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What, no fluoride? Other ways to improve oral health

Dec. 4, 2019
Your patients may prefer to avoid fluoride for diverse reasons. The good news is that there are many innovative fluoride-free dental products that can help these patients maintain oral health.

Fluoride is a mineral naturally found in soil, water, and foods, and not quite the poison some would argue. It has a negative connotation when people equate an overdose of fluoride with a beneficial dose. As the saying goes, “Everything in moderation.” A glass of wine a day is proven to be healthy while a bottle of wine a day is not. Although fluoride is very beneficial in hardening enamel to lower the risk of cavities, there are other great alternatives. Patients may prefer products without fluoride for many reasons, including medical conditions, personal beliefs, lack of knowledge, or simply because the literature they’ve read has convinced them that fluoride is less of a benefit and more of a risk.

Coral Nano Silver toothpaste

Coral toothpaste is the only toothpaste with the duo of coral calcium and SilverSol technology. Its purpose is to restore enamel while annihilating over 650 types of bacteria and pathogens. Its patented Nano Silver is antibacterial, antimicrobial, anti-inflammatory, and antifungal. This Nano Silver technology uses Ag404 molecules that have been shown to be 10 times more effective in destroying bacteria than silver alone. Each silver core has thousands of Ag404 molecules to create a silver oxide coating.1

These silver molecules remove the electrons from pathogenic bacteria, causing death to harmful bacteria while being harmless to good bacteria.

The coral calcium element is scientifically proven to neutralize acid and restore oral pH balance. This toothpaste contains the purest form of coral calcium with 73 essential trace minerals. The coral is mined from “eco-safe” mines, earning the Friend of the Sea certification. The toothpaste claims to be probiotic friendly since the all-natural silver kills just the bad germs and avoids the good germs.1 It is embedded with 15% xylitol, which prevents bacteria from sticking to the teeth and helps repair weakened enamel.

Coral Nano Silver is free of sodium lauryl sulfate (SLS), glycerin, parabens, and fluoride. It is all-natural, safe to swallow, kid friendly, and best of all, it tastes great with essential oil flavorings. Products include toothpaste and mouthwash, and they even offer a toothbrush.


Theodent is an elegantly packaged toothpaste that resembles an expensive, high-quality chocolate bar. This nontoxic, swallowable alternative to fluoride uses a patented ingredient called Rennou. The active ingredient in Rennou is theobromine, a cacao extract, also found in chocolate. Theobromine is blended with calcium and phosphate to maximize remineralization of enamel.2 Enamel is the hardest substance in the body and the most highly mineralized, primarily by hydroxyapatite. Rennou catalyzes the growth of larger hydroxyapatite crystals with the help of  calcium and phosphorus to harden the enamel. Regular enamel has the hydroxyapatite unit crystal of about half a micron, while enamel exposed to theobromine encourages hydroxyapatite unit crystals to quadruple to two microns. These larger crystals make enamel more resistant to bacterial acid erosion, thus improving the health of the teeth.3

Theodent Classic is the company’s initial product, made by extracting theobromine from the cocoa bean and using it as a fluoride alternative to harden enamel. Theodent 300 claims to have the highest dose of Rennou in toothpaste. It is the company’s extra-strength formula. Theodent Kids is the newest addition to the Theodent product line with a chocolate chip flavor. Theodent Kids is SLS free, nontoxic, and safe to swallow, and, like all Theodent products, has an FDA status of GRAS (generally recognized as safe).3


Xylitol is a great alternative to fluoride in preventing dental decay. It is a natural sweetener classified as a sugar alcohol, extracted from the fibrous parts of plants. It is derived from corn or birch, with corn being more widely used since it is easily renewable and cheaper than birch. Corn xylitol is produced to pharmaceutical standards while birch xylitol is produced to food standards, which are less rigorous. Patients with corn allergies should be cautious when using xylitol, although after processing there are no proteins left in the finished product that tend to cause allergies. This sugar alcohol is not digestible by oral bacteria, nor is it digestible by bacteria in the rest of the digestive system. It doesn’t get absorbed into the bloodstream from the small intestine, so there is a tendency to cause gastrointestinal issues.

Xylitol’s dental purpose is to inhibit the growth of Streptococcus mutans. Based on scientific evidence from the ADA and FDA, xylitol is recognized as a contributor to oral health.4 Xylitol starves bacteria and neutralizes the pH level, whereas sugar combines with plaque and lowers the pH level to create an acidic state.

Sugar and xylitol are opposites when combining with plaque. Sugar is a catalyst, causing a strong accord with bacteria, damaging enamel. The prolonged acid saturation of sugar and plaque lasts for approximately 20 to 40 minutes. With repeated consumption of sugary drinks or snacks, the oral environment may remain acidic for hours, leaving teeth demineralized and decayed over time.

