-HA safe up to 29.5%, which hasn't yet changed the legal limit as far as we found[65]. Micro-HA isn't covered by that limit. RiseWell PRO's “5% NanoXIM CarePaste” is 5% of a paste that is itself 15.5% nano-HA, so about 0.78% nano-HA by our math[20][21]. Bite's 5% appears in a variant name on its own store[26].
Clean label
What else is in the tube
Flags come from each brand's current ingredient list. The number is what the flag costs on our Clean ingredients pillar. Clay is scored under heavy metals instead, so it's never counted twice.
CAPB = cocamidopropyl betaine, a foaming agent with contact-allergy reports. Glycerin, essential oils, xylitol, erythritol and sodium benzoate take no deduction. Sodium lauroyl sarcosinate (Boka) and sodium cocoyl glutamate are milder foaming agents than SLS and aren't flagged. Only hello's kids gel, not the adult paste scored here, listed titanium dioxide in the tester's chart[1]. Shaded rows missed our top 10.
How we score: the Dr. Axe Clean Smile Score™
Most fluoride-free rankings go by ingredient lists and brand claims. Ours starts with two questions a label can’t answer: how much lead did an independent lab find, and how much hydroxyapatite does the brand actually disclose? Then we check what else is in the tube and whether the label stays inside the law. It’s an editorial assessment built from lab reports, brand pages and public records, not our own lab testing and not a medical grade. Price isn’t part of the score; see the price chart.
Remineralizer25%
Hydroxyapatite with a disclosed 10% or more scores 9, 5–9% scores 8, undisclosed 7, listed low (after preservatives or flavor) 6. Arginine or calcium glycerophosphate without HA 5.5; xylitol in the top five plus calcium carbonate 4.5; none 3.
Heavy metals25%
Lead in an independent lab test of the product line: 50 ppb or less 10, up to 150 ppb 8.5, 300 ppb 7, 600 ppb 5.5, 1,000 ppb 4, over 1,000 ppb (Washington's limit) 1.5. No test 6; clay formula with no test 4.
Clean ingredients20%
Starts at 10. Carrageenan and SLS −1.5 each; titanium dioxide, PEGs, artificial sweeteners or dyes, and nano silver −1 each; cocamidopropyl betaine and charcoal −0.5.
Label honesty & track record15%
Starts at 10. A cavity claim without an FDA anticavity ingredient −2, “safe to swallow” messaging −1, an unsupported superlative −0.5, a mislabeled-fluoride recall −3, an FDA warning letter −2, a recent Prop 65 lead notice −0.5.
Transparency15%
Publishes its own heavy-metal numbers 10; full ingredients plus HA percentage and type 7.5; plus percentage only 7; full ingredients only 5; incomplete 3.
Lab reports, read line by line. Nearly all metals data comes from Lead Safe Mama, a crowd-funded advocate who sends products to independent labs (SGS North America and Purity Laboratories on these reports) and earns advertising and Amazon affiliate income[1]. We read every value from the lab report itself; none comes from a secondary summary (which would score one band lower). A result for a sibling, usually the kids paste, counts for the brand line but scores no higher than 8.5, and we name the SKU every time. A maker’s own COA with numbers would score on the same table but no higher than 7.5; no brand here publishes one. Arsenic over 1,000 ppb costs 1 more point.
The 1 ppm cap. An independent result over 1,000 ppb of lead, Washington’s legal limit for cosmetics[46], caps a product at 5.0 and keeps it out of the top 10. With no test, metals score a class-typical 6; a clay paste (bentonite, kaolin or montmorillonite in the first three ingredients) scores 4, and a maker’s own Prop 65 lead warning 3.5.
Remineralizer. Nano and micro-HA score the same, because the main trials used micro-HA[58][59]. A percentage counts only if the brand discloses it; HA listed after preservatives or flavor scores 6.
Label honesty and track record. FDA’s anticavity monograph allows only three active ingredients, all fluorides[45], so a fluoride-free paste that says it prevents, fights or corrects cavities loses 2 points; we quote every claim we score. “Safe to swallow” messaging costs 1, an unsupported superlative 0.5, a recall for fluoride paste in fluoride-free-labeled tubes within 5 years 3, an FDA warning letter to the brand’s toothpaste plant within 3 years 2, and a Prop 65 lead notice within 2 years 0.5, because a notice is only an allegation. A certification we look up and can’t find costs 1; we found Davids' EWG Verified and Wellnesse’s B Corp listings[16][17].
Who’s eligible. The top 10 needs an independent metals result for the brand line, or a remineralizer score of 7 or more with no clay in the first three ingredients. One product per brand line, in stock on the brand’s U.S. store. Ties at one decimal are ranked by the unrounded score. Products with no findable price or ingredients are listed as not rated. We leave out brands whose main business is dietary supplements.
Why we avoid clay-based pastes
Clay is sold as a gentle, natural cleanser. In the lab data, it’s the ingredient behind the highest lead results. Every product we scored with a sample over Washington’s 1 ppm limit is built on bentonite or kaolin clay.
Earthpaste: 3,500 ppb
The lab Lead Safe Mama used found 3,500 ppb of lead and 2,700 ppb of arsenic in Lemon Twist Earthpaste, whose second ingredient is bentonite clay[13]. Its product page carries a Prop 65 cancer and reproductive-harm warning[37].
