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. 2019 Mar 4;3(3):CD007868.
doi: 10.1002/14651858.CD007868.pub3.

Fluoride toothpastes of different concentrations for preventing dental caries

Tanya Walsh  1 , Helen V Worthington, Anne-Marie Glenny, Valeria Cc Marinho, Ana Jeroncic
Affiliations

Fluoride toothpastes of different concentrations for preventing dental caries

Tanya Walsh et al. Cochrane Database Syst Rev. .

Abstract

Background: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). Regular toothbrushing with fluoride toothpaste is the principal non-professional intervention to prevent caries, but the caries-preventive effect varies according to different concentrations of fluoride in toothpaste, with higher concentrations associated with increased caries control. Toothpastes with higher fluoride concentration increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010.

Objectives: To determine and compare the effects of toothpastes of different fluoride concentrations (parts per million (ppm)) in preventing dental caries in children, adolescents, and adults.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 August 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7) in the Cochrane Library (searched 15 August 2018); MEDLINE Ovid (1946 to 15 August 2018); and Embase Ovid (1980 to 15 August 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 August 2018). No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: Randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least 1 year. The primary outcome was caries increment measured by the change from baseline in the decayed, (missing), and filled surfaces or teeth index in all permanent or primary teeth (D(M)FS/T or d(m)fs/t).

Data collection and analysis: Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. We graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference (MD) or standardised mean difference (SMD) caries increment. Where it was appropriate to pool data, we used random-effects pairwise or network meta-analysis.

Main results: We included 96 studies published between 1955 and 2014 in this updated review. Seven studies with 11,356 randomised participants (7047 evaluated) reported the effects of fluoride toothpaste up to 1500 ppm on the primary dentition; one study with 2500 randomised participants (2008 evaluated) reported the effects of 1450 ppm fluoride toothpaste on the primary and permanent dentition; 85 studies with 48,804 randomised participants (40,066 evaluated) reported the effects of toothpaste up to 2400 ppm on the immature permanent dentition; and three studies with 2675 randomised participants (2162 evaluated) reported the effects of up to 1100 ppm fluoride toothpaste on the mature permanent dentition. Follow-up in most studies was 36 months.In the primary dentition of young children, 1500 ppm fluoride toothpaste reduces caries increment when compared with non-fluoride toothpaste (MD -1.86 dfs, 95% confidence interval (CI) -2.51 to -1.21; 998 participants, one study, moderate-certainty evidence); the caries-preventive effects for the head-to-head comparison of 1055 ppm versus 550 ppm fluoride toothpaste are similar (MD -0.05, dmfs, 95% CI -0.38 to 0.28; 1958 participants, two studies, moderate-certainty evidence), but toothbrushing with 1450 ppm fluoride toothpaste slightly reduces decayed, missing, filled teeth (dmft) increment when compared with 440 ppm fluoride toothpaste (MD -0.34, dmft, 95%CI -0.59 to -0.09; 2362 participants, one study, moderate-certainty evidence). The certainty of the remaining evidence for this comparison was judged to be low.We included 81 studies in the network meta-analysis of D(M)FS increment in the permanent dentition of children and adolescents. The network included 21 different comparisons of seven fluoride concentrations. The certainty of the evidence was judged to be low with the following exceptions: there was high- and moderate-certainty evidence that 1000 to 1250 ppm or 1450 to 1500 ppm fluoride toothpaste reduces caries increments when compared with non-fluoride toothpaste (SMD -0.28, 95% CI -0.32 to -0.25, 55 studies; and SMD -0.36, 95% CI -0.43 to -0.29, four studies); there was moderate-certainty evidence that 1450 to 1500 ppm fluoride toothpaste slightly reduces caries increments when compared to 1000 to 1250 ppm (SMD -0.08, 95% CI -0.14 to -0.01, 10 studies); and moderate-certainty evidence that the caries increments are similar for 1700 to 2200 ppm and 2400 to 2800 ppm fluoride toothpaste when compared to 1450 to 1500 ppm (SMD 0.04, 95% CI -0.07 to 0.15, indirect evidence only; SMD -0.05, 95% CI -0.14 to 0.05, two studies).In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste reduces DMFS increment when compared with non-fluoride toothpaste in adults of all ages (MD -0.53, 95% CI -1.02 to -0.04; 2162 participants, three studies, moderate-certainty evidence). The evidence for DMFT was low certainty.Only a minority of studies assessed adverse effects of toothpaste. When reported, effects such as soft tissue damage and tooth staining were minimal.

Authors' conclusions: This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations is more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and our confidence in these effect estimates are uncertain and could be challenged by further research. The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis.