Xylitol does not feed bacteria as sugar does. Even though bacteria do consume xylitol, they cannot use xylitol to grow and reproduce, leaving the bacteria to starve to death. Since S. mutans cannot utilize xylitol for growth purposes, it prevents proliferation of pathogenic bacteria. With repeated xylitol use, the quality and quantity of bacteria in the mouth changes, and fewer decay-causing bacteria survive on the teeth. Over time, less plaque accumulates, causing less acidity and a more neutral pH.

Xylitol largely absorbs into the saliva, causing the saliva concentration of basic amino acids and ammonia to rise, thus increasing the oral pH. When the pH level is above 7, calcium and phosphate salts in the saliva start to strengthen the weaker areas of enamel.5

Since xylitol is a natural sweetener, it can be a blood sugar regulator, which is good for diabetes and the oral/systemic health correlation. Since xylitol is an alcohol sugar, it isn’t completely absorbed into the small intestine, leaving a small amount to be fermented in the large intestine. With this slow process and very little absorption, minimal or no insulin is released. As we know, when blood sugar is stable, oral health tends to be more stable.

Not only is xylitol found in foods, it is also found in oral health products such as toothpaste, mouthwash, chewing gum, candy, and mints. Although the indigestible aspect of xylitol is harmless to humans, it can be a danger to dogs. Even small amounts in dogs can be extremely toxic. A tiny portion can be enough to cause seizures, hypoglycemia, liver failure, and even death in dogs.


Arginine is an amino acid that is naturally found in saliva. When combined with calcium, arginine has been clinically proven to be effective in reducing dental caries and treating dentinal sensitivity.6 Arginine is metabolized by oral bacteria that raise the pH. In laboratory studies, arginine was proven to disrupt and stop the formation of dental plaque.

Arginine bicarbonate coupled with calcium carbonate helps prevent sensitivity by plugging and sealing dentinal tubules, thus preventing fluid from reaching the nerve of the tooth.

Arginine products include Colgate Sensitive Pro-Relief toothpaste (which is not available in the United States, but is available in Canada and some other countries), Tom’s of Maine Rapid Relief Sensitive toothpaste, Colgate Anywhere, Anytime sensitivity relief serum, and BasicBites.


BasicBites are sugar-free soft chews, offered in two great flavors of chocolate and caramel. The combination of arginine, calcium, and bicarbonate calcium helps maintain healthy teeth by enriching and fortifying the enamel. BasicBites also support a favorable pH level to fight against dry mouth and bacterial acids by coating and replenishing the mouth with vital nutrients.7

BasicBites are recommended with diets high in sugar, dry mouth, or when extra oral care support is needed. Just two chews a day are proven to be beneficial as an adjunct to oral care. They are free of gluten, dairy, preservatives, and contain no artificial sweeteners, colors, or flavors. BasicBites are also a good source of calcium, with 200 mg in one chew. BasicBites also have the benefit of xylitol in increasing pH for healthier enamel.

These alternatives to fluoride have been proven beneficial for a healthy mouth. Suggesting xylitol, coral calcium, silver, arginine, and theobromine provides beneficial options to patients who choose not to use fluoride.


  1. Coral Nano Silver website. https://shop.nanosilvertoothpaste.com.  Accessed October 4, 2019.
  2. Theodent website. http://www.theodent.com/index.html. Accessed October 4, 2019.
  3. Helwick C. “Chocolate-based” toothpaste remineralizes enamel. Medscape website. November 8, 2013. https://www.medscape.com/viewarticle/814085. Accessed October 4, 2019.
  4. Sollid K. What is xylitol? International Food Information Council Foundation. January 3, 2019. https://foodinsight.org/what-is-xylitol/. Accessed October 3, 2019.
  5. Xylitol.org website. https://xylitol.org/xylitol-uses/dental-benefits-of-xylitol/. Accessed October 3, 2019.
  6. Nanne S. Arginine: new study exposes additional oral health benefits. Dentistry iQ website. September 2, 2015. https://www.dentistryiq.com/dental-hygiene/clinical-hygiene/article/16349990/arginine-new-study-exposes-additional-oral-health-benefits. Accessed October 3, 2019.
  7. BasicBites website. https://www.basicbites.com/.

Lara James, RDH, is a licensed dental hygienist with more than 15 years of clinical hygiene experience in corporate, dental management, and private practices. She has created DentalAisle.com, a dental blog to educate consumers on dental products and dental issues. Lara also has written an online continuing education course on dentalcare.com. For more information, email her at [email protected].