Topical fluoride as a cause of dental fluorosis in children

Abstract

BackgroundFor many years, topical use of fluorides has gained greater popularity than systemic use of fluorides. A possible adverse effect associated with the use of topical fluoride is the development of dental fluorosis due to the ingestion of excessive fluoride by young children with developing teeth. ObjectivesTo describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis. Search strategyElectronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, EMBASE, BIOSIS, Dissertation Abstracts and LILACS/BBO. Reference lists from relevant articles were searched. Date of the most recent searches: 9th March 09. Selection criteriaRandomised controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies and cross-sectional surveys, in which fluoride toothpastes, mouthrinses, gels, foams, paint-on solutions, and varnishes were compared to an alternative fluoride treatment, placebo or no intervention group. Children under the age of 6 years at the time topical fluorides were used. Data collection and analysisData from all included studies were extracted by two review authors. Risk ratios for controlled, prospective studies and odds ratios for case-control studies or cross-sectional surveys were extracted or calculated. Where both adjusted and unadjusted risk ratios or odds ratios were presented, the adjusted value was included in the meta-analysis. Main results25 studies were included: 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias. Studies were included in four intervention/exposure comparisons. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months odds ratio 0.70 (random-effects: 95% confidence interval 1 Topical fluoride as a cause of dental fluorosis in children (Review)

Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial

“…Regarding caries experience at baseline, our data is in line with previous observations for the permanent dentition that the effect of fluoride toothpaste increases with higher baseline levels of DMFS [17]. Taken together, these data reinforce the concept that for part of the population (caries-free children), the use of LFDs may be a viable option, given that it considers risks and benefits for both caries control and fluoride intake during toothbrushing [3,5,18].…”

Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial

“…Regarding caries experience at baseline, our data is in line with previous observations for the permanent dentition that the effect of fluoride toothpaste increases with higher baseline levels of DMFS [17]. Taken together, these data reinforce the concept that for part of the population (caries-free children), the use of LFDs may be a viable option, given that it considers risks and benefits for both caries control and fluoride intake during toothbrushing [3,5,18].…”

Current Guidance for Fluoride Intake: Is It Appropriate?

“…Comments on the Review. The results on the association between levels of fluoride in toothpastes and the occurrence of fluorosis differ from the results reported in the systematic review by Wong et al (2010). Indeed, the latter review found the opposite: a higher level of fluoride in the toothpaste was significantly associated with fluorosis.…”

Fluoride toothpaste efficacy and safety in children younger than 6 years

“…Our meta-analysis of three case-control studies ( Figure 5 23,25,26 ) showed that beginning to brush with a fluoride toothpaste after 24 months of age decreased the odds of having dental fluorosis (OR [95 percent CI] = 0.66 [0.48-0.90]) compared with initiation of fluoride toothpaste use before 24 months of age. The direction and statistical significance of our finding did not differ from those in the previously conducted meta-analysis, 8 whereas the addition of the study by Pendrys and colleagues 23 did decrease the magnitude of effect twofold.…”

Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial

“…Regarding caries experience at baseline, our data is in line with previous observations for the permanent dentition that the effect of fluoride toothpaste increases with higher baseline levels of DMFS [17]. Taken together, these data reinforce the concept that for part of the population (caries-free children), the use of LFDs may be a viable option, given that it considers risks and benefits for both caries control and fluoride intake during toothbrushing [3,5,18].…”

Current Guidance for Fluoride Intake: Is It Appropriate?

“…Comments on the Review. The results on the association between levels of fluoride in toothpastes and the occurrence of fluorosis differ from the results reported in the systematic review by Wong et al (2010). Indeed, the latter review found the opposite: a higher level of fluoride in the toothpaste was significantly associated with fluorosis.…”

Fluoride toothpaste efficacy and safety in children younger than 6 years

“…Our meta-analysis of three case-control studies ( Figure 5 23,25,26 ) showed that beginning to brush with a fluoride toothpaste after 24 months of age decreased the odds of having dental fluorosis (OR [95 percent CI] = 0.66 [0.48-0.90]) compared with initiation of fluoride toothpaste use before 24 months of age. The direction and statistical significance of our finding did not differ from those in the previously conducted meta-analysis, 8 whereas the addition of the study by Pendrys and colleagues 23 did decrease the magnitude of effect twofold.…”

Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial

“…Regarding caries experience at baseline, our data is in line with previous observations for the permanent dentition that the effect of fluoride toothpaste increases with higher baseline levels of DMFS [17]. Taken together, these data reinforce the concept that for part of the population (caries-free children), the use of LFDs may be a viable option, given that it considers risks and benefits for both caries control and fluoride intake during toothbrushing [3,5,18].…”

Current Guidance for Fluoride Intake: Is It Appropriate?

“…Comments on the Review. The results on the association between levels of fluoride in toothpastes and the occurrence of fluorosis differ from the results reported in the systematic review by Wong et al (2010). Indeed, the latter review found the opposite: a higher level of fluoride in the toothpaste was significantly associated with fluorosis.…”

Fluoride toothpaste efficacy and safety in children younger than 6 years

“…Our meta-analysis of three case-control studies ( Figure 5 23,25,26 ) showed that beginning to brush with a fluoride toothpaste after 24 months of age decreased the odds of having dental fluorosis (OR [95 percent CI] = 0.66 [0.48-0.90]) compared with initiation of fluoride toothpaste use before 24 months of age. The direction and statistical significance of our finding did not differ from those in the previously conducted meta-analysis, 8 whereas the addition of the study by Pendrys and colleagues 23 did decrease the magnitude of effect twofold.…”