Clay powders: up to 7,800 ppb
A Primal Life powder with nano-HA tested at 5,361.7 ppb of lead and 5,544.2 ppb of arsenic[14]; its kids bubblegum powder tested at 7,800 ppb of lead[15]. The powder’s first two ingredients are bentonite and kaolin[39].
A brand’s own warning
Uncle Harry’s says it plainly on its page: “Bentonite clay contains naturally occurring trace minerals, including lead,” followed by a Prop 65 lead warning[38].
Minerals carry metals too
Even “clean” minerals aren’t lead-free: plain hydroxyapatite powder tested at 268.7 ppb of lead and plain calcium carbonate at 292[1]. That’s why sourcing and testing matter more than the word “natural.”
What to do: skip pastes and powders with clay in the first three ingredients unless the brand publishes a recent lead test under 1 ppm. For kids, who swallow more, look for a result under 50 ppb.
Is hydroxyapatite as good as fluoride?
In the few head-to-head trials so far, HA matched fluoride. But there are only a handful of those trials, most used micro-HA, and most were funded or co-authored by one HA manufacturer. Independent reviewers rate the evidence low to very low, while fluoride has decades of large trials behind it. Here’s the evidence, strongest to weakest:
of children developed early cavities in one year on micro-HA vs a fluoride kids paste (207 enrolled, 177 analyzed); HA was non-inferior. Both groups brushed three times a day; the fluoride comparison was a low-strength (500 ppm) kids paste, and the study was funded by the HA paste’s maker.
of adults had no new decay after 18 months on HA vs 1,450 ppm fluoride (189 enrolled, 171 analyzed); non-inferior. Several co-authors work for the HA paste’s maker.
with HA than controls in a meta-analysis of 3 randomized trials (22 studies reviewed). An update pooled 5 clinical and 8 in-mouth trials and called HA effective without fluoride; both reviews share industry-affiliated authors.
of nano-HA (5 in people, which couldn’t be pooled, and 5 in-mouth); 6 were at high risk of bias and 6 were funded or published by manufacturers. Under strong acid challenge, fluoride held up better.
in new or worsening cavities between HA and fluoride pastes in 4 in-situ trials in people under 25 (pooled risk ratio 0.98; 68 screened); lesion size and fluorescence did differ at 6 months.
from 1955 to 2014 in a Cochrane review, most lasting 3 years, found fluoride toothpaste of 1,000 ppm or more prevents cavities. HA has nothing close to that track record yet.
EU law allows nano-HA in toothpaste below 10%, only as uncoated rod-shaped particles; needle-shaped particles are out. Micro-HA isn’t restricted this way.
In June 2025, the EU’s safety committee found rod-shaped nano-HA safe up to 29.5% in toothpaste, based on new data showing no genetic damage or cell toxicity.
between back teeth remineralized one year after starting a 6-month home nano-HA gel, in 92 young adults; ozone plus the gel did better (69.3%). A gel, not a toothpaste, and no fluoride comparison.
Sci Rep, 2020
Our read: HA is the best-supported fluoride-free option, and the trials that exist are encouraging. If you or your kids get cavities often, fluoride toothpaste still has the longer record, and that’s a reasonable choice. Either way, the brushing habits in our routine matter as much as the paste.
How to read a fluoride-free toothpaste label
Here’s what each part of the tube tells you, and where to check it.
On the label
What it tells you
Where to find it
Hydroxyapatite (nano or micro)
The enamel mineral. Nano particles are smaller; the biggest trials used micro. Both score the same here.[58]
Ingredient list; FAQ
HA percentage
The single most useful number on an HA paste. 10% is common; only a few brands publish it.[24]
Product page or FAQ
“Anticavity” and a Drug Facts box
Only fluoride pastes can use them; the monograph allows three fluoride actives.[45]
The label’s Drug Facts panel
Xylitol position
Ingredients are listed from most to least. Xylitol in the top five means a meaningful amount.[66]
Ingredient list
Bentonite, kaolin, montmorillonite
Clays. The highest lead results we found were all clay-based.[1]
First three ingredients
SLS vs gentler foamers
SLS is linked to longer, more painful canker sores in some people. Sodium cocoyl glutamate and taurates are milder.[68]
Ingredient list
Prop 65 warning
California requires it when a product exposes you to a listed chemical like lead above a threshold.[38]
Product page or package
“Safe to swallow”
Marketing. Kids still need the smear-or-pea amount, and adults should spit.[53]
Directions
EWG Verified, B Corp
Real certifications you can look up, but neither sets a lead limit for toothpaste.[16]
EWG and B Lab databases
More picks by category
Best fluoride-free toothpaste for kids
Kids pastes are where most of the lead testing happened, so here are the actual kids SKUs and their results, lowest lead first.
How much for kids: a smear the size of a rice grain under age 3, and no more than a pea (0.25 g) from 3 to 6. More than 38% of kids 3 to 6 use more than that[53]. Young children swallow some paste no matter what the label says, which is why we’d pick a kids paste with a lead result under 50 ppb.
·
RiseWell Kids Hydroxyapatite Toothpaste$12 · 3.4 oz
The exact kids paste Lead Safe Mama had tested: 26 ppb lead, 8 arsenic, 9 cadmium, no mercury detected[4]. Same hydroxyapatite line as our #1 pick[18], not separately scored. Its page says it’s “safe enough to eat—even if your kids … eat the whole … tube”[19]. We disagree: use a rice-grain smear under 3 and a pea from 3 to 6, and teach kids to spit.
