What’s Up With Toothpaste in 2026

Toothpaste was simple 30 years ago, with a few big brands, and dentists recommended you choose from those with the ADA (American Dental Association) approval. The options have multiplied, so how do you choose a toothpaste, and what is recommended in 2026? That answer is as varied as the number of toothpaste options available.  This article will explain the newest categories and options available to simplify your choices.

Fluoride toothpastes are still the foundation for cavity prevention and considered the gold standard. Brands like Crest and Colgate rely on fluoride because it works and have demonstrated safety and effectiveness. Fluoride helps reduce mineral loss during acid attacks and helps rebuild enamel when your mouth returns to normal pH. Over time, it makes teeth more resistant to future decay. From an evidence standpoint, fluoride remains the most reliable option for most people.

If you have a high cavity risk, there is a stronger, prescription strength fluoride toothpaste (typically 5000 parts per million fluoride). This is especially helpful for those with frequent cavities, dry mouth, orthodontic appliances, or significant restorative history. Not everyone needs it, but in the right situation, it can be very safe and effective.

There is a recent surge in people avoiding fluoride for various reasons. Nano-hydroxyapatite (nHAp) has become the most promoted alternative in anti-fluoride circles. Brands like Boka, RiseWell, and Davids use this enamel-like mineral to help fill microscopic surface defects. Think of it more like a mineral patch or scaffold. Early research is encouraging that it can smooth the and surface and may provide a small anticavity effect. Compared to fluoride, it has not yet demonstrated the same level of long-term evidence for stopping or reversing early cavities. Research is ongoing, so at this time, nHAp toothpaste is only recommended for those who refuse fluoride or are low cavity risk. Another downside is a much higher cost.

Calcium-phosphate is another alternative that is being promoted as a fluoride alternative which has some positive attributes. It that provides the building blocks of enamel to support remineralization and can help with sensitivity. Again, helpful — but not as deeply studied for cavity prevention as fluoride.

Among the fluoride toothpastes, there are many varieties such as sensitivity, whitening, gum health, and more. Each has a place depending on your specific situation.

Charcoal and many herbal or “natural” toothpastes continue to trend. Charcoal is marketed heavily for whitening, but meaningful cavity-prevention evidence is limited. Herbal pastes may offer mild antimicrobial effects, but unless they include fluoride or another proven remineralizing ingredient, their decay protection is less predictable.

The bottom line in 2026 is that there is no magic toothpaste or one size fits all.  Fluoride still has the strongest evidence for preventing cavities but there are alternatives that show promise. When it comes down to it, the physical act of brushing off the plaque and food debris is critical. The toothpaste in combination with brushing long enough (two minutes typically), often enough (twice a day for most), with good technique (high end electric brushes like Sonicare are excellent), and maintaining healthy dietary habits will give you the best oral health possible.

Originally printed in the Capital Democrat February 2026 and authored by Dr. Joiner