The Fluoride Debate: Why xylitol is a better ally when it comes to preventing cavities

In the US we have an epidemic of cavities in children’s teeth, but the facts are that fluoride has no power to prevent cavities. Cavities are caused by bacteria that erode holes in teeth, and fluoride does nothing to help us fight these bacteria (except at dangerously strong concentrations, when it works as a poison to kill them).

The usefulness of fluoride is to promote tooth repair, after damage has been done. If enamel crystals re-grow in the presence of fluoride, they become bigger, smoother, and more perfect, than enamel formed without fluoride. Big crystals have the opportunity to connect with each other, providing a way to bridge gaps and heal holes in the tooth’s outer layer. We know that a smoother outer layer will reflect light, to make teeth shinier and appear whiter. More importantly, a strong outer layer will better resist future attacks by mouth acidity.

Enamel repair and re-building happens every time a weak solution of fluoride is in contact with damaged tooth enamel. There is no reason to drink fluoride, since the benefits are from the interaction of fluoride with the tooth surface. Toothpaste and rinses offer these benefits without the risks that come from ingesting a toxic kind of fluoride, or too much of it.

Most fluoride in tap water is a silico-aluminum fluoride compound, a product of industry that has never been approved by the FDA for human consumption. If someone regularly drinks a lot of water, they may ingest too much of this, and it can concentrate in bones to make them brittle. Fluoride toxicity is a real concern for young children or if you have damaged kidneys or delicate bones. Formula milk has fluoride in the powder and so it should never be mixed with fluoridated tap water. The American Academy of Pediatric Dentistry warns fluoride-free bottled water should always be used to mix formula milk. In the same way, fluoridated toothpaste should not be recommended for small children, since they usually swallow paste. Xylitol granular crystals on a toothbrush would be a much better alternative to toothpaste for young children. (The only time we recommend a tiny amount of fluoridated paste for a young child is if they have cavities).

A study from Environmental Health Perspectives in July this year showed ingesting high levels of fluoride may harm children’s brain development. The study was a systematic review and showed children in high fluoride areas had lower IQ scores than peers in low fluoride areas. These studies were in China where fluoride levels are extremely high (as a contaminant from industry). You cannot extrapolate this study to fluoridation in the US, but neither should you believe that a lack of fluoride causes tooth decay.

A comparison of the oral health benefits of xylitol and fluoride

The synergistic effects of Xylitol & Dilute Sodium Fluoride

The effect of xylitol and fluoride is synergistic. This means that when you use xylitol it is beneficial, and fluoride can also be beneficial (if you have damaged teeth). When you use these products together for oral health, the effects are greater than you expect by using each product alone.

The following picture shows the cavity-healing effects of using both xylitol and fluoride. The complete study from the Journal of Oral Science can be found HERE. One of the conclusions of this specific study showed that remineralization is accelerated when xylitol is used with fluoride.

How to use xylitol for oral health

We have a number of articles in the Ultimate Oral Health blog that talk about how to best use xylitol for oral health. Here are some quick tips as well as some links to past articles.

  • Zellies Granular Xylitol can be wiped on infant teeth to protect them
  • Zellie Bears can be used to protect toddlers and young children from cavities, by cleaning their teeth after meals and before sleeping
  • Zellies can help prevent cavities in adult teeth. Eat Zellies Mints or Gum after meals, snacks or drinks as all their new teeth erupt.

Approximate conversion: (1 teaspoon xylitol = 5 grams of xylitol = 5 pieces Zellies gum = 10 Zellies mints= 3 ZellieBears/Polar Bears)

Remember best results are seen when you have at least 5 exposures to xylitol throughout the day, with a total amount of 5-10 grams per day.

For more information on fluoride, click HERE to read the chapter dedicated to this topic in Dr. Ellie’s book “Kiss Your Dentist Goodbye“.

For more information on xylitol, please check out the following articles:


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About the Author Dr. Ellie

My passion is educating people about oral health. For decades I’ve worked with patients of all ages, in different countries, in high and low-risk communities, and from every walk of life. I’ve seen the same results over and over again –people who transformed their oral health – sometimes in days or weeks, even after they had suffered years of pain and frustration. It’s never too late, and my ways will give you the key to a lifetime of improved oral health.

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