A Critique of Topical Fluoride Methods (Dentifrices, Mouthrinses, Operator‐, and Self‐applied Gels) in an Era of Decreased Caries and Increased Fluorosis Prevalence

Abstract

Within the last 20 years there has been a decrease in the caries prevalence of US schoolchildren, a change in the intraoral caries pattern, and a slowing of the progress of lesions. Simultaneously, the prevalence of enamel milder, cosmetically acceptable forms and is more noticeable in fluoride-deficient communities than those with optimal or above-optimal water fluoride concentrations. Circumstantial evidence indicates that a principal contributor to the caries decline is the extensive use of fluoride dentifrices. Conversely, although use of a fluoride dentifrice can add to the total daily amount of ingested fluoride in preschool children, there is little evidence to suggest that dentifrice ingestion is a principal factor causing the fluorosis increase. The value of fluoride methods may be assessed in relative or absolute terms. The relative, or percentage, caries reduction attributed to fluoride mouthrinses and gels appears to be a property intrinsic to the methods themselves and generally is little affected by the caries activity of the population being treated. Conversely, the absolute, or numerical, caries reduction is dependent upon the level of disease in the population. Thus, the reported caries decline reduces the number of surfaces prevented from developing caries, even though the percentage reduction remains substantially unchanged. Although inadvertent ingestion of fluoride can result from the use of mouthrinses and gels, there is little evidence to suggest that they have contributed to the fluorosis increase. When using topical methods, prudence should prevail to avoid ingestion of fluoride. Fluoride dentifrices should continue to be used routinely, and although lower potency dentifrices may be considered, the literature does not provide strong support for their need. Use of fluoride mouthrinses and gels for individual patients should be predicted upon their caries activity or risk. Use of these methods in public health programs is a matter of cost-effectiveness, which will be influenced by the caries prevalence of the target population.

Toothpaste Utilization Profiles among Preschool Children

“…Multiple tooth brushing episodes each day, probably can result in ingestion of excess fluoride, especially by children [25]. Commonly, it is recommended that tooth brushing should be done twice daily, at least to maintain good oral health and also we should not ignore the fact that effectiveness of tooth brushing is much more important than frequency of tooth brushing Young children lack complete mastery of the swallowing reflex [21,[25][26][27] and children under the age of six years may ingest 25-65% of the dentrifice which is placed on the tooth brush [28,29]. Parents should be educated regarding total fluoride ingestion and its ill effects in children.…”

Fluorose dentária: comparação de dois estudos de prevalência

“…De fato, a interpretação dos resultados relativos aos estudos de fluorose dentária e suas implicações para a Saúde Coletiva têm desafiado os pesquisadores e os sanitaristas nas últi-mas duas décadas, especialmente em virtude da multiplicação das fontes de flúor, do risco potencial que isso tem representado para a ocorrência de fluorose e o efetivo aumento observado em sua prevalência em diversas partes do mundo, em regiões com e sem as águas de abastecimento fluoretadas 4,5,7,8,26 . Essa elevação tem sido atribuída basicamente à associação de métodos sistêmicos (água + medicamentos + polivitamínicos) e à ingestão de flúor a partir do uso inadequado de produtos tópi-cos, principalmente cremes dentais na primeira infância.…”

“…Alguns autores notaram maior aumento proporcional em locais com teores deficientes de flúor na água 4,5 ; outros observaram diferenças pequenas entre áreas fluoretadas e não fluoretadas 6,7 ; e outros, sem entrar no mérito do seu aumento, atribuíram a ocorrência das formas leves à fluoretação da água 8 .…”

Evaluation of fluoride bioavailability in toothpastes

“…As the beneficial effect of topical fluoride has been proven through number of studies 2,3) , there was a huge improvement on the topical fluorides, with toothpaste still remaining as the most widespread and significant form of fluoride 4,5) . There was a Cochrane systematic review that also emphasized the role of fluoride toothpaste in anti-caries activity, yet it stated that the concentration of fluoride in toothpastes needs to be 1,000 ppm or more in order to be effective 6) .…”