Effects of Low and Standard Fluoride Toothpastes on Caries and Fluorosis: Systematic Review and Meta-AnalysisSantos A.P.P. · Oliveira B.H. · Nadanovsky P.
aDepartment of Community and Preventive Dentistry, School of Dentistry and bDepartment of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
Although the anti-caries effects of standard fluoride (F) toothpastes are well established, their use by preschoolers (2- to 5-year-olds) has given rise to concerns regarding the development of dental fluorosis. Thus, a widespread support of low F toothpastes has been observed. The aim of this study was to assess the effects of low (<600 ppm) and standard (1,000-1,500 ppm) F toothpastes on the prevention of caries in the primary dentition and aesthetically objectionable (moderate to severe) fluorosis in the permanent dentition. A systematic review of clinical trials and meta-analyses were carried out. Two examiners independently screened 1,932 records and read 159 potentially eligible full-text articles. Data regarding characteristics of participants, interventions, outcomes, length of follow-up and potential of bias were independently extracted by two examiners and disagreements were solved by consensus after consulting a third examiner. In order to assess the effects of low and standard F toothpastes on the proportion of children developing caries and fluorosis, pooled relative risks (RR) and associated 95% confidence intervals were estimated using a fixed and a random-effects model, respectively. Five clinical trials fulfilled the inclusion criteria. Low F toothpastes significantly increased the risk of caries in primary teeth [RR = 1.13 (1.07-1.20); 4,634 participants in three studies] and did not significantly decrease the risk of aesthetically objectionable fluorosis in the upper anterior permanent teeth [RR = 0.32 (0.03-2.97); 1,968 participants in two studies]. There is no evidence to support the use of low F toothpastes by preschoolers regarding caries and fluorosis prevention.
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