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Conflict of interest statement

Tanya Walsh: none known. Professor Walsh is a Cochrane Oral Health Editor. Helen V Worthington: none known. Professor Worthington was involved in the design and analysis of three included trials, but she did not undertake the risk of bias assessment or the data extraction for these trials. Professor Worthington is one of the Co‐ordinating Editors of Cochrane Oral Health. Anne‐Marie Glenny: none known. Professor Glenny is Deputy Co‐ordinating Editor of Cochrane Oral Health. Valeria CC Marinho: none known. Dr Marinho is Cochrane Oral Health Editor. Ana Jeroncic: none known. Professor Jeroncic is Cochrane Oral Health Editor.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Study flow diagram.
4
4
Plot of the decayed, missing, filled surfaces (D(M)FS) network in children and adolescents (immature permanent dentition).
5
5
Forest plot of 95% confidence intervals (CI) and predictive intervals (PI) for the decayed, missing, filled surfaces (D(M)FS) network in children and adolescents (immature permanent dentition).
6
6
Plot of the decayed, missing, filled teeth (D(M)FT) network in children and adolescents (immature permanent dentition).
7
7
95% confidence intervals (CI) and predictive intervals (PI) for the decayed, missing, filled teeth (D(M)FT) network in children and adolescents (immature permanent dentition).
1.1
1.1. Analysis
Comparison 1 0 ppm F versus 1000 ppm F in adults (mature permanent dentition), Outcome 1 DMFS.
1.2
1.2. Analysis
Comparison 1 0 ppm F versus 1000 ppm F in adults (mature permanent dentition), Outcome 2 DMFT.
2.1
2.1. Analysis
Comparison 2 0 ppm F versus 1500 ppm F in young children (primary dentition), Outcome 1 dfs.
3.1
3.1. Analysis
Comparison 3 250 ppm F versus 1450 ppm F in young children (primary dentition), Outcome 1 dmfs.
3.2
3.2. Analysis
Comparison 3 250 ppm F versus 1450 ppm F in young children (primary dentition), Outcome 2 dmft.
3.3
3.3. Analysis
Comparison 3 250 ppm F versus 1450 ppm F in young children (primary dentition), Outcome 3 Proportion developing new caries.
4.1
4.1. Analysis
Comparison 4 500 to 550 ppm F versus 1055 to 1100 ppm F in young children (primary dentition), Outcome 1 dmfs/ANC.
4.2
4.2. Analysis
Comparison 4 500 to 550 ppm F versus 1055 to 1100 ppm F in young children (primary dentition), Outcome 2 dmft.
4.3
4.3. Analysis
Comparison 4 500 to 550 ppm F versus 1055 to 1100 ppm F in young children (primary dentition), Outcome 3 Proportion developing new caries.
5.1
5.1. Analysis
Comparison 5 440 ppm F versus 1450 ppm F in young children (primary dentition), Outcome 1 dmft.
5.2
5.2. Analysis
Comparison 5 440 ppm F versus 1450 ppm F in young children (primary dentition), Outcome 2 Proportion developing new caries.
6.1
6.1. Analysis
Comparison 6 0 ppm F versus 250 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS closest to 3 years.
6.2
6.2. Analysis
Comparison 6 0 ppm F versus 250 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
6.3
6.3. Analysis
Comparison 6 0 ppm F versus 250 ppm F in children and adolescents (immature permanent dentition), Outcome 3 Proportion developing new caries.
7.1
7.1. Analysis
Comparison 7 0 ppm F versus 500 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS closest to 3 years.
7.2
7.2. Analysis
Comparison 7 0 ppm F versus 500 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
8.1
8.1. Analysis
Comparison 8 0 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
8.2
8.2. Analysis
Comparison 8 0 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
8.3
8.3. Analysis
Comparison 8 0 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 3 Proportion developing new caries.
9.1
9.1. Analysis
Comparison 9 0 ppm F versus 1450 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
9.2
9.2. Analysis
Comparison 9 0 ppm F versus 1450 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
9.3
9.3. Analysis
Comparison 9 0 ppm F versus 1450 ppm F in children and adolescents (immature permanent dentition), Outcome 3 Proportion developing new caries.
10.1
10.1. Analysis
Comparison 10 0 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS closest to 3 years.
10.2
10.2. Analysis
Comparison 10 0 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
11.1
11.1. Analysis
Comparison 11 250 ppm F versus 500 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
11.2
11.2. Analysis
Comparison 11 250 ppm F versus 500 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
12.1
12.1. Analysis
Comparison 12 250 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
12.2
12.2. Analysis
Comparison 12 250 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
12.3
12.3. Analysis
Comparison 12 250 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 3 Proportion developing new caries.
13.1
13.1. Analysis
Comparison 13 500 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
13.2
13.2. Analysis