Top kids pick
·
Boka Kids (Orange Cream and other flavors)$11.62 · 4 oz
27.4 ppb lead and 8.2 ppb mercury; arsenic and cadmium below detection[3]. Nano-HA, % not disclosed[22].
A plain, honest paste: glycerin, aloe, silica, calcium carbonate, baking soda and a coconut soap, with no cavity claim (it says only that it helps reduce plaque and whiten).
Two separate labs have tested Davids pastes, and both results landed in our fourth lead band: 457 ppb of lead (202 ppb arsenic) in the Sensitive + Whitening peppermint paste, which lists the same ingredients as this Hydroxi tube, and 422.5 ppb (185.4 ppb arsenic) in Hydroxi Orange Vanilla in September 2025.
A lot of remineralizing chemistry for $11.99: nano-hydroxyapatite from Fluidinova (the nanoXIM supplier whose material the EU reviewed), plus L-arginine and calcium glycerophosphate, which are used for sensitivity.
Good products that missed the top 10 because they were sold out, a sibling of a top-10 pick, or not eligible without a metals test or HA.
1
Lumineux 10% Nano Hydroxyapatite Performance Whitening Toothpaste$19.99 for two (sold out) · $2.67/oz
Would rank #5 on score, but its U.S. store showed it sold out on Sept. 29. A disclosed 10% nano-HA with an aloe and xylitol base; no metals test; its page says xylitol “can help reduce the risk of cavities,” which costs it 2 points on label honesty.[32]
8.0/10
2
RiseWell PRO Hydroxyapatite Toothpaste$22 · $6.47/oz
Adds nano-HA to the Original's 10% micro-HA, sold as “5% NanoXIM CarePaste.” CarePaste is a paste that is 15.5% nano-HA, so 5% of it is roughly 0.78% nano-HA by our math. The page also claims “the highest concentration of hydroxyapatite you can find on the market” and that PRO helps “prevent decay,” so it scores below the Original.[20][21]
8.5/10
3
Tom's of Maine Fluoride-Free Antiplaque & Whitening$7.99 · $1.78/oz
Just outside our top 10. No HA, but xylitol is fourth and calcium carbonate first. The lab Lead Safe Mama used found 240 ppb of lead in Tom's kids fluoride-free paste. It contains carrageenan, and FDA sent Colgate-Palmolive/Tom's of Maine a warning letter in November 2024 about its Sanford, Maine toothpaste plant.[33][11][42]
6.5/10
4
Burst Natural Wild Mint Toothpaste (fluoride-free)$7.99 · $1.70/oz
Inexpensive and clean apart from cocamidopropyl betaine, but no HA and no metals test, so it isn't eligible for our top 10. Its page says the xylitol “helps prevent tooth decay”; without an FDA anticavity ingredient that's a drug claim. Buy “Natural Wild Mint”: Burst's plain “Wild Mint” contains fluoride.[35]
Not sold on the brand's site. No HA, no metals test, and it contains PEG-8 and charcoal. Arm & Hammer's “Whiten & Strengthen” Essentials paste contains fluoride; don't mix them up.[40]
6.2/10
What about Earthpaste, Tom’s and hello?
Three familiar names, three different problems. Here’s what the records show.
Earthpaste’s lead and Prop 65 warningThe lab Lead Safe Mama used found 3,500 ppb of lead, 2,700 ppb of arsenic and 31 ppb of cadmium in Lemon Twist Earthpaste in January 2025[13], and Redmond’s own product page shows a Prop 65 “Cancer and Reproductive Harm” warning[37]. That result is 3.5 times Washington’s 1 ppm limit for cosmetics[46] and below FDA’s 10 ppm draft guidance for other cosmetics[47]. Redmond’s newer Leaf paste, built on micro-HA with far less clay, carries no warning on its page[28]. Earthpaste score: 4.9.
Tom’s of Maine’s FDA warning letterOn Nov. 5, 2024, FDA sent a warning letter to Colgate-Palmolive/Tom’s of Maine after a May 2024 inspection of its Sanford, Maine toothpaste plant. FDA cited Pseudomonas aeruginosa in water samples from June 2021 to October 2022, Paracoccus yeei in a released batch of Wicked Cool! Anticavity Toothpaste, “a black mold-like substance” near equipment, and about 400 uninvestigated complaints about odor, color and taste[42]. The letter names fluoride products, not the fluoride-free paste we scored, but it’s the same plant. Tom’s says it tests every batch it makes, including for harmful bacteria and mold[34]. Its kids fluoride-free paste tested at 240 ppb of lead[11]. Score: 6.5.
hello’s fluoride mix-up recallIn August 2023, Colgate-Palmolive recalled 182,046 tubes after some hello wild strawberry fluoride toothpaste “were incorrectly filled in tubes labeled as hello fresh watermelon fluoride free toothpaste”[43]. That was hello’s kids line, not the adult paste we scored, but it matters to any family choosing fluoride-free on purpose. The same kids fluoride-free gel later tested at 493 ppb of lead[12]. Mix-ups aren’t unique to hello: a Native fluoride paste was recalled in 2021 because tubes may have been labeled fluoride-free[44]. Score: 5.8.
Prop 65 notices (allegations)Private enforcers filed 60-day notices alleging lead exposure without a warning against Davids, including its Hydroxi line (July 2025), and Dr. Jen (September 2025); neither has a complaint, settlement or judgment on file[48][49]. Two 2022 notices, against a Tom’s whitening paste and a hello toothpaste, were withdrawn within two months[50]. A notice isn’t a finding, so it costs only half a point.
