The rational use of fluoride toothpaste

Well-formulated fluoride toothpastes are clinically proven to prevent and control dental caries. They may also be a risk factor in the aetiology of dental fluorosis. This review considers the available evidence to support the appropriate use of fluoride toothpaste to maximise the benefit and minimise the risk. Three factors have an important influence on the anticaries efficacy of fluoride toothpaste, namely concentration, frequency of brushing and post brushing rinsing behaviour. The evidence suggests that low-fluoride (<600 ppm F) toothpastes provide less caries protection than standard (1,000 ppm F) or high (1,500 ppm F) concentration formulations. However, low-fluoride toothpastes are appropriate for very young children (under 7 years) at low caries risk, particularly if living in fluoridated areas. For other young children, higher concentrations of fluoride should be used. Brushing should be recommended twice daily, whilst rinsing with large volumes of water should be discouraged. Small amounts of toothpaste are comparable in efficacy to large amounts. The risk of fluorosis is associated with the ingestion of high doses of fluoride during tooth development and consequently only young children are at risk. The variability in the dose of fluoride ingested is mainly a function of the amount used, less so its concentration. To minimise fluorosis risk, parents should be advised to use only a pea-sized amount of toothpaste and encourage spitting out of excess. It is concluded that by using fluoride toothpastes appropriately, the benefits can be maximised and the risks of fluorosis minimised.