Comparison 13 500 ppm F versus 1000 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
14.1
14.1. Analysis
Comparison 14 1000 ppm F versus 1450 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
14.2
14.2. Analysis
Comparison 14 1000 ppm F versus 1450 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
14.3
14.3. Analysis
Comparison 14 1000 ppm F versus 1450 ppm F in children and adolescents (immature permanent dentition), Outcome 3 Proportion developing new caries.
15.1
15.1. Analysis
Comparison 15 1000 ppm F versus 1700 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
15.2
15.2. Analysis
Comparison 15 1000 ppm F versus 1700 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
16.1
16.1. Analysis
Comparison 16 1000 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
16.2
16.2. Analysis
Comparison 16 1000 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
17.1
17.1. Analysis
Comparison 17 1450 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
18.1
18.1. Analysis
Comparison 18 1700 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 1 D(M)FS.
18.2
18.2. Analysis
Comparison 18 1700 ppm F versus 2400 ppm F in children and adolescents (immature permanent dentition), Outcome 2 D(M)FT.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Abrams 1980 {published data only}
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Held 1968b {published data only}
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Hodge 1980 {published data only}
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Kinkel 1972 {published data only}
    1. Kinkel HJ, Raich R. Caries prevention by means of a Na2FPO3 toothpaste after 3 years of application [Die Karieshemmung einer Na2FPO3 ‐Zahnpasta nach 3 Jahren Applikation]. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1972;82:1240‐4. - PubMed
    1. Kinkel HJ, Raich R. Caries‐inhibiting properties of Na2FPO3 toothpaste after 5‐year evaluation studies [Die Karieshe‐mung einer Na2FPO3‐Zahnpasta nach 5 Jahren Applikation]. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1974;84:1245‐7. - PubMed
    1. Kinkel HJ, Raich R. Effectiveness of a Na2FP03 toothpaste on caries in children [Zur Wirkung einer Na2FPO3‐Zahnpasta auf die Karies bei Kindern]. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1972;82:169‐75. - PubMed
    1. Kinkel HJ, Raich R. The caries‐inhibiting property of a Na2FPO3 toothpaste after 4‐year use [Die Karieshemmung einer Na2FPO3‐Zahnpasta nach 4 Jahren Applikation]. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1974;84:226‐9. - PubMed
    1. Kinkel HJ, Raich R, Muller M. Caries prevention by means of a Na2FPO3‐toothpaste after 7 year's application [Die Karieshemmung durch eine Na2FPO3‐Zahnpasta nach 7 Jahren Applikation]. Deutsche Zahnarztliche Zeitschrift 1977;32:859‐60. - PubMed
Kleber 1996 {published data only}
    1. Kleber CJ, Putt MS, Smith CE, Gish CW. Effect of supervised use of an alum mouthrinse on dental caries incidence in caries‐susceptible children: a pilot study. ASDC Journal of Dentistry for Children 1996;63:393‐402. - PubMed
Koch 1990 {published data only}
    1. Bjarnason S. On dental health in Icelandic children. Observations during a clinical dentifrice trial. Swedish Dental Journal Supplement 1989;57:1‐40. - PubMed
    1. 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 Research 1990;24(1):72‐9. - PubMed
Lima 2008 {published data only}
    1. Lima TJ, Ribeiro CC, Tenuta LM, Cury JA. Low‐fluoride dentifrice and caries lesion control in children with different caries experience: a randomized clinical trial. Caries Research 2008;42(1):46‐50. - PubMed
Lind 1974 {published data only}
    1. Lind OP, Larsen MJ, Möller IJ, Fehr FR. A 2% sodium monofluorophosphate toothpaste's caries preventive effect in a Danish fluoride area [En 2% natrium monofluorfosfattandpasta's cariesforebyggende effekt i et dansk fluoromrade]. Tandlaegebladet 1975;79:793‐9. - PubMed
    1. Lind OP, Möller IJ, Fehr FR, Larsen MJ. Caries‐preventive effect of a dentifrice containing 2 percent sodium monofluorophosphate in a natural fluoride area. Results after 3 years. Helvetica Odontologica Acta 1974;18:53. - PubMed
    1. Lind OP, Möller IJ, Fehr FR, Larsen MJ. Caries‐preventive effect of dentifrice containing 2 percent sodium monofluorophosphate in a natural fluoride area in Denmark. Community Dentistry and Oral Epidemiology 1974;2(3):104‐13. - PubMed
    1. Lind OP, Fehr FR, Larsen MJ, Moller IJ. Anti‐caries effect of a 2% Na2PO3F‐dentifrice in a Danish fluoride area. Community Dentistry and Oral Epidemiology 1976;4:7‐14. - PubMed
Lu 1980 {published data only}
    1. Lu KH, Hanna JD, Peterson JK. Effect on dental caries of a stannous fluoride‐calcium pyrophosphate dentifrice in an adult population: one‐year results. Pharmacology and Therapeutics in Dentistry 1980;5(1‐2):11‐6. - PubMed
Lu 1987 {published data only}
