Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Jan 20;2010(1):CD007693.
doi: 10.1002/14651858.CD007693.pub2.

Topical fluoride as a cause of dental fluorosis in children

May Cm Wong  1 , Anne-Marie Glenny, Boyd Wk Tsang, Edward Cm Lo, Helen V Worthington, Valeria Cc Marinho
Affiliations
Meta-Analysis

Topical fluoride as a cause of dental fluorosis in children

May Cm Wong et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: For many years, topical use of fluorides has gained greater popularity than systemic use of fluorides. A possible adverse effect associated with the use of topical fluoride is the development of dental fluorosis due to the ingestion of excessive fluoride by young children with developing teeth.

Objectives: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis.

Search strategy: Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, EMBASE, BIOSIS, Dissertation Abstracts and LILACS/BBO. Reference lists from relevant articles were searched. Date of the most recent searches: 9th March 09.

Selection criteria: Randomised controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies and cross-sectional surveys, in which fluoride toothpastes, mouthrinses, gels, foams, paint-on solutions, and varnishes were compared to an alternative fluoride treatment, placebo or no intervention group. Children under the age of 6 years at the time topical fluorides were used.

Data collection and analysis: Data from all included studies were extracted by two review authors. Risk ratios for controlled, prospective studies and odds ratios for case-control studies or cross-sectional surveys were extracted or calculated. Where both adjusted and unadjusted risk ratios or odds ratios were presented, the adjusted value was included in the meta-analysis.

Main results: 25 studies were included: 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias. Studies were included in four intervention/exposure comparisons. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months odds ratio 0.70 (random-effects: 95% confidence interval 0.57 to 0.88) (data from observational studies). Inconsistent statistically significant associations were found between starting using fluoride toothpaste/toothbrushing before or after the age of 24 months and fluorosis (data from observational studies). From the RCTs, use of higher level of fluoride was associated with an increased risk of fluorosis. No significant association between the frequency of toothbrushing or the amount of fluoride toothpaste used and fluorosis was found.

Authors' conclusions: There should be a balanced consideration between the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis. The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm).More evidence with low risk of bias is needed. Future trials assessing the effectiveness of different types of topical fluorides (including toothpastes, gels, varnishes and mouthrinses) or different concentrations or both should ensure that they include an adequate follow-up period in order to collect data on potential fluorosis. As it is unethical to propose RCTs to assess fluorosis itself, it is acknowledged that further observational studies will be undertaken in this area. However, attention needs to be given to the choice of study design, bearing in mind that prospective, controlled studies will be less susceptible to bias than retrospective and/or uncontrolled studies.

PubMed Disclaimer

Conflict of interest statement

Helen Worthington has an office located in the University of Manchester's Dental Health Unit which is jointly supported by the University of Manchester and Colgate Palmolive. Helen Worthington does not receive any funding from Colgate Palmolive and does not view this as a conflict of interest. There are no other known potential conflicts of interest.

