The Need for Toothpastes with Lower than Conventional Fluoride Concentrations for Preschool‐aged Children

Abstract

Since 1945, when community water fluoridation was first implemented in the United States, not only has the procedure grown to cover more than half of the US population, but the development and use of other fluoride methods have expanded greatly. A concomitant, dramatic decrease has occurred in the caries prevalence of US school-aged children. Recent studies indicate, however, that the prevalence and, to a lesser extent, the intensity of dental fluorosis have increased in schoolchildren in both fluoridated and fluoride-deficient areas. Several studies show that young children inadvertently ingest sizable proportions of toothpaste during toothbrushing. Although ingestion of fluoride toothpastes by preschool-aged children may not be the major contributor to the increase in fluorosis, the findings of at least four studies suggest that the use of fluoride toothpastes by young children is a risk factor. The direct dose-response relation between effectiveness and fluoride concentration of toothpastes is far from clear-cut and, at best, is weak. Thus, considering today's reduced risk of caries, it is timely to market fluoride toothpastes in the US with 400-500 ppm fluoride for preschool-aged children, who are still at risk for developing fluorosis, as has been done in several other countries. Dental public health authorities must work with toothpaste manufacturers, professional organizations, and regulatory agencies to facilitate the approval and marketing of such pediatric fluoride toothpastes.

Effect of 1000 or More ppm Relative to 440 to 550 ppm Fluoride Toothpaste - A Systematic Review

“…The results of different estimations of the combined effect following the meta-analytic procedures with heterogeneous criteria, using the Dersimonian-Laird random effect model are shown in the metaview (7,8,14,17).…”

“…There is concern about dental fluorosis related to the chronic intake of excessive quantities of fluoride in children under 6 years of age. Some authors have reported that the early use of fluoridated toothpastes in young children is a very important risk factor (13,17,22,33,34). Beside fluoride concentration, the duration and age of exposure are important factors in fluorosis prevalence (2).…”

Effect of a Low–Fluoride–Content, Two–Component Rinse on Fluoride Uptake and on De– and Remineralization of Enamel Lesions: An in vitro Study

“…Recent concerns about the prevalence of dental fluorosis [Pendrys and Stamm, 1990;Horowitz, 1992;Levy, 1993] suggest the need to develop low F rinses and dentifrices; however, it is important that such formulations maintain a high level of anticaries activity [Winter et al, 1989;Holt et al, 1994]. Low-F two-component rinses and perhaps dentifrices can be devised to address these concerns.…”

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 .…”