Role of Fluoride Toothpastes in a Caries-Preventive Strategy

Abstract

While the clinical relevance of fluoride toothpastes per se is firmly established, the multifactorial processes involved in causation and prevention of caries render it difficult to define their exact role in an overall caries-preventive strategy. Therefore, an indirect pragmatic approach was chosen: the interpretation of secular trends in caries prevalence and other parameters is used to estimate the relative importance of this method of topical fluoride administration and to compare it with the contributions by other methods of prevention. All methods of caries prevention, with the exception of population-administered measures such as fluoridation of drinking water or domestic salt, can only work when applied regularly and conscientously. For this reason behavioural aspects such as compliance and the chances for widespread (if not universal) application have to be considered. There is indirect evidence that toothbrushing with fluoride toothpastes is a highly probable explanation for the decline of caries prevalence in developed countries since the 70s; moreover, toothbrushing, and the use of therapeutic dentrifices, is considered to meet spreading compliance because a ‘healthy mouth’ becomes more and more socially desirable in growing numbers of subpopulations.

The Relationship Between Diet, Nutrition and Dental Health: an Overview and Update for the 90s

“…For a comprehensive account of the role of fluoride dentifrices the reader is referred to Murray et af. (1991) and Konig (1993). A significant amount of fluoride is, however, provided by the diet, in water and other food items, and the effectiveness of this in caries prevention is summarized below.…”

Oral Health in the United States: The Post-Fluoride Generation

“…Tooth brushing disrupts cariogenic plaque mechanically and serves as an excellent vehicle to deliver fluoride to the plaque-tooth interface. In countries where caries prevalence has declined, the single common factor appears to be fluoride toothpaste (58,65,119).…”

“…Some countries have developed toothpastes with a content of <500 ppm to avoid chronic toxic effects of fluoride (65). But these toothpastes have been reported to be less effective (93,112).…”

“…The greatest hazard occurs with the use of 1.23% APF gel, because only 4-8 ml of these gels contain the probable toxic dose for children between 10 and 20 kg in weight (20-40 lb) (65). The acute side effects of ingesting high amounts of fluoride include nausea, vomiting, abdominal pain, and hypersalivation (36).…”

Fluoride Level In Dentifrices

“…These reports were not limited to areas with optimal fluoride water but include fluoride deficient communities as well (7,8). While the fluoride regiments used may differ, what is common in all these areas is the use of dentifrices containing between 1000 to 1500 ppm of fluoride (9,10). In view of this, researchers had in turn expressed concern in that fluoride from fluoridated toothpastes might be a contributing factor to fluorosis when excessively ingested by young chiidren (3,(10)(11)(12)(13).…”