Caries prevention with fluoride toothpaste in children: an update

Aim: The aim was to examine recent literature and review the caries-preventive effect of fluoride toothpaste in children. Methods: Based on three comprehensive systematic reviews published in 2003, a broad search of the PubMed and Cochrane library databases was conducted for papers published 2002-2008 using fluoride toothpaste, fluoride dentifrice and fluoride dental cream as index terms. Relevant publications were identified after assessment of their abstracts. Papers were selected if they reported a prospective controlled design with caries data reported at baseline and at the end of the study. The targeted papers were critically assessed concerning design, methodology and performance according to a pre-determined checklist. Results: The initial search revealed 179 papers of which 15 met the inclusion criteria. There was strong evidence that daily use of fluoride toothpaste has a significant caries-preventive effect in children compared with placebo (prevented fraction 24%). The effect was boosted by supervised tooth brushing, increased brushing frequency to twice daily, and use of a toothpaste concentration of 1,500 ppm fluoride. There were few studies of high quality reporting findings from the primary dentition. There were no studies available, and therefore insufficient evidence, on when to commence brushing with fluoride toothpaste as well as on the post-brushing behaviour. The use of adult toothpaste in very young children seemed to increase the risk for mild dental fluorosis in lowcaries communities but not in socially deprived high-caries populations. Conclusions: The results reinforced the outstanding role of fluoride toothpaste as an effective caries preventive measure in children.