    1. Lu KH, Ruhlman CD, Chung KL, Sturzenberger OP, Lehnhoff RW. A three‐year clinical comparison of a sodium monofluorophosphate dentifrice with sodium fluoride dentifrices on dental caries in children. ASDC Journal of Dentistry for Children 1987;54(4):241‐4. - PubMed
Mainwaring 1978 {published data only}
    1. Mainwaring PJ, Naylor MN. A three‐year clinical study to determine the separate and combined caries‐inhibiting effects of sodium monofluorophosphate toothpaste and an acidulated phosphate‐fluoride gel. Caries Research 1978;12:202‐12. - PubMed
Mainwaring 1983 {published data only}
    1. Mainwaring PJ, Naylor MN. A four‐year clinical study to determine the caries‐inhibiting effect of calcium glycerophosphate and sodium fluoride in calcium carbonate base dentifrices containing sodium monofluorophosphate. Caries Research 1983;17:267‐76. - PubMed
    1. Mainwaring PJ, Naylor MN. Anti‐caries effects of NaMFP/CaCO3 toothpastes containing calcium glycerohosphate (CaGP) or sodium fluoride (NaF) ‐ A 4 year clinical study. Journal of Dental Research 1981;60:1091.
Marks 1994 {published data only}
    1. Marks RG, Conti AJ, Moorhead JE, Cancro L, D'Agostino RB. Results from a three year caries clinical trial comparing NaF and SMFP fluoride formulations. International Dental Journal 1994;44:275‐85. - PubMed
    1. Marks RG, D'Agostino R, Moorhead JE, Conti AJ, Cancro L. A fluoride dose response evaluation in an anticaries clinical trial. Journal of Dental Research 1992;71(6):1286‐91. - PubMed
Marthaler 1965 {published data only}
    1. König KG, Mühlemann HR. Caries inhibiting effect of amine fluoride containing dentifrices tested in an animal experiment and in a clinical study. In: Mühlemann HR, König KG editor(s). Caries Symposium Zürich: the Present Status of Caries Prevention by Fluorine‐Containing Dentifrices; Proceedings. Berne and Stuttgart: Huber, 1961:30.
    1. Marthaler T. The caries inhibiting effect of amine fluoride dentifrices in children during three years of unsupervised use. British Dental Journal 1965;119:153‐63. - PubMed
    1. Marthaler TM. Caries control with the use of an amine fluoride dentifrice for 5 years. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1965;75:509‐15. - PubMed
    1. Marthaler TM. Caries inhibition with amino fluoride toothpastes following a 7‐year‐long study [Karieshemmung durch Aminfluoridzahnpasten nach 7 jahriger Studiendauer]. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1968;78:134‐47. - PubMed
    1. Marthaler TM. Caries‐inhibition after seven years of unsupervised use of an amine fluoride dentifrice. British Dental Journal 1968;124:510‐5. - PubMed
Marthaler 1965a {published data only}
    1. König KG, Mühlemann HR. Caries inhibiting effect of amine fluoride containing dentifrices tested in an animal experiment and in a clinical study. In: Mühlemann HR, König KG editor(s). Caries Symposium Zürich: the Present Status of Caries Prevention by Fluorine‐Containing Dentifrices; Proceedings. Berne and Stuttgart: Huber, 1961:30.
    1. Marthaler T. The caries inhibiting effect of amine fluoride dentifrices in children during three years of unsupervised use. British Dental Journal 1965;119:153‐63. - PubMed
    1. Marthaler TM. Caries control with the use of an amine fluoride dentifrice for 5 years. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1965;75:509‐15. - PubMed
    1. Marthaler TM. Caries inhibition with amino fluoride toothpastes following a 7‐year‐long study [Karieshemmung durch Aminfluoridzahnpasten nach 7 jahriger Studiendauer]. SSO Schweizerische Monatsschrift Fuer Zahnheilkund 1968;78:134‐47. - PubMed
    1. Marthaler TM. Caries‐inhibition after seven years of unsupervised use of an amine fluoride dentifrice. British Dental Journal 1968;124:510‐5. - PubMed
Marthaler 1970 {published data only}
    1. Marthaler TM, König KG, Mühlemann HR. The effect of a fluoride gel used for supervised toothbrushing 15 or 30 times per year. Helvetica Odontologica Acta 1970;14:67‐77. - PubMed
Marthaler 1970a {published data only}
    1. Marthaler TM, König KG, Mühlemann HR. The effect of a fluoride gel used for supervised toothbrushing 15 or 30 times per year. Helvetica Odontologica Acta 1970;14:67‐77. - PubMed
Marthaler 1974 {published data only}
    1. Marthaler TM. Caries‐inhibition by an amine fluoride dentifrice. Results after 6 years in children with low caries activity. Helvetica Odontologica Acta 1974;18(Suppl VIII):35‐44. - PubMed
Mergele 1968 {published data only}
    1. Mergele M. Report II. An unsupervised brushing study on subjects residing in a community with fluoride in the water. Bulletin of the New York Academy of Medicine 1968;14:251‐5.
Mitropolous 1984 {published data only}
    1. Mitropoulos CM, Holloway PJ, Davies TGH, Worthington HV. Relative efficacy of dentifrices containing 250 or 1000 ppm F‐ in preventing dental caries ‐ report of a 32‐month clinical trial. Community Dental Health 1984;1:193‐200. - PubMed
Muhler 1955 {published data only}
