Fluoride toothpastes make up more than 95% of all toothpaste sales. It is well recognised that the decline in the prevalence of dental caries recorded in most industrialised countries over the past 30 years can be attributed mainly to the widespread use of toothpaste that contain fluoride. Investigations into the effectiveness of adding fluoride to toothpaste have been carried out since 1945 and cover a wide range of active ingredients in various abrasive formulations. Fluoride compounds and their combinations which have been tested for the control of dental decay include sodium fluoride, stannous fluoride, sodium monofluorophosphate and amine fluoride. The most widely used fluoride compounds in the Republic of Ireland are sodium fluoride and sodium monofluorophosphate.
Amount of fluoride in toothpaste
The amount of fluoride contained in fluoride toothpaste should be indicated on the toothpaste tube, although this information may sometimes be hard to locate. It may appear after the label "Active ingredient" or as a component under "Ingredients" on the toothpaste tube. Whereas previously fluoride content was given as a percent of volume (% w/v) or weight (% w/w), it is now accepted that the most efficient method of informing people of the amount of fluoride in a toothpaste is to give the "parts per million" fluoride (ppm F). Most manufacturers now give fluoride content in ppm F.
Under EU Directive 76/768/EEC, toothpastes are classified as cosmetic products. EU Directives governing cosmetic products prohibit the marketing of cosmetic products (including toothpastes) with over-the-counter levels of fluoride greater than 1,500 ppm F. At present, most toothpastes in Ireland contain 1,000-1,500 ppm F.
Fluoride toothpastes are more effective at preventing tooth decay at higher fluoride concentrations. If needed for therapeutic reasons, toothpastes containing more than 1,500 ppm F (e.g., 2,800 ppm F) are available but may be obtained only with a prescription.
Fluoride toothpaste for children
Because young infants and children under age 2 years can swallow most, if not all, of the toothpaste when brushing, there has been concern that the use of fluoride toothpaste containing 1,000-1,500 ppm F could give rise to enamel fluorosis of the front permanent incisors.
Enamel fluorosis is a condition which can vary from minor white spots to unsightly yellow/ brown discolouration of the enamel due to excessive intake of fluoride. In response to the concern over enamel fluorosis, some manufacturers now market low fluoride "children's" or "paediatric" toothpastes containing less than 600 ppm fluoride. The effectiveness of these low fluoride 'children's' or 'paediatric' toothpstes in preventing caries has not been established. What has been shown by a number of systematic reviews is that toothpastes with a low fluoride concentration of 250ppm F are less effective than toothpastes with the standard 1,000-1,500 ppm F at preventing caries in permanent teeth.
Recommendations on the use of fluoride toothpaste in children have been produced by the Expert Body on Fluorides and Health. These recommendations aim to minimise the risk of fluorosis from fluoride toothpaste while maximising its caries-preventive benefits.
For further information on dental fluorosis please see http://www.ada.org/en/member-center/oral-health-topics/fluorosis.
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