Figures

1
1
Forest plot of comparison: 1 Age started using fluoride toothpaste/toothbrushing: case‐control study, outcome: 1.1 Fluorosis.
2
2
Forest plot of comparison: 2 Age started using fluoride toothpaste/toothbrushing: cross‐sectional survey, outcome: 2.1 Fluorosis.
3
3
Forest plot of comparison: 3 Frequency of toothbrushing: cross‐sectional survey, outcome: 3.1 Fluorosis.
4
4
Forest plot of comparison: 4 Amount of fluoride toothpaste used: cross‐sectional survey, outcome: 4.1 Fluorosis.
5
5
Forest plot of comparison: 5 Fluoride level of toothpaste used: RCT, outcome: 5.1 Fluorosis.
6
6
Forest plot of comparison: 6 Fluoride level of toothpaste used: cross‐sectional survey, outcome: 6.1 Fluorosis.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Beltran‐Valladares 2005 {published data only}
    1. Beltran‐Valladares PR, Cocom‐Tun H, Casanova‐Rosado JF, Vallejos‐Sanchez AA, Medina‐Solis CE, Maupome G. Prevalence of dental fluorosis and additional sources of exposure to fluoride as risk factors to dental fluorosis in schoolchildren of Campeche, Mexico. Revista de Investigacion Clinica 2005;57(4):532‐9. - PubMed
Bottenberg 2004 {published data only}
    1. Bottenberg P, Declerck D, Ghidey W, Bogaerts K, Vanobbergen J, Martens L. Prevalence and determinants of enamel fluorosis in Flemish schoolchildren. Caries Research 2004;38(1):20‐8. - PubMed
Brothwell 1999 {published data only}
    1. Brothwell DJ, Limeback H. Fluorosis risk in grade 2 students residing in a rural area with widely varying natural fluoride. Community Dentistry & Oral Epidemiology 1999;27(2):130‐6. - PubMed
Conway 2005 {published data only}
    1. Conway DI, MacPherson LMD, Stephen KW, Gilmour WH, Petersson LG. Prevalence of dental fluorosis in children from non‐water‐fluoridated Halmstad, Sweden: fluoride toothpaste use in infancy. Acta Odontologica Scandinavica 2005;63(1):56‐63. - PubMed
Do 2007 {published data only}
    1. Do LG, Spencer AJ. Decline in the prevalence of dental fluorosis among South Australian children. Community Dentistry & Oral Epidemiology 2007;35(4):282‐91. - PubMed
    1. Do LG, Spencer AJ. Risk‐benefit balance in the use of fluoride among young children. Journal of Dental Research 2007;86(8):723‐8. - PubMed
    1. Spencer AJ, Do LG. Changing risk factors for fluorosis among South Australian children. Community Dentistry & Oral Epidemiology 2008;36(3):210‐8. - PubMed
Franzman 2006 {published data only}
    1. Franzman MR, Levy SM, Warren JJ, Broffitt B. Fluoride dentifrice ingestion and fluorosis of the permanent incisors. Journal of the American Dental Association 2006;137(5):645‐52. - PubMed
Holt 1994 {published data only}
    1. 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. International Dental Journal 1994;44(4):331‐41. - PubMed
Mascarenhas 1998 {published data only}
    1. Mascarenhas AK. Fluoride Toothpaste: a Risk Factor in Dental Fluorosis. Michigan, USA: University of Michigan, 1995.
    1. Mascarenhas AK, Burt BA. Fluorosis risk from early exposure to fluoride toothpaste. Community Dentistry & Oral Epidemiology 1998;26(4):241‐8. - PubMed
Maupome 2003 {published data only}
    1. Clark DC, Berkowitz J. The influence of various fluoride exposures on the prevalence of esthetic problems resulting from dental fluorosis. Journal of Public Health Dentistry 1997;57(3):144‐9. - PubMed
    1. Maupome G, Shulman JD, Clark DC, Levy SM. Socio‐demographic features and fluoride technologies contributing to higher fluorosis scores in permanent teeth of Canadian children. Caries Research 2003;37(5):327‐34. - PubMed
Morgan 1998 {published data only}
    1. Morgan L, Allred E, Tavares M, Bellinger D, Needleman H. Investigation of the possible associations between fluorosis, fluoride exposure, and childhood behavior problems. Pediatric Dentistry 1998;20(4):244‐52. - PubMed
Osuji 1988 {published data only}