    1. Muhler JC, Radike AW, Nebergall WH, Day HG. A comparison between the anticariogenic effects of dentifrices containing stannous fluoride and sodium fluoride. Journal of the American Dental Association 1955;51(5):556‐9. - PubMed
Muhler 1957 {published data only}
    1. Muhler JC, Radike AW. Effect of a dentifrice containing stannous fluoride on dental caries in adults. II. Results at the end of two years of unsupervised use. Journal of the American Dental Association 1957;55(2):196‐8. - PubMed
Muhler 1962 {published data only}
    1. Muhler JC. Effect of a stannous fluoride dentifrice on caries reduction in children during a three year study period. Journal of the Americal Dental Association 1962;64:216‐24. - PubMed
    1. Muhler JC. The effect of a stannous fluoride dentifrice on caries reduction in children during a three‐year study period (Summary). In: Mühlemann HR, König KG editor(s). Caries Symposium Zürich: the Present Status of Caries Prevention by Fluorine‐Containing Dentifrices; Proceedings. Berne and Stuttgart: Huber, 1961:9‐13.
Muhler 1970 {published data only}
    1. Muhler JC. A clinical comparison of fluoride and antienzyme dentifrices. ASDC Journal of Dentistry for Children 1970;37:501. - PubMed
    1. Muhler JC. A clinical comparison of fluoride and antienzyme dentifrices. Journal of Dental Research 1967;IADR Abstr No 273:105. - PubMed
Naylor 1967 {published data only}
    1. Ashley FP, Naylor MN, Emslie RD. Stannous fluoride and sodium monofluorophosphate dentifrices. Clinical testing in London school children‐radiological findings. British Dental Journal 1969;127:125‐8. - PubMed
    1. Naylor MN, Emslie RD. Clinical testing of stannous fluoride and sodium monofluorophosphate dentifrices in London school children. British Dental Journal 1967;123:17‐23. - PubMed
Naylor 1979 {published data only}
    1. Naylor MN, Glass RL. A 3‐year clinical trial of calcium carbonate dentifrice containing calcium glycerophosphate and sodium monofluorophosphate. Caries Research 1979;13:39‐46. - PubMed
O'Mullane 1997 {published data only}
    1. O'Mullane DM, Kavanagh D, Ellwood RP, Chesters RK, Schafer F, Huntington E, et al. A three‐year clinical trial of a combination of trimetaphosphate and sodium fluoride in silica toothpastes. Journal of Dental Research 1997;76(11):1776‐81. - PubMed
Peterson 1967 {published data only}
    1. Peterson JK, Williamson L. Comparative effectiveness of a sodium fluoride‐acid orthophosphate‐insoluble metaphosphate dentifrice on caries reduction in children. Journal of Dental Research 1966;IADR Abstr No 249:100.
    1. Peterson JK, Williamson L. Field test of a sodium fluoride dentifrice containing acid orthophosphate and an insoluble metaphosphate abrasive‐second year report. Journal of Oral Therapeutics and Pharmacology 1967;4:1‐4. - PubMed
    1. Peterson JK, Williamson L. Three‐years caries inhibition of a sodium fluoride acid orthophosphate dentifrice compared with a stannous fluoride dentifrice and a non‐fluoride dentifrice. Journal of Dental Research 1968;IADR Abstr No 255:101.
Peterson 1979 {published data only}
    1. Peterson JK. A supervised brushing trial of sodium monofluorophosphate dentifrices in a fluoridated area. Caries Research 1979;13:68‐72. - PubMed
    1. Peterson JK, Williamson L, Casad R. Caries inhibition with MFP‐calcium carbonate dentifrice in fluoridated area. Journal of Dental Research 1975;54:L85.
Petersson 1991 {published data only}
    1. Petersson LG, Borkhed D, Gleerup A, Johansson M, Jonsson G. Caries‐preventive effect of dentifrices containing various types and concentrations of fluorides and sugar alcohols. Caries Research 1991;25:74‐9. - PubMed
Piccione 1979 {published data only (unpublished sought but not used)}
    1. Piccione N. Controlled clinical study of the caries prophylactic activity of a new bifluoride toothpaste (sodium monofluorophosphate + sodium fluoride) [Studio clinico controllato sull'attivita carioprofilattica di una nuova pasta dentifricia bifluorurata (monofluorofosfato di sodio + fluoruro di sodio)]. Minerva Stomatologica 1979;28:325‐7. - PubMed
Powell 1981 {published data only}
    1. Powell KR, Barnard PD, Craig GG. Effect of stannous fluoride treatments on the progression of initial lesions in approximal surfaces of permanent posterior teeth. Journal of Dental Research 1981;60:1648‐54. - PubMed
Rao 2009 {published data only}
    1. Rao SK, Bhat GS, Aradhya S, Devi A, Bhat M. Study of the efficacy of toothpaste containing casein phosphopeptide in the prevention of dental caries: a randomized controlled trial in 12‐ to 15‐year‐old high caries risk children in Bangalore, India. Caries Research 2009;43(6):430‐5. - PubMed
Reed 1973 {published data only}
    1. Reed MW. Clinical evaluation of three concentrations of sodium fluoride in dentifrices. Journal of the American Dental Association 1973;87:1401‐3. - PubMed
Reed 1975 {published data only}
