Journal Mobile Options
Table of Contents
Vol. 37, No. 2, 2003
Issue release date: March–April 2003
Caries Res 2003;37:85–92

Systematic Review of Studies Comparing the Anti-Caries Efficacy of Children’s Toothpaste Containing 600 ppm of Fluoride or Less with High Fluoride Toothpastes of 1,000 ppm or Above

Ammari A.B. · Bloch-Zupan A. · Ashley P.F.
Department of Paediatric Dentistry, Eastman Dental Institute for Oral Health Care Sciences, University College London, London, UK

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Objective: To determine the clinical effectiveness of low fluoride (F) toothpastes, containing 600 ppm or less, with toothpaste containing 1,000 ppm or more fluoride in preventing dental caries. Design: Systematic review of randomised controlled trials comparing low fluoride toothpastes containing 600 ppm F or less with toothpastes containing 1,000 ppm or more in children or adults. Results: Seven randomised controlled trials were included. These were categorised into two groups depending on the fluoride concentration in the low fluoride group (250 and 500 ppm) and analysed separately. 250 ppm: Results of the meta-analysis were statistically significant (p = 0.002 and 0.0005) and in favour of the control group (1,000 ppm). DFS increments in the 250-ppm group were 0.6–0.7 greater than the 1,000-ppm group. 500 ppm: Only two studies were in this category, and one of them failed to present the baseline caries levels, so a meta-analysis was not carried out. Conclusion: 250 ppm fluoride dentifrice was not as effective in caries prevention in permanent dentition as dentifrice containing 1,000 ppm F or more. More studies have to be carried out to test the anticaries efficacy of 500 against 1,000 ppm and above.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Adair SM, Piscitelli WP, McKnight-Hanes C: Comparison of the use of a child and an adult dentifrice by a sample of preschool children. Pediatr Dent 1997;19:99–103.
  2. Antman E, Lau J, Kupelnick B, Mosteller F, Chalmers T: A comparison of results of meta-analyses of randomised control trials and recommendations of clinical experts. J Am Med Assoc 1992;268:240–247.
  3. Beltran ED, Szpunar SM: Fluoride in toothpastes for children: Suggestion for change. Pediatr Dent 1988;10:185–188.
  4. Bjarnason S, Finnbogason S: Effect of different fluoride levels in dentifrices on the development of approximal caries. Caries Res 1991;25:207–212.

    External Resources

  5. Blinkhorn AS, Clarkson JE: The international scientific assembly on the comparative anticaries efficacy of sodium fluoride and sodium monofluorophosphate. Am J Dent 1993;6:5.
  6. Blinkhorn AS, Kay E: A critical review of the 10 pivotal caries clinical studies used in recent meta-analysis comparing the anticaries efficacy of sodium fluoride and sodium monofluorophosphate dentifrices. Am J Dent 1993;6(suppl):13–24.
  7. Bloch-Zupan A: Is the fluoride concentration limit of 1,500 ppm in cosmetics (EU Guideline) still up to date? Caries Res 2001;35(suppl):22–25.
  8. Centre for Reviews and Dissemination (CDR): Undertaking systematic reviews of research on effectiveness. CDR’s Guidance for Those Carrying Out or Commissioning Reviews 2001. CDR report No. 4, ed 2.
  9. Day S, Altman D: Blinding in clinical trials and other studies. Br Med J 2000;321:504.
  10. Deeks JJ: Systematic review of published evidence: Miracles or minefields? Ann Oncol 1998;9:703–709.
  11. DenBesten P, Ko HS: Fluoride levels in whole saliva of preschool children after brushing with 0.25 g (pea-sized) as compared to 1.0 g (full-brush) of a fluoride dentifrice. Pediatr Dent 1996;18:277–280.
  12. Dickerson K, Min Y, Meinert C: Factors influencing publication of research results. J Am Med Assoc 1992;267:374–378.
  13. Dickerson K, Berlin J: Meta-analysis: State of science. Epidemiol Rev 1992;14:154–176.
  14. Easterbrook P, Berlin J, Copalan R: Publication bias in clinical research. Lancet 1991;337:867–872.
  15. Egger M, Smith GD, Altman D: Systematic Reviews in Health Care, ed 2. London, BMJ Books, 2001.
  16. Fejerskov Ø, Ekstrand J, Brian B: Fluorides in Dentistry, ed 2. Christianseld, Fr. Martin, 1996.
  17. Fleiss J, Cohen J, Everitt B: Large sample standard errors of kappa and weighted kappa. Psychol Bull 1971;76:378–382
  18. Forsman B: Studies on the effect of dentifrices with low fluoride content. Community Dent Oral Epidemiol 1974;2:166–175.