    1. Osuji OO, Leake JL, Chipman ML, Nikiforuk G, Locker D, Levine N. Risk factors for dental fluorosis in a fluoridated community. Journal of Dental Research 1988;67(12):1488‐92. - PubMed
Pendrys 1989 {published data only}
    1. Pendrys DG. An Analytical Epidemiologic Study of the Association Between Enamel Fluorosis and a History of Fluoride Supplementation, Infant Formula Ingestion, and Fluoride Dentifrice Use by Young Children. Ann Arbor, MI: University Microfilms International, 1988.
    1. Pendrys DG, Katz RV. Risk of enamel fluorosis associated with fluoride supplementation, infant formula, and fluoride dentifrice use. American Journal of Epidemiology 1989;130(6):1199‐208. - PubMed
Pendrys 1994 {published data only}
    1. Pendrys DG, Katz RV, Morse DE. Risk factors for enamel fluorosis in a fluoridated population. American Journal of Epidemiology 1994;140(5):461‐71. - PubMed
Pendrys 1996 {published data only}
    1. Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association 2000;131(6):746‐55. - PubMed
    1. Pendrys DG, Katz RV, Morse DE. Risk factors for enamel fluorosis in a nonfluoridated population. American Journal of Epidemiology 1996;143(8):808‐15. - PubMed
Pendrys 1998 {published data only}
    1. Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association 2000;131(6):746‐55. - PubMed
    1. Pendrys DG, Katz RV. Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers' decision to reduce the fluoride concentration of infant formula. American Journal of Epidemiology 1998;148(10):967‐74. - PubMed
Pereira 2000 {published data only}
    1. Pereira AC, Cunha FL, Meneghim MdeC, Werner CW. Dental caries and fluorosis prevalence study in a nonfluoridated Brazilian community: trend analysis and toothpaste association. ASDC Journal of Dentistry for Children 2000;67(2):132‐5. - PubMed
Riordan 1993 {published data only}
    1. Riordan PJ. Dental fluorosis, dental caries and fluoride exposure among 7‐year‐olds. Caries Research 1993;27(1):71‐7. - PubMed
Riordan 2002 {published data only}
    1. Riordan PJ. Dental fluorosis decline after changes to supplement and toothpaste regimens. Community Dentistry & Oral Epidemiology 2002;30(3):233‐40. - PubMed
Rock 1997 {published data only}
    1. Rock WP, Sabieha AM. The relationship between reported toothpaste usage in infancy and fluorosis of permanent incisors. British Dental Journal 1997;183(5):165‐70. - PubMed
Sagheri 2007 {published data only}
    1. Sagheri D, McLoughlin J, Clarkson JJ. The prevalence of dental fluorosis in relation to water or salt fluoridation and reported use of fluoride toothpaste in school‐age children. European Archives of Paediatric Dentistry 2007;8(1):62‐8. - PubMed
Skotowski 1995 {published data only}
    1. Skotowski MC, Hunt RJ, Levy SM. Risk factors for dental fluorosis in pediatric dental patients. Journal of Public Health Dentistry 1995;55(3):154‐9. - PubMed
Szpunar 1988 {published data only}
    1. Szpunar SM, Burt BA. Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren. Journal of Dental Research 1988;67(5):802‐6. - PubMed
Tabari 2000 {published data only}
    1. Tabari ED, Ellwood R, Rugg‐Gunn AJ, Evans DJ, Davies RM. Dental fluorosis in permanent incisor teeth in relation to water fluoridation, social deprivation and toothpaste use in infancy. British Dental Journal 2000;189(4):216‐20. - PubMed
Tavener 2006 {published data only}
    1. Tavener A, Davies GM, Davies RM, Ellwood RP. The prevalence and severity of fluorosis in children who received toothpaste containing either 440 or 1,450 ppm F from the age of 12 months in deprived and less deprived communities. Caries Research 2006;40(1):66‐72. - PubMed
Wang 1997 {published data only}
    1. Wang NJ, Gropen AM, Ogaard B. Risk factors associated with fluorosis in a non‐fluoridated population in Norway. Community Dentistry & Oral Epidemiology 1997;25(6):396‐401. - PubMed