    1. Reed MW, King JD. A clinical evaluation of a sodium fluoride dentifrice. Journal of Dental Research 1970;IADR Abstr No 340:133.
    1. Reed MW, King JD. A clinical evaluation of a sodium fluoride dentifrice. Pharmacology and Therapeutics in Dentistry 1975;2:77‐82. - PubMed
Ringelberg 1979 {published data only}
    1. Ringelberg ML, Webster DB. Effects of an amine fluoride mouthrinse and dentifrice on the gingival health and the extent of plaque of school children. Journal of Periodontology 1977;48(6):350‐3. - PubMed
    1. Ringelberg ML, Webster DB, Dixon DO. Effects of an amine fluoride dentifrice and mouthrinse on the dental caries of school children after 18 months. Journal of Preventive Dentistry 1978;5(4):26‐30. - PubMed
    1. Ringelberg ML, Webster DB, Dixon DO, Fairchild S, Driscoll WS. Results of gingival, plaque, and stain assessments after 30 months use of amine fluorides and their inorganic counterparts. Pharmacology and Therapeutics in Dentistry 1979;4(1):27‐31. - PubMed
    1. Ringelberg ML, Webster DB, Dixon DO, LeZotte DC. The caries‐preventive effect of amine fluorides and inorganic fluorides in a mouthrinse or dentifrice after 30 months of use. Journal of the American Dental Association 1979;98(2):202‐8. - PubMed
Ripa 1988 {published data only}
    1. Ripa LW, Leske GS, Forte F, Varma A. Caries inhibition of mixed NaF‐Na2PO3F dentifrices containing 1,000 and 2,500 ppm F: 3‐year results. Journal of the American Dental Association 1988;116(1):69‐73. - PubMed
    1. Ripa LW, Leske GS, Sposato A, Varma A. Clinical comparison of the caries inhibition of two mixed NaF‐Na2PO3F dentifrices containing 1,000 and 2,500 ppm F compared to a conventional Na2PO3F dentifrice containing 1,000 ppm F: results after two years. Caries Research 1987;21(2):149‐57. - PubMed
Rule 1984 {published data only}
    1. Rule J, Smith M, Truelove R, Macko D, Castaldi C. Anticaries properties of a 0.78% sodium monofluorophosphate‐silica base dentifrice. Journal of Dental Research 1982;61:281.
    1. Rule JT, Smith MR, Truelove RB, Macko DJ, Castaldi CR. Caries inhibition of a dentifrice containing 0.78% sodium monofluorophosphate in a silica base. Community Dentistry and Oral Epidemiology 1984;12(4):213‐7. - PubMed
Segal 1967 {published data only}
    1. Segal AH, Stiff RH, George WA. Caries inhibiting effectiveness of a stannous fluoride‐insoluble sodium metaphosphate (IMP) dentifrice in children. Two year results. Journal of Dental Research 1966;IADR Abstr No 250:101.
    1. Segal AH, Stiff RH, George WA, Picozzi A. Cariostatic effect of a stannous fluoride‐containing dentifrice on children: two‐year report of a supervised toothbrushing study. Journal of Oral Therapeutics and Pharmacology 1967;4:175‐80. - PubMed
Slack 1964 {published data only}
    1. Slack GL, Martin WJ. The use of a dentifrice containing stannous fluoride in the control of dental caries. Report of an unsupervised clinical trial. British Dental Journal 1964;117:275‐80.
Slack 1967 {published data only}
    1. Slack GL, Berman DS, Martin WJ, Young J. Clinical testing of stannous fluoride‐insoluble metaphosphate dentifrice in Kent girls. British Dental Journal 1967;123:9‐16.
Slack 1967a {published data only}
    1. Slack GL, Berman DS, Martin WJ, Hardie JM. Clinical testing of a stannous fluoride‐calcium pyrophosphate dentifrice in Essex school girls. British Dental Journal 1967;123:26‐33.
Slack 1971 {published data only}
    1. Slack GL, Bulman JS, Osborn JF. Clinical testing of fluoride and non‐fluoride containing dentifrices in Hounslow school children. British Dental Journal 1971;130:154‐8. - PubMed
Stephen 1988 {published data only}
    1. Stephen KW, Creanor SL, Russell JI, Burchell CK, Huntington E, Downie CF. A 3‐year oral health dose‐response study of sodium monofluorophosphate dentifrices with and without zinc citrate: anti‐caries results. Community Dentistry and Oral Epidemiology 1988;16(6):321‐5. - PubMed
Stephen 1994 {published data only}
    1. Chestnutt IG, Schäfer F, Jacobson AP, Stephen KW. The influence of toothbrushing frequency and post‐brushing rinsing on caries experience in a caries clinical trial. Community Dentistry and Oral Epidemiology 1998;26(6):406‐11. - PubMed
    1. Stephen KW, Chestnutt IG, Jacobson AP, Chesters RK, Schäfer F. Effect of NaF and SMFP dentifrices on 3‐year caries increments. Journal of Dental Research 1993;72(1 Suppl):346. - PubMed
    1. Stephen KW, Chestnutt IG, Jacobson AP, McCall DR, Chesters RK, Huntington E, et al. The effect of NaF and SMFP toothpastes on three‐year caries increments in adolescents. International Dental Journal 1994;44(3 Suppl 1):287‐95. - PubMed
Stookey 2004 {published data only}
    1. Stookey GK, Mau MS, Isaacs RL, Gonzalez‐Gierbolini C, Bartizek RD, Biesbrock AR. The relative anticaries effectiveness of three fluoride‐containing dentifrices in Puerto Rico. Caries Research 2004;38(6):542‐50. - PubMed
