As soon as your baby’s first teeth come in—which can start as early as 6 months—you’ll want to get started with toothbrushing, according to the American Dental Association. Children under three should have their teeth cleaned twice a day with a soft-bristled toothbrush and a rice-grain-sized dab of kids’ toothpaste.
What’s important to have in that toothpaste? Should it include fluoride, as is recommended for adults? And what about all of those chemicals in the ingredients list—do any of them raise concerns, either for your child’s health or for the environment?
To answer these and other questions, Consumer Reports partnered with Made Safe, a nonprofit organization that screens products for safety and sustainability, to evaluate the ingredients in 10 children’s toothpaste, and we consulted with pediatric dental experts and reviewed the most recent advice from the ADA.
Here’s what we learned.
What to Look for in Kids’ Toothpaste
Fluoride: According to the ADA, fluoride should be in all toothpaste, even those for children. Just a smear the size of a grain of rice can help prevent cavities and is safe, says Mirissa Price, DDS, a pediatric dentist and consumer adviser for the ADA. So, all of the products we like best have that key ingredient.
No hidden ingredients: In addition, kids’ toothpaste often comes flavored, though the ingredients used to make them are trade secrets and companies don’t have to—and often don’t—disclose them. Our favorite toothpaste comes from companies that list the ingredients used to make their flavors on their labels or websites or are at least willing to tell us what those ingredients are. For example, Hello told us it uses orange oil in its Kids Magical Mermaid Fluoride Toothpaste and Tom’s of Maine’s website says its Kids’ Anticavity Natural Silly Strawberry toothpaste gets its flavor from strawberry and other juices. Burt’s Bees, Colgate, and Crest, on the other hand, didn’t respond to our questions about what they use in their flavors.
Child-safe and planet-safe ingredients: Finally, we looked for products without ingredients that raise safety concerns, either for health reasons or because they might harm the environment in one way or another. That includes things like titanium dioxide and blue dye 1, both of which are added as colorants to many products. Some research has linked certain dyes to hyperactivity in children and titanium dioxide to potential damage to the body’s genetic material and immune system. The European Union has banned titanium dioxide in food, and here in the U.S., California and Pennsylvania are considering taking similar steps against several food dyes.
Keeping risks in perspective: If your child is already using a kids’ toothpaste that didn’t make our experts’ “safe” list, don’t panic. The experts we spoke to stressed that none of the ingredients they flagged pose immediate health risks to children. That said, we feel that parents should be aware when certain ingredients are suspected (or known) to have a negative environmental effect or may present potential harm over time with repeated exposure. We also know that cost and availability are important considerations for families—it’s worth noting, for example, that Hello’s toothpaste costs roughly twice as much per ounce as Colgate’s or Crest’s. So we encourage you to use this report as a guide, balancing effectiveness, possible risks, and cost as you choose the right product for your family.
Kids’ Toothpaste Review
Consumer Reports and Made Safe partnered to analyze the ingredients list for seven kids’ toothpastes with fluoride. The “Best” toothpastes shown below contain safer and more sustainable ingredients.
Two toothpastes – Hello Kids Magical Mermaid Fluoride Toothpaste and Jason Sea Fresh Anti-Cavity & Strengthening Toothpaste stood out as favorites, containing safer and more sustainable ingredients.
ACT Kids Anticavity Toothpaste and Tom’s of Maine Kid’s Natural Silly Strawberry, both contained ingredients with possible risks.
And three products—Burt’s Bees Kids Strawberry Splash, Colgate Kids Cavity Protection Bubble Fruit, and Crest Kid’s Crest Cavity Protection Sparkle Fun Toothpaste—contained titanium dioxide and other ingredients linked to potential health concerns.
None of these three companies responded to requests for comment on their product’s ingredient safety.
While the American Dental Association recommends fluoride in all toothpastes, some parents prefer to give their children products without it. So our analysis included these three toothpastes without fluoride that are otherwise good choices because the manufacturers disclose all of the ingredients used to make their flavors and the products lack other ingredients of concern: Aramoon Kids Toothpaste 2nd step, BOTAO Baby Strawberry Flavored Toothpaste, and Risewell Cake Batter Kids Mineral Toothpaste.
