Low-Fluoride Toothpaste Versus Nonfluoride Toothpaste

Low-Fluoride toothpaste is no better than nonfluoride toothpaste in preventing tooth decay among children.

Toothpastes containing less than 1,000 parts per million of fluoride concentrations are as ineffective at preventing tooth decay as toothpastes with no fluoride at all. This finding, published in the Cochrane Database of research group Cochrane Collaboration, is taken from 79 clinical studies involving 73,000 children worldwide.

Children’s toothpastes are in the range of 100 ppm to 1,400 ppm fluoride concentration. “Toothpastes with lower fluoride levels, in the 440 to 550 range, give results that are no better than the results seen with toothpaste that does not contain fluoride,” said co-authors Helen Worthington and Anne-Marie Glenny of the Cochrane Oral Health Group, School of Dentistry, University of Manchester.

The researchers sought to establish the link between the use of topical fluorides (toothpastes) and the risk of dental fluorosis in young children. Dental fluorosis refers to changes in the appearance of tooth enamel caused by long-term ingestion of fluoride while the teeth are forming. It can range from mild white patches on the teeth to severe mottling with brown staining.

The results suggest that brushing a child’s teeth with a fluoride toothpaste before the age of 12 months can increase the risk of the child developing mild fluorosis. And although 1,000 parts per million of fluoride is effective in fighting tooth decay, there is strong evidence that such levels may still cause fluorosis in children up to 6 years of age whose permanent teeth are still developing.

The authors, however, pointed out that for some children considered to be at a high risk of tooth decay by their dentist, the benefit to health of preventing decay may outweigh the risk of fluorosis. In such cases, careful brushing of children’s teeth with a small amount of toothpaste containing higher levels of fluoride would be beneficial.

“The risk of tooth decay and its consequences, such as pain and extractions, is greater than the small risk of fluorosis. Children would have to swallow a lot of toothpaste over a long period of time to get the severe brown mottling on the teeth,” Dr. Glenny added. Parents are advised to speak to their family dentist if in doubt.