Dental caries: Which fluoride dental products provide the best protection against tooth decay?
Brushing with fluoride toothpaste every day protects children and young people from tooth decay just as effectively as fluoride mouthwashes and gels applied directly to the teeth.
Tooth decay (dental caries) is still a common health problem, particularly in children. It has been known for a long time that fluoride can help strengthen teeth. That is why it is common for toothpastes to contain a small amount of fluoride. Fluoride occurs naturally too, for example in drinking water, mineral water and black tea. In some countries, fluoride is added to the community's water supply. In Germany, you can get table salt which has been enriched with fluoride, as well as fluoride tablets.
Fluoride can also have disadvantages for children though. If they swallow too much, the fluoride inside their bodies can have a negative impact on the growth of their second set of teeth (permanent teeth). This happens most easily if they swallow products such as toothpaste or gels that are meant to be spat out. Typical signs include white, yellowish or brown patches on permanent teeth, as well as superficial damage. This condition is called fluorosis.
With this in mind, experts have considered how to achieve the best protection against tooth decay. There are different ways to protect your teeth. Teeth sealants are one option. You can read more about them here. Another common approach is the use of dental products with fluoride in them. These include many toothpastes, mouthwashes and gels that you can use yourself. There are also gels and varnishes that are applied by dentists. The idea behind this is that it is easier to make sure that the products are not accidentally swallowed if they are applied by a dentist.
How suitable are the different fluoride products for the prevention of tooth decay? To answer this question, researchers from the Cochrane Collaboration (an international network of researchers) analysed 15 trials that compared different fluoride products with each other. Fluoride products that are taken orally were not included in these studies. Most of the trials looked at children between the ages of 12 and 14. They usually compared the use of ordinary toothpaste with special fluoride products. So far it has not been possible to draw any reliable conclusions from the results of research in which two products, such as varnishes and gels, were directly compared with each other.
The researchers only looked at the effects of fluoride products on the second set of teeth (permanent teeth). Their most important finding was that fluoride toothpastes appear to prevent tooth decay just as well as mouthwashes and gels. There is currently no strong evidence that fluoride varnishes applied by the dentist are better than toothpaste, mouthwashes or gels. The studies did not provide enough information about adverse effects such as fluorosis.
In another Cochrane review, researchers found that using a combination of different fluoride products did not have a big additional benefit.
Fluoride products should not be used as a substitute for brushing your teeth.
Author: German Institute for Quality and Efficiency in Health Care (IQWiG)
- December 11th 2009 15:00
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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. [Cochrane summary]
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. [Cochrane summary]
Salanti G, Marinho V, Higgins JP. A case study of multiple-treatments meta-analysis demonstrates that covariates should be considered. J Clin Epidemiol 2009; 62: 857-864. [PubMed summary]