A: The American Dental Association always wants you to use a toothpaste with fluoride. I always recommend fluoride first.
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If parents are absolutely adamantly against fluoride, then I recommend a product containing xylitol. Studies have shown that it may work as an anti-cavity agent, but it is not a substitute for fluoride. There are also reports of abdominal distress and diarrhea when it’s consumed, so I always warn parents about that.
With some other ingredients in natural toothpastes like coconut oil, there’s no evidence that they reduce cavities or improve oral health. Another ingredient we absolutely do not want for pediatric patients is activated charcoal – it’s too abrasive.
— Pediatric dentist Trista Onesti, DDS