Our advicePick a brand that has had its line tested and lands under 300 ppb, avoid clay-based pastes and powders, and if you’re buying fluoride-free for a child, check the tube itself says fluoride-free.
Label and track-record deductions
Every deduction on our Label honesty & track record pillar, with the source. The pillar starts at 10 and can’t fall below 3.
cavity claim without an FDA anticavity ingredient; “safe to swallow” messaging[39]
−2 −1
7
5.0 (capped)
What we’d skip
Two had samples test over Washington’s 1 ppm lead limit, one carries its own lead warning, and one had a fluoride mix-up recall in its kids line.
1
Redmond Earthpaste with Silver$9.89 · $2.47/oz
The lab Lead Safe Mama used found 3,500 ppb of lead and 2,700 ppb of arsenic in Lemon Twist Earthpaste, and the product page carries a Prop 65 cancer and reproductive-harm warning. Bentonite clay is its second ingredient. Capped at 5.0.[13][37]
4.9/10Over 1 ppm lead
2
Primal Life Organics Powdered Mineral Toothpaste + Nano-Hydroxyapatite$25.99 · $25.99/oz
Clay-based tooth powder. The lab Lead Safe Mama used found 5,361.7 ppb of lead and 5,544.2 ppb of arsenic in the Polished Peppermint flavor of this line, more than 5 times Washington's limit in that sample, and 7,800 ppb of lead in its kids bubblegum powder. Its page also calls HA “just as effective at preventing cavities” and “safe if swallowed.” Capped at 5.0.[14][15][39]
5.0/10Over 1 ppm lead
3
Uncle Harry's Bliss Mint Toothpaste, Lightly Sweet$10 · $3.33/oz
A bentonite-clay paste in a glass jar. Its own page carries a Prop 65 warning that the product contains lead from the clay. No independent test and no remineralizer, so it isn't eligible for our top 10.[38]
The lab Lead Safe Mama used found 493 ppb of lead and 19 ppb of mercury in hello's kids fluoride-free watermelon gel. In 2023, Colgate-Palmolive recalled 182,046 tubes of hello's kids wild strawberry fluoride toothpaste because some had been filled into tubes labeled as the kids fluoride-free watermelon paste, which costs the brand 3 points on track record.[12][43][36]
5.8/10
Not rated
Brands people ask about that we couldn’t score fairly.
·
Kinder Karex (Germany)
The lab Lead Safe Mama used found 72.6 ppb of lead in its fluoride-free kids paste, but we couldn't reach the brand's store or find a U.S. price or current ingredient list.[1]
Not rated
·
Squigle Enamel Saver
The brand site shows its ingredients only in images, and we found no price on it. Lead Safe Mama has tested its Squigle Jr. toddler paste.[1]
Not rated
·
Apagard Premio (Japan)
Sangi's medical-grade nano-HA paste; the Japanese product page gives no full ingredient list or U.S. price.[41]
Not rated
·
Twice
We couldn't identify the brand's official store.
Not rated
·
Schmidt's toothpaste and adult Jason toothpastes
No longer listed on the brands' own sites; Jason's site lists only a kids paste.
Not rated
Cavity claims vs. what the FDA allows
A toothpaste can say it “aids in the prevention of dental cavities” only if it contains sodium fluoride, sodium monofluorophosphate or stannous fluoride[45]. These fluoride-free products make cavity claims anyway. Each costs 2 points on our label pillar.
I’m a fan of fluoride-free toothpaste built on hydroxyapatite, the same mineral your enamel is made of. The head-to-head trials are encouraging, and it lets you control how much fluoride your family gets. But “natural” on a tube tells you nothing about what’s inside, so my first non-negotiable is a lab test. Choose a brand whose line has been tested for lead, and walk away from clay-based pastes and powders.
Second, look for the number. A brand that prints its hydroxyapatite percentage is telling you what you’re paying for. Third, read the claims: a fluoride-free paste that promises to prevent or correct cavities is making a promise the law doesn’t allow, and that tells you something about the brand.
And don’t forget the basics: two minutes, twice a day, a pea-sized amount for kids, clean between your teeth, and keep sugar to mealtimes. Know what’s in your water, too; if you want less fluoride overall, filtering your drinking water matters more than your toothpaste.
— Dr. Axe
Frequently asked questions
What is the best fluoride-free toothpaste?
RiseWell Mineral Toothpaste ($12, 8.9/10). It discloses 10% micro-hydroxyapatite, has nothing on our ingredient flag list, makes no cavity claim, and the brand’s kids paste tested at 26 ppb of lead in an independent lab. For the lowest lead on the exact tube, Boka Ela Mint tested at 32 ppb. For a disclosed 10% nano-HA, Dr. Jen or Elims; for tablets, Bite.
Is hydroxyapatite toothpaste as good as fluoride?
In the few head-to-head trials so far, HA matched fluoride: a micro-HA paste was non-inferior to fluoride in a one-year trial of young children (72.7% vs 74.2% of 177 analyzed developed early cavities) and an 18-month trial of adults (89.3% vs 87.4% of 171 analyzed had no new decay). But those trials were funded or co-authored by the HA paste’s maker, and independent reviews rate the evidence low to very low, while fluoride has decades of large trials. HA is the best-supported fluoride-free option.