References to studies excluded from this review

Alonge 2000 {published data only}
    1. Alonge OK, Williamson DD, Narendran S. Dental fluorosis among third graders in Harris County, Texas‐‐1998 study findings. Texas Dental Journal 2000;117(9):22‐9. - PubMed
Bohaty 1989 {published data only}
    1. Bohaty BS, Parker WA, Seale NS, Zimmerman ER. The prevalence of fluorosis‐like lesions associated with topical and systemic fluoride usage in an area of optimal water fluoridation. Pediatric Dentistry 1989;11(2):125‐8. - PubMed
Burgstahler 2008 {published data only}
    1. Burgstahler AW, Spittle B. XVIIITH conference of the International Society for Fluoride Research. Fluoride: bone and brain effects. Fluoride 2008;41(3):173‐5.
Clark 1994 {published data only}
    1. Clark DC, Hann HJ, Williamson MF, Berkowitz J. Influence of exposure to various fluoride technologies on the prevalence of dental fluorosis. Community Dentistry & Oral Epidemiology 1994;22(6):461‐4. - PubMed
Connett 2008 {published data only}
    1. Connett P. 3rd citizens conference of the Fluoride Action Network. Fluoride 2008;41(3):175.
D'Hoore 1992 {published data only}
    1. D'Hoore W, Nieuwenhuysen JP. Benefits and risks of fluoride supplementation: caries prevention versus dental fluorosis. European Journal of Pediatrics 1992;151(8):613‐6. - PubMed
Disney 1992 {published data only}
    1. Disney J, Cutress T, Bohannan H, Graves R, Zack D. Fluorosis experience of children enrolled in a caries risk study. Journal of Dental Research 1992;71(Spec Issue):749.
Ellwood 1992 {published data only}
    1. Ellwood RP, O'Mullane DM. Enamel opacities and brushing frequency in non‐fluoridated and fluoridated areas. Journal of Dental Research 1992;71(Spec Issue):612.
Ellwood 1994 {published data only}
    1. Ellwood RP, O'Mullane DM. Tooth brushing behaviour in twelve year old children and dental enamel. Journal of the Irish Dental Association 1994;40(1):12‐5. - PubMed
Evans 1991 {published data only}
    1. Evans DJ. A study of developmental defects in enamel in 10‐year‐old high social class children residing in a non‐fluoridated area. Community Dental Health 1991;8(1):31‐8. - PubMed
Gomez‐Santos 2008 {published data only}
    1. Gomez‐Santos G, Gonzalez‐Sierra MA, Vazquez‐Garcia‐Machinena J. Evolution of caries and fluorosis in schoolchildren of the Canary Islands (Spain): 1991, 1998, 2006. Medicina Oral, Patologia Oral y Cirugia Bucal 2008;13(9):E599‐608. - PubMed
Gopalakrishnan 1999 {published data only}
    1. Gopalakrishnan P, Vasan RS, Sarma PS, Nair KS, Thankappan KR. Prevalence of dental fluorosis and associated risk factors in Alappuzha district, Kerala. National Medical Journal of India 1999;12(3):99‐103. - PubMed
Heller 1996 {published data only}
    1. Heller KE. Risk Factors for Dental Fluorosis Prevalence and Severity in US Schoolchildren, 1986‐1987. Ann Arbor, MI: University of Michigan, 1996.
Hong 2006a {published data only}
    1. Hong L, Levy SM, Warren JJ, Broffitt B, Cavanaugh J. Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars. Caries Research 2006;40(6):494‐500. - PubMed
Hong 2006b {published data only}
    1. Hong L, Levy SM, Broffitt B, Warren JJ, Kanellis MJ, Wefel JS, et al. Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry & Oral Epidemiology 2006;34(4):299‐309. - PubMed
Houwink 1979 {published data only}
    1. Houwink B, Wagg BJ. Effect of fluoride dentifrice usage during infancy upon enamel mottling of the permanent teeth. Caries Research 1979;13(4):231‐7. - PubMed
Kumar 2000 {published data only}
    1. Kumar J, Swango P, Haley V, Green E. Intra‐oral distribution of dental fluorosis in Newburgh and Kingston, New York. Journal of Dental Research 2000;79(7):1508‐13. - PubMed
Larsen 1985a {published data only}
    1. Larsen MJ, Kirkegard E, Fejerskov O, Poulsen S. Prevalence of dental fluorosis after fluoride‐gel treatments in a low‐fluoride area. Journal of Dental Research 1985;64(8):1076‐9. - PubMed
Larsen 1985b {published data only}
    1. Larsen MJ, Richards A, Fejerskov O. Development of dental fluorosis according to age at start of fluoride administration. Caries Research 1985;19(6):519‐27. - PubMed
Levy 1991 {published data only}
    1. Levy SM, Zarei‐M Z. Evaluation of fluoride exposures in children. ASDC Journal of Dentistry for Children 1991;58(6):467‐73. - PubMed
Machado 2008 {published data only}
    1. Machado MAdeAM, Silva TCdaS, Silva SMBda, Oliveira TM. Critical analysis of the use of fluoride in pediatric dentistry [Abordagem critica do uso do fluoreto em odontopediatria]. In: Buzalaf MAR editor(s). Fluoretos e Saude Bucal. Sao Paulo, Brazil: Editora Santos, 2008:271‐95.
Martignon 2000 {published data only}
    1. Martignon S, Granados OL. Prevalence of dental fluorosis and association to risk factors in schoolchildren in Santafe de Bogota, Colombia. Caries Research 2000;34(4):352‐3.
Martins 2008 {published data only}
    1. Martins CC, Paiva SM, Lima‐Arsati YB, Ramos‐Jorge ML, Cury JA. Prospective study of the association between fluoride intake and dental fluorosis in permanent teeth. Caries Research 2008;42(2):125‐33. - PubMed
Momeni 2007 {published data only}
    1. Momeni A, Neuhaeuser A, Renner N, Heinzel‐Gutenbrunner M, Abou‐Fidah J, Rasch K, et al. Prevalence of dental fluorosis in German schoolchildren in areas with different preventive programmes. Caries Research 2007;41(6):437‐44. - PubMed
Nowjack‐Raymer 1995 {published data only}
    1. Nowjack‐Raymer RE, Selwitz RH, Kingman A, Driscoll WS. The prevalence of dental fluorosis in a school‐based program of fluoride mouthrinsing, fluoride tablets, and both procedures combined. Journal of Public Health Dentistry 1995;55(3):165‐70. - PubMed
Toassi 2005 {published data only}
    1. Toassi RFC, Abegg C. Dental fluorosis in schoolchildren in a county in the mountainous region of Rio Grande do Sul State, Brazil. Cadernos de Saude Publica 2005;21(2):652‐5. - PubMed
van der Hoek 2003 {published data only}
    1. Hoek W, Ekanayake L, Rajasooriyar L, Karunaratne R. Source of drinking water and other risk factors for dental fluorosis in Sri Lanka. International Journal of Environmental Health Research 2003;13(3):285‐93. - PubMed
Wetzel 1989 {published data only}
    1. Wetzel WE. Dental fluorosis from repeated fluoride use. Die Quintessenz 1989;40(10):1799‐807. - PubMed
Wotlgens 1989 {published data only}
    1. Woltgens JHM, Etty WJ, Nieuwland WMD, Lyaruu DM. Use of fluoride by young children and prevalence of mottled enamel. Advances in Dental Research 1989;3(2):177‐82. - PubMed