Sønju Clasen 1995 {published data only}
    1. Clasen AB, Ogaard B, Sønju T. A comparison of the anticaries effect on the primary dentition of two dentifrices containing 250 ppm and 1450 ppm fluoride. International Journal of Paediatric Dentistry 1995;5(1):3‐8. - PubMed
Takeuchi 1968 {published data only}
    1. Takeuchi M, Shimizu T, Kawasaki T, Kizu T. A field study effect of a dentifrice containing sodium monofluorophosphate in caries prevention. Koku Eisei Gakkai Zasshi 1968;18:26‐38.
Thomas 1966 {published data only}
    1. Thomas AE, Jamison HC. Effect of SnF2 dentrifices on caries in children: two‐year clinical study of supervised brushing in children's homes. Journal of the American Dental Association 1966;73:844‐52. - PubMed
Torell 1965 {published data only}
    1. Torell P. The Goteborg studies of methods for applying fluorides topically. Advances in Fluorine Research and Dental Caries Prevention 1965;21:255‐8. - PubMed
    1. Torell P. Two‐year clinical tests with different methods of local caries‐preventive fluorine application in Swedish school‐children (Part I: the Goteborg study). Acta Odontologica Scandinavica 1965;23:287‐312. - PubMed
Torell 1965a {published data only}
    1. Torell P. Two‐year clinical tests with different methods of local caries‐preventive fluorine application in Swedish school‐children (Part II: the Sodertalje study). Acta Odontologica Scandinavica 1965;23:313‐22. - PubMed
Torell 1965b {published data only}
    1. Torell P. Two‐year clinical tests with different methods of local caries‐preventive fluorine application in Swedish school‐children (Part II: the Sodertalje study). Acta Odontologica Scandinavica 1965;23:313‐22. - PubMed
Vilhena 2010 {published data only}
    1. Vilhena FV, Olympio KP, Lauris JR, Delbem AC, Buzalaf MA. Low‐fluoride acidic dentifrice: a randomized clinical trial in a fluoridated area. Caries Research 2010;44(5):478‐84. - PubMed
Weisenstein 1972 {published data only}
    1. Weisenstein PR, Zacherl WA. A multiple‐examiner clinical evaluation of a sodium fluoride dentifrice. Journal of the American Dental Association 1972;84(3):621‐3. - PubMed
Winter 1989 {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
    1. Winter GB, Holt RD, Williams BF. Clinical trial of a low fluoride toothpaste for young children. International Dental Journal 1989;39(4):227‐35. - PubMed
Zacherl 1970 {published data only}
    1. Zacherl WA, McPhail CW. Final report on the efficacy of a stannous fluoride‐calcium pyrophosphate dentifrice. Journal of the Canadian Dental Association 1970;36(7):262‐4. - PubMed
    1. Zacherl WA, McPhail WB. Evaluation of a stannous fluoride‐calcium pyrophosphate dentifrice. Journal of the Canadian Dental Association 1965;31:174‐80. - PubMed
Zacherl 1970a {published data only}
    1. Zacherl WA, McPhail CW. Final report on the efficacy of a stannous fluoride‐calcium pyrophosphate dentifrice. Journal of the Canadian Dental Association 1970;36(7):262‐4. - PubMed
    1. Zacherl WA, McPhail WB. Evaluation of a stannous fluoride‐calcium pyrophosphate dentifrice. Journal of the Canadian Dental Association 1965;31:174‐80. - PubMed
Zacherl 1972 {published data only}
    1. Zacherl WA. Clinical evaluation of an aged stannous fluoride‐calcium pyrophosphate dentifrice. Journal of the Canadian Dental Association 1972;38(4):155‐7. - PubMed
Zacherl 1972a {published data only}
    1. Zacherl WA. A clinical evaluation of a sodium fluoride and stannous fluoride dentifrices. Journal of Dental Research 1968;IADR Abstr No 253:101.
    1. Zacherl WA. Clinical evaluation of neutral sodium fluoride, stannous fluoride, sodium monofluorophosphate and acidulated fluoride‐phosphate dentifrices. Journal of the Canadian Dental Association 1972;38(1):35‐8. - PubMed
Zacherl 1973 {published data only}
    1. Zacherl WA. A clinical evaluation of a stannous fluoride and a sarcosinate dentifrice. ASDC Journal of Dentistry for Children 1973;40(6):451‐3. - PubMed
    1. Zacherl WA. Clinical evaluation of a sarcosinate dentifrice. Journal of Dental Research 1970;IADR Abstr No 339:133.
Zacherl 1981 {published data only}
    1. Biesbrock AR, Faller RV, Bartizek RD, Court LK, McClanahan SF. Reversal of incipient and radiographic caries through the use of sodium and stannous fluoride dentifrices in a clinical trial. Journal of Clinical Dentistry 1998;9(1):5‐10. - PubMed
    1. Caplan DJ, Slade GD, Biesbrock AR, Bartizek RD, McClanahan SF, Beck JD. A comparison of increment and incidence density analyses in evaluating the anticaries effects of two dentifrices. Caries Research 1999;33(1):16‐22. - PubMed
    1. Zacherl WA. A three‐year clinical caries evaluation of the effect of a sodium fluoride‐silica abrasive dentifrice. Pharmacology and Therapeutics in Dentistry 1981;6(1‐2):1‐7. - PubMed
    1. Zacherl WA. Clinical evaluation of a sodium fluoride‐silica abrasive dentifrice. Journal of Dental Research 1981;60:577. - PubMed