    External Resources

  19. Harris N and Garcia-Godoy F: Primary Preventive Dentistry. Stamford, Appleton & Lange, 1999.
  20. Holt RD, Morris CE, Winter GB, Downer MC: Enamel opacities and dental caries in children who used a low fluoride toothpaste between 2 and 5 years of age. Int Dent J 1994;44:331–341.
  21. Holt RD, Murray JJ: Developments in fluoride toothpastes: An overview. Community Dent Health 1997;14:4–10.
  22. Hutton JL, Williamson RR: Bias in meta-analysis due to outcome variable selection within studies. Appl Stat 2000;49:359–370.
  23. Jadad AR: Randomised Controlled Trials. London, BMJ Books, 1998.
  24. Jadad AR, Moore RA, Carroll D: Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 1996;17:1–12.
  25. Jüni P, Witschi A, Bloch R, Egger M: The hazard of scoring the quality of clinical trails for meta-analysis. J Am Med Ass 1999;282:1054–1060.
  26. Jüni P, Altman D, Egger M: Assessing the quality of controlled clinical trails. Br Med J. 2001;323:42–46.
  27. Koch G, Bergmann-Arnadottir I, Bjarnason S, Finnbogason S, Hoskuldsson O, Karlsson R: Caries-preventive effect of fluoride dentifrices with and without anticalculus agents: A 3-year controlled clinical trial. Caries Res 1990;24:72–79.

    External Resources

  28. Koch G, Petersson LG, Kling E, Kling L: Effect of 250 and 1,000 ppm fluoride dentifrice on caries: A three-year clinical study. Swed Dent J 1982;6:233–238.

    External Resources

  29. Mellberg J: Fluoride dentifrices: Current status and prospects. Int Dent J 1991;41:9–16.
  30. Mitropoulos CM, Holloway PJ, Davies TG, Worthington HV: Relative efficacy of dentifrices containing 250 or 1,000 ppm fluoride in preventing dental caries: Report of 32-month clinical trial. Community Dent Health 1984;1:193–200.
  31. Moher D, Jadad A, Nichol G, Penman M, Tugwell P, Walsh S: Assessing the quality of randomized controlled trials: An annotated bibliography of scales and checklists. Control Clin Trials 1995;16:62–73.
  32. Oxman A: Checklists for review articles. Br Med J 1994;309:648–651.
  33. Petersson LG, Birkhed D, Gleerup A, Johansson M, Jonsson G: Caries-preventive effect of dentifrices containing various types and concentrations of fluorides and sugar alcohols. Caries Res 1991;25:74–79.

    External Resources

  34. Reed MW: Clinical evaluation of three concentrations of sodium fluoride in dentifrices. J Am Dent Assoc 1973;87:1401–1403.

    External Resources

  35. Rock WP, Sabieha AM: The relationship between reported toothpaste usage in infancy and fluorosis of permanent incisors. Br Dent J 1997;183:165–170.

    External Resources

  36. Rølla G, Őgaard B, de Almeida Cruz R: Clinical effect and mechanism of cariostatic action of fluoride-containing toothpastes: A review. Int Dent J 1991;41:171–174.
  37. Sønju Clasen A, Øgaard B, Duscher H, Ruben J, Arends J, Sönju T: Caries development in fluoridated and non-fluoridated deciduous and permanent enamel in situ examined by microradiography and confocal laser scanning microscopy. Adv Dent Res 1997;11:442–447.
  38. Stookey GK: Review of fluorosis risk of self applied topical fluorides: Dentifrices, mouthrinses and gels. Community Dent Oral Epidemiol 1994;22:181–186.

    External Resources

  39. Winter GB, Holt RD, Williams BF: Clinical trial of a low-fluoride toothpaste for young children. Int Dent J 1989;39:227–235.

    External Resources

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50