Fluoride Toothpaste Market Surveillance in the Dominican Republic: Quality Gaps and Policy Implications

The objective was to determine whether toothpastes marketed across the Dominican Republic provide fluoride levels that consistently meet internationally recommended benchmarks for caries prevention.

A total of 22 toothpaste products representing 11 brands were sampled from four of the country's most populated provinces. Six tubes per toothpaste were analysed using standardised fluoride measurement protocols. Total soluble fluoride (TSF) concentrations were evaluated against two internationally recognised benchmarks: ≥ 90% of labelled content and the 1000 ppm threshold for effective caries prevention. The proportion of toothpastes meeting these benchmarks was calculated, and Welch's ANOVAs assessed regional variability in TSF.

Results showed that while 68.2% of toothpastes met both fluoride benchmarks, 31.8% failed to do so by containing insufficient TSF relative to labelled content, falling below the 1000-ppm threshold, or both. Toothpastes with sodium monofluorophosphate (SMFP) exhibited the highest non-soluble fluoride levels, averaging up to 44.1%. Significant variability in TSF concentrations was observed across provinces, with Greater Santo Domingo consistently showing lower TSF levels than other regions. Locally manufactured toothpastes and products with incompatible abrasives demonstrated the greatest fluoride losses.

Our findings provide market-wide surveillance evidence from a low- and middle-income country directly supporting WHO's Global Oral Health Action Plan (2023-2030). They highlight quality assurance gaps in fluoride toothpaste that undermine population-level caries prevention. These results underscore the global need for routine market monitoring, ISO-concordant standards, and fiscal policies to ensure effective, affordable fluoride toothpaste is reliably available worldwide.