Is nano-hydroxyapatite safe?
The EU’s safety committee judged rod-shaped nano-HA safe in toothpaste, first up to 10% (now the legal limit) and, in June 2025, up to 29.5%, based on new data showing no genetic damage or cell toxicity. The EU allows only uncoated rod-shaped particles; needle-shaped nano-HA isn’t permitted. Micro-HA, the form in the largest trials, isn’t nano at all.
Why is there lead in toothpaste?
It comes in with mineral ingredients. In one advocate’s lab tests, 46 of 51 toothpastes had detectable lead, fluoride pastes included. The highest results were clay-based pastes and powders, from 3,500 to 7,800 ppb, and even plain hydroxyapatite and calcium carbonate powders tested at 268.7 and 292 ppb. The best HA pastes we found tested under 50 ppb.
How much lead is too much in toothpaste?
There’s no federal toothpaste limit. Washington bans cosmetics with 1 ppm (1,000 ppb) of lead or more from 2025, and FDA’s draft guidance of 10 ppm covers lip products and externally applied cosmetics, not toothpaste. We give full marks to 50 ppb or less and cap anything over 1,000 ppb at 5.0.
Is fluoride-free toothpaste safe for kids?
Yes, if you pick a paste with a low lead result and use the right amount: a rice-grain smear under 3 and no more than a pea (0.25 g) from 3 to 6. RiseWell Kids (26 ppb) and Boka Kids (27.4 ppb) had the lowest lead of the kids pastes tested. For cavity-prone kids, fluoride paste has the longer track record.
Can fluoride-free toothpaste prevent cavities?
FDA lets only three fluoride ingredients carry an anticavity claim, so a fluoride-free paste legally can’t say it prevents cavities. Several do anyway, and we deduct for it. HA trials suggest it can match fluoride, but that’s the research, not an approved claim.
Is xylitol in toothpaste safe for my heart?
The 2024 study linked higher fasting blood xylitol to heart events in about 3,300 people in two cohorts, and showed that drinking a sweetener-sized dose raised blood levels sharply and made platelets stickier in 10 volunteers. Toothpaste contains far less, and you spit it out; we found no study linking toothpaste xylitol to heart risk. For teeth, a Cochrane review found 13% fewer cavities when 10% xylitol was added to fluoride paste, on low-quality evidence.
Is SLS bad for you?
For most people it’s just a foaming agent, but in people who get canker sores, SLS-free paste shortened sores and eased pain in a 90-person trial, and a review of 4 trials found fewer sores. None of the fluoride-free pastes we scored uses SLS.
Is Tom’s of Maine fluoride-free toothpaste safe?
Its kids fluoride-free paste tested at 240 ppb of lead, in the middle of the pack. In November 2024 FDA sent Colgate-Palmolive/Tom’s of Maine a warning letter about bacteria in the water system and in a released batch at its toothpaste plant; the letter names fluoride products. The adult fluoride-free paste also contains carrageenan. It scores 6.5, just outside our top 10.
Do tooth powders work better than paste?
We don’t recommend clay tooth powders. The powders tested had the highest lead we found: 5,361.7 ppb in a Primal Life powder with nano-HA and 7,800 ppb in its kids powder. If you want to skip the tube, Bite’s tablets are clay-free and disclose 5% nano-HA.
References
Update history
Sept. 29, 2026: First published. Metals values read from Lead Safe Mama lab reports (SGS North America and Purity Laboratories, 2025). Prices, ingredients and claims checked on each brand’s U.S. site; FDA warning letter, recall, OTC monograph, Washington statute and Prop 65 records checked Sept. 29, 2026.
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Toothpaste chart: laboratory test results (chart data updated Apr. 22, 2025; list updated May 2026, 73 products). Chart header: 46 of 51 positive for lead, 33 of 51 arsenic, 24 of 51 mercury, 18 of 51 cadmium; Crest Regular 399 ppb lead, Sensodyne Extra Whitening 116, single-ingredient hydroxyapatite 268.7 (arsenic 58.9), calcium carbonate 292 (arsenic 274), Kinder Karex 72.6. Crowd-funded; the site earns advertising and affiliate income. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Boka Nano-Hydroxyapatite Toothpaste, Ela Mint. SGS North America report W6WYUD (reported Jan. 27, 2025): lead 32, arsenic 21, mercury 10 µg/kg; cadmium not detected (AOAC 2015.01). Includes Boka's response. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Boka Kids Orange Cream. Purity Laboratories case 2503148 (Mar. 14, 2025): lead 27.4 ppb, mercury 8.2; arsenic <10, cadmium <5 (ICP-MS). Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). RiseWell Kids Mineral Toothpaste, Cake Batter. SGS North America report BHZ88T (Jan. 31, 2025): lead 26, arsenic 8, cadmium 9 µg/kg; mercury not detected. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Dr. Bronner's Peppermint All-One Toothpaste. SGS North America report 3ZM5M4 (Feb. 26, 2025): lead 0.16, arsenic 0.023, mercury 0.006 mg/kg; cadmium not detected. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Dr. Jen Fluoride-Free Strawberry Toothpaste for Kids. SGS North America report FP2RES (Feb. 7, 2025): lead 200, arsenic 60, cadmium 9, mercury 6 µg/kg. Quotes Dr. Jen's statement: “Independent testing of our formula confirmed a lead level of only 0.2 ppm.” Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Desert Essence For Kids Fluoride-Free Tutti Frutti gel. Purity Laboratories case 2503160 (Mar. 14, 2025): lead 217.5 ppb, mercury 8.0; arsenic <10, cadmium <5. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Wellnesse Fluoride Free Children's Toothpaste, Strawberry. SGS North America report 5AFLDQ (Jan. 6, 2025): lead 273, arsenic 133, cadmium 8 µg/kg; mercury not detected. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Davids Premium Toothpaste Sensitive + Whitening, Natural Peppermint. SGS North America report WASKRO (Feb. 27, 2025): lead 0.457, arsenic 0.202 mg/kg; cadmium and mercury not detected (<0.025). Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Davids Hydroxi Whitening + Enamel Health, Natural Orange Vanilla (“EWG Verified”). Purity Laboratories case 2509169, retest (Sept. 17, 2025): lead 422.5, arsenic 185.4, cadmium 11.65, mercury 5.25 ppb. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Tom's of Maine Kid's Natural Fluoride-Free, Silly Strawberry. SGS North America report ZU2RKG (Jan. 31, 2025): lead 240, arsenic 40 µg/kg; cadmium and mercury not detected. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Hello Fluoride Free Toothpaste, Fresh Watermelon (kids). SGS North America report 2MUVCD (Jan. 27, 2025): lead 493, mercury 19, arsenic 6 µg/kg; cadmium not detected. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Silver Earthpaste Mineral Toothpaste, Lemon Twist. SGS North America report JW8SA3 (Jan. 9, 2025): lead 3,500, arsenic 2,700, cadmium 31 µg/kg; mercury not detected. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). PrimalLife Premium Dirty Mouth Powdered Mineral Toothpaste + Nano-Hydroxyapatite, Polished Peppermint. Purity Laboratories case 2504266 (Apr. 18, 2025): lead 5,361.7, arsenic 5,544.2, cadmium 70.4, mercury 11.2 ppb. Open source
Independent lab Lead Safe Mama, LLC (Tamara Rubin). Primal Life Organics Dirty Mouth Sweet Bubblegum Toothpowder. SGS North America report CSFDYL (Mar. 4, 2025): lead 7.8, arsenic 5.5, cadmium 0.082 mg/kg. Open source
Certifier database B Lab directory listing, Wellnesse PBC, Certified B Corporation (found Sept. 29, 2026). Open source
Maker's data RiseWell. Hydroxyapatite (Mineral) Toothpaste page: $12, 3.4 oz; full ingredients; FAQ: “10% concentration of micro-hydroxyapatite” sourced from a mine in France; “100% Safe to Swallow.” Open source
Maker's data RiseWell. Kids Hydroxyapatite Toothpaste page: $12, 3.4 oz; “100% Safe to Swallow”; “safe enough to eat—even if your kids (or you, wink wink) eat the whole delicious tube!” Open source
Maker's data RiseWell. PRO Hydroxyapatite Toothpaste page: $22, 3.4 oz; “5% NanoXIM CarePaste ... and 10% micro hydroxyapatite”; “the highest concentration of hydroxyapatite you can find on the market”; “prevent decay”; “100% Safe to Swallow.” Open source
Maker's data Fluidinova. Paste or powder? nanoXIM•CarePaste is “15.5% nano-hydroxyapatite particles in the form of rod-shaped nano-particles.” Open source
Maker's data Boka. Ela Mint Nano-hydroxyapatite Toothpaste page: $11.62, 4 oz; ingredients (“Hydroxyapatite* (*Nano)”); “PETA cruelty free certified.” Open source
Maker's data Dr. Jen Natural. Fluoride-Free 10% Premium Nano-Hydroxyapatite Toothpaste page: $18.50 per tube; ingredients; “Cavity Protection Without Fluoride”; FAQ: “the #1 dentist-recommended Nanohydroxyapatite toothpaste”; “the same cavity protection as fluoride ... at the optimal 10% concentration”; package: 3.4 fl oz (100 mL). Open source
Maker's data Elims. Reflection 10% Nano-Hydroxyapatite Toothpaste, 4 oz, $16; ingredients list “10% Nano-Hydroxyapatite”; “Our toothpaste is safe to swallow so we recommend spitting without rinsing”; “brushing at least twice a day for two minutes.” Open source
Maker's data Bite. Fluoride-Free Toothpaste Bits, 4 oz: $48 for 248 Bits; ingredients; Benefits: “Helps Fight Cavities”; FAQ: nHAp “just as effective” at helping protect against cavities; “it is safe to swallow and non-irritating.” Open source
Maker's data Bite. Toothpaste Bits listing (variant named “5% Nano-Hydroxyapatite”). Open source
Maker's data Desert Essence. Nano-Hydroxyapatite Sensitive + Whitening Toothpaste page: $11.99; complete ingredients; directions “at least 2 times a day” and “do not swallow”; “Certified B Corporation”; package: 4 oz (113 g). Open source
Maker's data Redmond. Leaf Micro Hydroxyapatite Toothpaste, 4 oz: $12.99; ingredients (hydroxyapatite; Redmond bentonite clay). Open source
Maker's data Wellnesse. Whitening Toothpaste Fresh Mint page: $15; ingredients; “Natural micro-hydroxyapatite”; benefit list includes “Correct cavities”; “B-corp Certified”; package: 4 oz (113 g). Open source
Maker's data Davids. Hydroxi whitening + enamel health nano hydroxyapatite premium toothpaste, peppermint: $10.95, 4 oz; ingredients (hydroxyapatite (nano), carrageenan); “EWG VERIFIED”; FAQ on rod-shaped n-HA. Open source
Maker's data Dr. Bronner's. Peppermint All-One Toothpaste: $7.99, 5 oz; ingredients; 70% organic ingredients. Open source
