Fluoride toothpaste prevents caries

Abstract

Data sources The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE (1966–January 2000) and several other databases were sources. Journals and reference lists of articles were handsearched and selected authors and manufacturers were contacted.

Study selection Randomised controlled trials (RCT) or quasi-RCT that had blind outcome assessment, compared fluoride toothpaste with placebo in children up to 16 years of age over at least 1 year were included. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).

Data extraction and synthesis Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one-third of the studies, and consensus was achieved by discussion or by a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF), that is, the difference in caries increments between the treatment and control groups expressed as a percentage of the increment in the control group. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects meta-regression analyses.

Results In total, 74 studies were included of which 70 contributed to the meta-analysis (42 300 children). The pooled PF was 24% (95% confidence interval (CI), 21–28%, P<0.0001). This means that 1.6 children need to brush with a fluoride rather than nonfluoride toothpaste over 3 years to prevent 1 D(M)FS in populations with a caries increment of 2.6 D(M)FS per year (or 3.7 children in populations with a caries increment of 1.1 D(M)FS per year). There was statistically significant heterogeneity within the studies. The effect of fluoride toothpaste increased with higher baseline levels of D(M)FS, higher fluoride concentration, higher frequency of use and supervised brushing, but was not influenced by exposure to water fluoridation. There is little information concerning deciduous dentition or adverse effects (fluorosis).

Conclusions Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established. Taken together, the trials are of relatively high quality, and provide clear evidence that fluoride toothpastes are efficacious in preventing caries.

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