References to studies awaiting assessment

Larsen 1987 {published data only}
    1. Larsen MJ, Kirkegaard E, Poulsen S, Fejerskov O. Dental fluorosis in Denmark. II. Large single doses of fluoride and dental fluorosis. Tandlaegebladet 1987;91(18):761‐4. - PubMed

Additional references

Alvarez 2009
    1. Alvarez JA, Rezende K, Marocho SMS, Alves FBT, Celiberti P, Ciamponi AL. Dental fluorosis: Exposure, prevention and management. Medicina Oral, Patologia Oral y Cirugia Bucal 2009;14(2):E103‐7. - PubMed
Barnhart 1974
    1. Barnhart WE, Hiller LK, Leonard GJ, Michaels SE. Dentifrice usage and ingestion among four age groups. Journal of Dental Research 1974;53(6):1317‐22. - PubMed
Chen 2006
    1. Chen H, Czajka‐Jakubowska A, Spencer NJ, Mansfield JF, Robinson C, Clarkson BH. Effects of systemic fluoride and in vitro fluoride treatment on enamel crystals. Journal of Dental Research 2006;85(11):1042‐5. - PMC - PubMed
Clark 1993
    1. Clark DC. Appropriate uses of fluorides for children: guidelines from the Canadian Workshop on the Evaluation of Current Recommendations Concerning Fluorides. Canadian Medical Association Journal 1993;149(12):1787‐93. - PMC - PubMed
Cunha 2006
    1. Cunha LF, Tomita NE. Dental fluorosis in Brazil: a systematic review from 1993 to 2004. Cadernos de Saude Publica 2006;22(9):1809‐16. - PubMed
Do 2007
    1. Do LG, Spencer AJ. Risk‐benefit balance in the use of fluoride among young children. Journal of Dental Research 2007;86(8):723‐8. - PubMed
Ekstrand 1987
    1. Ekstrand J. Pharmacokinetic aspects of topical fluorides. Journal of Dental Research 1987;66(5):1061‐5. - PubMed
Ekstrand 1996
    1. Ekstrand J. Fluoride metabolism. In: Fejerskov O, Ekstrand J, Burt BA editor(s). Fluoride in Dentistry. 2nd Edition. Copenhagen: Munksgaard, 1996:50‐68.
Gillcrist 1996
    1. Gillcrist JA. Fluoridation status of Tennesseans, declining caries prevalence rates, increasing fluorosis, and a review of the appropriate use of fluoride products. Journal of Tennessee Dental Association 1996;76(3):12‐7. - PubMed
Higgins 2008
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.0.1 (updated September 2008). The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Holloway 1997
    1. Holloway PJ, Ellwood RP. The prevalence, causes and cosmetic importance of dental fluorosis in the United Kingdom: a review. Community Dental Health 1997;14(3):148‐55. - PubMed
Ismail 2008
    1. Ismail AI, Hasson H. Fluoride supplements, dental caries and fluorosis: a systematic review. Journal of the American Dental Association 2008;139(11):1457‐68. - PubMed
Kargul 2003
    1. Kargul B, Caglar E, Tanboga I. History of water fluoridation. Journal of Clinical Pediatric Dentistry 2003;27(3):213‐7. - PubMed
Kubota 2005
    1. Kubota K, Lee DH, Tsuchiya M, Young CS, Everett ET, Martinez‐Mier EA, et al. Fluoride induces endoplasmic reticulum stress in ameloblasts responsible for dental enamel formation. Journal of Biological Chemistry 2005;280(24):23194‐202. - PubMed
Lecompte 1987
    1. Lecompte EJ. Clinical application of topical fluoride products: risks, benefits and recommendations. Journal of Dental Research 1987;66(5):1066‐71. - PubMed
Levy 1994
    1. Levy SM. Review of fluoride exposures and ingestion. Community Dentistry & Oral Epidemiology 1994;22(3):173‐80. - PubMed
Loke 2007
    1. Loke YK, Price D, Herxheimer A, Cochrane Adverse Effects Methods Group. Systematic reviews of adverse effects: framework for a structured approach. BMC Medical Research Methodology 2007;7:32. - PMC - PubMed