Maker's data Lumineux. 10% Nano Hydroxyapatite Performance Whitening Toothpaste, 2-pack of 3.75 oz: $19.99, shown sold out; ingredients; xylitol “can help reduce the risk of cavities.” Open source
Maker's data Tom's of Maine. Fluoride-Free Antiplaque & Whitening, Peppermint: $7.99, 4.5 oz; ingredients include xylitol and carrageenan. Open source
Maker's data Tom's of Maine. The safety of our toothpaste (responds to the FDA letter; “We test every batch of toothpaste we make, including for harmful bacteria and mold”). Open source
Maker's data Burst. Natural Wild Mint Toothpaste (fluoride-free): $7.99, 4.7 oz; ingredients; xylitol “also helps prevent tooth decay.” Open source
Maker's data hello. Antiplaque + Whitening Fluoride Free Toothpaste: $6.99; ingredients; package: NET WT 5.0 OZ (141 g). Open source
Maker's data Redmond. Earthpaste with Silver: $9.89; ingredients (water, bentonite clay, xylitol, nano silver solution ...); “WARNING: Cancer and Reproductive Harm”; package: 4 oz (113 g). Open source
Maker's data Uncle Harry's. Bliss Mint Toothpaste, Lightly Sweet, 3 oz jar: $10; ingredients (bentonite clay); “PROP 65 WARNING: This product contains lead.” Open source
Maker's data Primal Life Organics. Powdered Mineral Toothpaste (Cinnamon Shine and other flavors incl. Polished Peppermint): $25.99, 1 oz; ingredients: bentonite, kaolin, sodium bicarbonate, nano-hydroxyapatite, monk fruit, montmorillonite; “just as effective at preventing cavities” and “safe if swallowed”; jar label: NET WT 1 OZ (28 g). Open source
Maker's data Arm & Hammer. Essentials Whiten + Activated Charcoal (fluoride-free): ingredients include PEG-8 and charcoal; sold through retailers. Open source
Maker's data Sangi. Apagard Premio product page (Japanese). Open source
Public record / study FDA. Warning letter 687043 to Colgate-Palmolive/Tom's of Maine, Inc., Nov. 5, 2024 (Sanford, Maine inspection May 7–22, 2024): Pseudomonas aeruginosa in water samples June 2021–Oct. 2022; Paracoccus yeei in a released batch of Wicked Cool! Anticavity Toothpaste; “a black mold-like substance”; about 400 uninvestigated complaints. Open source
Public record / study FDA enforcement report D-1084-2023 (Class II, terminated; reported Aug. 23, 2023): 182,046 tubes; “Some hello wild strawberry fluoride toothpaste ... were incorrectly filled in tubes labeled as hello fresh watermelon fluoride free toothpaste” (via openFDA). Open source
Public record / study FDA enforcement report D-0598-2021 (Class II; recalling firm Accupac, Inc.): Native Fluoride Toothpaste for Sensitive Teeth, tube “may be incorrectly labeled as Fluoride-Free” (via openFDA). Open source
Public record / study FDA. OTC Monograph M021, Anticaries Drug Products (posted May 2, 2023): active ingredients limited to sodium fluoride, sodium monofluorophosphate and stannous fluoride; indication “Aids in the prevention of dental cavities” (also 21 CFR 355.10 and 355.50). Open source
Public record / study Washington State. RCW 70A.560.020: bans the sale of cosmetic products with “lead or lead compounds at one part per million (ppm) or above” beginning Jan. 1, 2025; in-state retailers could sell existing stock until Jan. 1, 2026. Open source
Public record / study FDA. Limiting lead in lipstick and other cosmetics (content current Nov. 22, 2022): draft guidance recommends no more than 10 ppm lead in cosmetic lip products and externally applied cosmetics; toothpaste isn't named. Open source
Public record / study California Attorney General. Prop 65 60-day notice 2025-02758 (filed July 31, 2025; alleged violator Davids Natural Toothpaste; lead). No complaint, settlement or judgment listed as of Sept. 29, 2026. Open source
Public record / study California Attorney General. Prop 65 60-day notice 2025-03661 (filed Sept. 16, 2025; alleged violators Dr Jen Natural, LLC; Mixt Solutions LLC; Amazon.com Services LLC; lead; toothpaste). No complaint, settlement or judgment listed as of Sept. 29, 2026. Open source
Public record / study California Attorney General. Prop 65 60-day notice search, product “toothpaste” (checked Sept. 29, 2026): includes 2022-01928 (Tom's of Maine Luminous White; lead; withdrawn Oct. 10, 2022) and 2022-01799 (Hello toothpaste; lead; withdrawn Oct. 13, 2022). Open source
Public record / study Taylor KW, et al. Fluoride exposure and children's IQ scores: a systematic review and meta-analysis. JAMA Pediatr, 2025 (74 studies; 13 individual-level studies: −1.63 IQ points per 1 mg/L urinary fluoride, 95% CI −2.33 to −0.93). Open source
Public record / study National Toxicology Program. Monograph on fluoride exposure and neurodevelopment (Aug. 21, 2024): moderate confidence that drinking water above 1.5 mg/L is associated with lower IQ; insufficient data for 0.7 mg/L. Open source
Public record / study Thornton-Evans G, et al. Use of toothpaste and toothbrushing patterns among children and adolescents, United States, 2013–2016. MMWR, 2019: rice-grain smear under 3; no more than a pea-sized amount (0.25 g) ages 3–6; more than 38% of children 3–6 used more. Open source