Kids’ Toothpaste Companies Respond
CR asked companies with undisclosed flavors to provide complete ingredient lists. Hello, the maker of Kids Magical Mermaid Fluoride Toothpaste, told us that they disclose flavor ingredients at or above 100 parts per million in the finished product. They also said that orange oil is the only such flavoring they use. All other companies with undisclosed flavors did not respond. We also asked companies to comment on known and suspected ingredients of concern. Tom’s of Maine confirmed that the sodium lauryl sulfate (SLS) in its Kid’s Natural Silly Strawberry is non-ethoxylated, which means it is a safer form of that chemical. All other companies did not respond to our request for comment on ingredient safety.
Tips for Safer and More Sustainable Kids’ Toothpaste
Try one of our top picks from our review above. You can also shop better by following our tips below. And note that there’s no need to stick to toothpaste specifically labeled for kids, Price says. Children can use adult toothpaste as long as it contains fluoride and doesn’t address oral health concerns beyond cavity prevention, such as gum disease or teeth whitening.
Be cautious of titanium dioxide. This ingredient is mainly used in toothpaste to make it appear whiter and brighter. While more research is needed on how much titanium dioxide is consumed from brushing our teeth, the ingredient has been banned in foods in the European Union because of the possibility that it could damage the body’s genetic material and undermine its immune system. In the U.S., CR supports a bill in California that would ban titanium dioxide from foods served in the state’s public schools. Numerous public health interest organizations have petitioned the FDA to ban the ingredient from foods in the U.S.
Be wary of dyes. Not all the dyes used in toothpaste pose risks, though several have raised concerns. For example, blue dye 1 and some others are linked to hyperactivity in children. You can spot dyes on labels by looking for a color, generally followed by a number and sometimes preceded by FD&C. Examples include: FD&C Blue No. 1, Blue No. 2, Red No. 3, and Yellow No. 6. As with titanium dioxide, six harmful dyes are up for a proposed ban in California public schools, due to their link to neurobehavioral problems in some children.
Shop for toothpaste with disclosed flavors. Because it’s impossible to know what you’re exposed to without ingredient disclosure, choose a toothpaste with all of its ingredients listed on the packaging. Steer clear of those that use catch-all terms like “flavor,” “artificial flavor,” or even “natural flavor.” This will help you avoid flavor ingredients that have been linked to human and environmental health issues, such as acetamide, which is associated with cancer, and musk ambrette, which may interfere with fertility reproductive toxicity and environmental harm.
Avoid ethoxylated ingredients. These are ingredients that use ethylene oxide, an ingredient linked to cancer when inhaled, in manufacturing. The process also gives rise to a contaminant linked to cancer called 1,4-dioxane. Because both of these ingredients are contaminants, you won’t find them listed on labels, but you can spot ethoxylated ingredients by looking for the terms PEG and polysorbate, typically followed by a number (for example, PEG-8, Polysorbate 20), as well as the suffix “-eth” like in “laureth”.
Toothbrushing How-to for Kids
The keys to brushing for kids? Using the right amount of paste and pressure, brushing the right amount, and adult supervision.
Children under 3 years old should use a dab of paste that’s about the size of a grain of rice, says the ADA’s Price. After that age, a pea-sized amount is sufficient. Adults should watch kids when they brush until they can spit out excess toothpaste themselves. Use a soft or extra-soft bristled brush, with gentle pressure. Finally, brush twice a day, for two minutes each session.
Expert-Recommended Toothbrush Options for Kids
In addition to choosing the right toothpaste, it’s also important to select an appropriate toothbrush.
“Children can usually start brushing their own teeth between the ages of about three and six, and while some research does suggest that an electric toothbrush may reduce plaque slightly more than using a manual, really whichever brush your child likes and will use consistently is best.”
In Consumer Report’s tests, Philips Sonicare for Kids came out on top, excelling at cleaning and ease of use.
For a more affordable option, this Brusheez Electric Set excelled at cleaning.
By making informed choices about your child’s dental products and encouraging good brushing habits, you can help set them up for a lifetime of healthy smiles.