Manji 1986
    1. Manji F, Kapila S. Fluorides and fluorosis in Kenya. Part III: Fluorides, fluorosis and dental caries. Odonto‐Stomatologie Tropicale 1986;9(3):135‐9. - PubMed
Marinho 2002
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 1. [Art. No.: CD002280. DOI: 10.1002/14651858.CD002280] - PubMed
Marinho 2002b
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 1. [Art. No.: CD002279. DOI: 10.1002/14651858.CD002279] - PubMed
Marinho 2003
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 4. [Art. No.: CD002782. DOI: 10.1002/14651858.CD002782] - PMC - PubMed
Marinho 2003b
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. [Art. No.: CD002278. DOI: 10.1002/14651858.CD002278] - PMC - PubMed
Marinho 2003c
    1. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 3. [Art. No.: CD002284. DOI: 10.1002/14651858.CD002284] - PubMed
Marinho 2004
    1. Marinho VCC, Higgins JPT, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. [Art. No.: CD002780. DOI: 10.1002/14651858.CD002780.pub2] - PMC - PubMed
Marinho 2004b
    1. Marinho VCC, Higgins JPT, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. [Art. No.: CD002781. DOI: 10.1002/14651858.CD002781.pub2] - PMC - PubMed
Mascarenhas 2000
    1. Mascarenhas AK. Risk factors for dental fluorosis: a review of the recent literature. Pediatric Dentistry 2000;22(4):269‐77. - PubMed
Pendrys 1990
    1. Pendrys DG, Stamm JW. Relationship of total fluoride intake to beneficial effects and enamel fluorosis. Journal of Dental Research 1990;69 Spec No:529‐38. - PubMed
Pendrys 2000
    1. Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association 2000;131(6):746‐55. - PubMed
Ripa 1991
    1. Ripa LW. A critique of topical fluoride methods (dentifrices, mouthrinses, operator‐, and self‐applied gels) in an era of decreased caries and increased fluorosis prevalence. Journal of Public Health Dentistry 1991;51(1):23‐41. - PubMed
Rozier 1994
    1. Rozier RG. Epidemiologic indices for measuring the clinical manifestations of dental fluorosis: overview and critique. Advances in Dental Research 1994;8(1):39‐55. - PubMed
Steiner 2004
    1. Steiner M, Helfenstein U, Menghini G. Effect of 1000 ppm relative to 250 ppm fluoride toothpaste. A meta‐analysis. American Journal of Dentistry 2004;17(2):85‐8. - PubMed
Stookey 1994
    1. Stookey GK. Review of fluorosis risk of self‐applied topical fluorides: dentifrices, mouthrinses and gels. Community Dentistry & Oral Epidemiology 1994;22(3):181‐6. - PubMed
Tobin 1988
    1. Tobin EA. Dental fluorosis in children in the 1980s. A review of the literature. Dental Hygiene 1988;62(8):380‐4. - PubMed
Walsh 2010
    1. Walsh T, Worthington HV, Glenny A‐M, Appelbe P, Marinho VCC, Shi X. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD007868.pub2] - DOI - PubMed
Warren 1999
    1. Warren JJ, Levy SM. A review of fluoride dentifrice related to dental fluorosis. Pediatric Dentistry 1999;21(4):265‐71. - PubMed
Wells 2008
    1. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle‐Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta‐analyses. Available from: www.ohri.ca/programs/clinical_epidemiology/oxford.htm (accessed 1 January 2008).
Whelton 2004
    1. Whelton HP, Ketley CE, McSweeney F, O'Mullane DM. A review of fluorosis in the European Union: prevalence, risk factors and aesthetic issues. Community Dentistry & Oral Epidemiology 2004;32 Suppl 1:9‐18. - PubMed