Public record / study American Dental Association. Statement on FDA action to limit fluoride supplements for children 3 and younger (Oct. 31, 2025). Open source
Public record / study Contemporary Pediatrics. FDA restricts sale of unapproved ingestible fluoride drugs for children (Oct. 31, 2025): enforcement notices to 4 companies. Open source
Public record / study Bergeson & Campbell. Fluoride federal and state actions (2025): Utah HB 81 in effect May 7, 2025; Florida law signed May 15, effective July 1, 2025; Food & Water Watch v. EPA ruling (Sept. 2024). Open source
Public record / study Walsh T, et al. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev, 2019 (96 studies, 1955–2014; most followed for 36 months). Open source
Public record / study Paszynska E, et al. Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial. Sci Rep, 2021 (207 children enrolled, 177 analyzed; 72.7% vs 74.2%; both groups brushed 3 times a day; control was a 500 ppm fluoride kids paste; funded by Dr. Kurt Wolff GmbH). Open source
Public record / study Paszynska E, et al. Caries-preventing effect of a hydroxyapatite-toothpaste in adults: an 18-month double-blinded randomized clinical trial. Front Public Health, 2023 (189 adults enrolled, 171 analyzed; 89.3% vs 87.4% with no DMFS increase vs 1,450 ppm fluoride; co-authors from Dr. Kurt Wolff GmbH). Open source
Public record / study Limeback H, Enax J, Meyer F. Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis. Can J Dent Hyg, 2021 (22 studies; 3-RCT meta-analysis, 17% protection). Open source
Public record / study Pawinska M, et al. Clinical evidence of caries prevention by hydroxyapatite: an updated systematic review and meta-analysis. J Dent, 2024 (authors include Meyer, Enax and Limeback). Open source
Public record / study Wierichs RJ, et al. Efficacy of nano-hydroxyapatite on caries prevention: a systematic review and meta-analysis. Clin Oral Investig, 2022 (very low level of evidence; 6 studies high risk of bias; 6 funded or published by manufacturers). Open source
Public record / study Chatzidimitriou K, et al. The role of hydroxyapatite-based, fluoride-free toothpastes on the prevention and the remineralization of initial caries lesions: a systematic review. J Dent, 2025 (68 retrieved, 4 eligible in-situ trials in people under 25; no significant DMFS/ICDAS differences vs fluoride, RR 0.98; lesion size and fluorescence differed at 6 months). Open source
Public record / study Commission Regulation (EU) 2024/858 (Mar. 14, 2024): nano-hydroxyapatite allowed in toothpaste below 10% and mouthwash below 0.465%, rod-shaped particles only (summary by VeilleNanos). Open source
Public record / study RIVM (Netherlands). New safety data confirms hydroxyapatite in nanoform is safe for oral care products (Sept. 2025): SCCS, June 2025, up to 29.5% in toothpaste and 10% in mouthwash, for rod-shaped particles with at least 87% aspect ratio 3 or less. Open source
Public record / study Riley P, et al. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev, 2015 (10% xylitol fluoride toothpaste: 13% fewer caries vs fluoride-only over 2.5–3 years; 4,216 children; low-quality evidence). Open source
Public record / study Witkowski M, et al. Xylitol is prothrombotic and associated with cardiovascular risk. Eur Heart J, 2024 (fasting plasma xylitol in discovery and validation cohorts of 1,157 and 2,149; top vs bottom tertile HR 1.57; 10 volunteers drank xylitol). Open source
Public record / study Shim YJ, et al. Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a randomized controlled clinical trial. Oral Dis, 2012 (90 people; SLS-free did not reduce number of ulcers or episodes but shortened duration and reduced pain). Open source
Public record / study Alli BY, et al. Effect of sodium lauryl sulfate on recurrent aphthous stomatitis: a systematic review. J Oral Pathol Med, 2019 (4 crossover trials, 124 people). Open source
Public record / study Worthington HV, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev, 2019 (35 trials, 3,929 adults). Open source
Public record / study Grocholewicz K, et al. Effect of nano-hydroxyapatite and ozone on approximal initial caries: a randomized clinical trial. Sci Rep, 2020 (92 adults, 546 lesions; remineralization at 1 year 36.5% with nano-HA gel alone, 69.3% with gel plus ozone). Open source
Public record / study World Health Organization. Guideline: sugars intake for adults and children, 2015 (free sugars under 10% of energy, ideally under 5%). Open source
DA
Dr. Josh Axe, DNM, DC, CNS
Founder, DrAxe.com
Dr. Axe is a doctor of natural medicine, chiropractor and clinical nutritionist with more than 20 years in functional medicine, and the founder of DrAxe.com.
How we make money: We may earn a commission when you buy through links on this page. It never changes our rankings: products are scored before any affiliate terms are discussed, brands can’t pay for placement, and we recommend products whether or not they have an affiliate program. Scores are editorial assessments based on independent lab reports, brand pages and public records, not our own lab testing. See also our mineral sunscreen rankings.