References to studies excluded from this review

Andlaw 1983 {published data only}
    1. Andlaw RJ, Palmer JD, King J, Kneebone SB. Caries preventive effects of toothpastes containing monofluorophosphate and trimetaphosphate: a 3‐year clinical trial. Community Dentistry and Oral Epidemiology 1983;11(3):143‐7. - PubMed
Baysan 2001 {published data only}
    1. Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P. Reversal of primary root caries using dentifrices containing 5,000 ppm and 1,100 ppm fluoride. Caries Research 2001;35(1):41‐6. - PubMed
Beiswanger 1978 {published data only}
    1. Beiswanger BB, Billings RJ, Sturzenberger OP, Bollmer BW. Effect of an SnF2‐Ca2P2O7 dentifrice and APF topical applications. ASDC Journal of Dentistry for Children 1978;45(2):137‐41. - PubMed
Beiswanger 1981 {published data only}
    1. Beiswanger BB, Gish CW, Mallatt ME. A three‐year study of the effect of a sodium fluoride‐silica abrasive dentifrice on dental caries. Pharmacology and Therapeutics in Dentistry 1981;6(1‐2):9‐16. - PubMed
Bibby 1945 {published data only}
    1. Bibby BG. A test of the effect of fluoride containing‐dentifrices on dental caries. Journal of Dental Research 1945;24:297‐303. - PubMed
Bixler 1966 {published data only}
    1. Bixler D, Muhler JC. Effectiveness of a stannous fluoride‐containing dentifrice in reducing dental caries in children in a boarding school environment. Journal of the American Dental Association 1966;72:653‐8. - PubMed
Blinkhorn 1988 {published data only}
    1. Blinkhorn AS, Kay EJ. A clinical study in children: comparing the anticaries effect of three fluoride dentifrices. Clinical Preventive Dentistry 1988;10(3):14‐6. - PubMed
Chedid 2012 {published data only}
    1. Chedid NR, Bourgeois D, Kaloustian H, Pilipili C, Baba NZ. Caries risk management: effect on caries incidence in a sample of Lebanese preschool children. Odonto‐Stomalogie Tropicale (Tropical Dental Journal) 2012;35(139):26‐40. - PubMed
Curnow 2002 {published data only}
    1. Curnow MM, Pine CM, Burnside G, Nicholson JA, Chesters RK, Huntington E. A randomised controlled trial of the efficacy of supervised toothbrushing in high caries risk children. Caries Research 2002;36(4):294‐300. - PubMed
    1. Pine CM, Curnow MM, Burnside G, Nicholson JA, Roberts AJ. Caries prevalence four years after the end of a randomised controlled trial. Caries Research 2007;41(6):431‐6. - PubMed
Cutress 1992 {published data only}
    1. Cutress T, Howell PT, Finidori C, Abdullah F. Caries preventive effect of high fluoride and xylitol containing dentifrices. ASDC Journal of Dentistry for Children 1992;59(4):313‐8. - PubMed
Damle 2012 {published data only}
    1. Damle SG, Deoyani D, Bhattal H, Yadav R, Lomba A. Comparative efficacy of dentifrice containing sodium monofluorophosphate + calcium glycerophosphate and non‐fluoridated dentifrice: a randomized, double‐blind, prospective study. Dental Research Journal (Isfahan) 2012;9(1):68‐73. - PMC - PubMed
De Paola 1993 {published data only}
    1. Paola PF, Soparkar PM, Triol C, Volpe AR, Garcia L, Duffy J, et al. The relative anticaries effectiveness of sodium monofluorophosphate and sodium fluoride as contained in currently available dentifrice formulations. American Journal of Dentistry 1993;6:S7‐S12. - PubMed
Dolles 1980 {published and unpublished data}
    1. Dolles OK, Eriksen HM, Gjermo P. Tooth stain during 2 years' use of chlorhexidine ‐ and fluoride‐containing dentifrices. Scandinavian Journal of Dental Research 1979;87(4):268‐74. - PubMed
    1. Dolles OK, Gjermo P. Caries increment and gingival status during 2 years' use of chlorhexidine ‐ and fluoride‐containing dentifrices. Scandinavian Journal of Dental Research 1980;88(1):22‐7. - PubMed
Downer 1976 {published data only}
    1. Downer MC, Holloway PJ, Davies TG. Clinical testing of a topical fluoride caries preventive programme. British Dental Journal 1976;141:242‐7. - PubMed
    1. Downer MC, Spencer SJ. Evaluating a dental caries preventive programme. Royal Society Health Journal 1973;93:129‐32. - PubMed
Edlund 1977 {published data only}
    1. Edlund K, Koch G. Effect on caries of daily supervised toothbrushing with sodium monofluorophosphate and sodium fluoride dentifrices after 3 years. Scandinavian Journal of Dental Research 1977;85:41‐5. - PubMed
Edward 1978 {published data only}
    1. Edward S, Torell P. Constituents of fluoride dentifrices. Caries Research 1978;12(2):107.
Ennever 1980 {published data only (unpublished sought but not used)}
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Mergele 1968a {published data only}
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References to studies awaiting assessment

NCT02016001 {published data only}
    1. NCT02016001. Effective fluoride concentration in toothpaste for dental caries prevention (DMFT) [Identification of effective fluoride concentration in toothpaste for dental caries prevention; a randomized controlled trial]. clinicaltrials.gov/ct2/show/NCT02016001 (first received 19 December 2013).

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References to other published versions of this review

Walsh 2009
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Publication types