Fluoridated Dentifrice

Toothpaste has come a long way from its beginnings as pastes made from things like mashed eggshells and bones mixed with myrrh. The first clinically proven fluoride toothpaste was introduced in 1955 by Crest; it contained 0.4% stannous fluoride (SnF₂). Each decade after that brought further advancements: In the 1960s, gel products hit the markets; in the 1970s antiplaque claims were introduced; tartar control products were first marketed in the 1980s; and the 1990s were marked by specialty products on the market, such as antigingivitis, whitening agents, and changes in the type of container used to deliver the dentifrice, such as pumps and dual chambers.¹

In many communities where water fluoridation is not available, fluoridated dentifrice are the major source of fluoride.¹⁴ Regular toothbrushing using fluoridated dentifrice is the most rational way to administer topical fluoride because it puts in place two protective mechanisms; mechanical dental biofilm disruption and sustained fluoride delivery.¹⁹

Today, most over-the-counter dentifrice products in the United States contain between 850 ppm to 1150 ppm fluoride. Clinical trials indicate a dose-dependent relationship between fluoride concentration and caries prevention, with a 6% increase in efficacy and 8.6% reduction in caries for every 500 ppm fluoride increase specially within the range in concentration from 1,000 to 2,500 ppm fluoride.^1,20,21 To recap the caries-reducing benefits of fluoridated dentifrice: Research has documented that a regular low-dose source of fluoride is the most efficient means to prevent demineralization of teeth and to enhance remineralization. Fluoride becomes incorporated with the enamel apatite crystal, rendering the enamel more resistant to acid dissolution. Fluoride in saliva and plaque also promotes remineralization. And finally, fluoride also has a modest antimicrobial effect on plaque bacteria, with stannous fluoride being particularly effective against Streptococcus mutans.¹

For patients 12 years or older, and with high caries activity or severe caries risk, 5,000 ppm F-toothpaste can be prescribed by the dentist. There is substantial evidence of the high-concentration fluoridated toothpastes in controlling caries progression, specially cavitated lesions and root caries lesions in elderly disabled people (lesions particularly difficult to control).^22,23 One 6-month study conducted in adults found that 57% of root caries lesions became hard in subjects using a 5000-ppm gel, compared to 29% for subjects who used a 1100-ppm toothpaste.²⁴ The fluoride action in inactivating demineralized lesions also lasts longer: at least for a couple of hours twice a day the fluoride concentration is 5 times higher in the saliva of those who use 5,000 versus those using 1,450 ppm F-toothpaste.²² Since it is It is observed that the formation of calcium fluoride (CaF₂) is concentration dependent and requires a concentration of >100 ppm fluoride to be formed.²⁵ the 5,000 ppm F-toothpaste provides a significant advantage over 1,100 and 1,450 ppm F-toothpaste in this sense. Therefore, the daily use of dentifrices containing 5,000 ppm F is more efficient in reducing active root caries lesions (dentin lesions) than dentifrices containing between 1,100 and 1,450 ppm fluoride.^23,26

The most common forms of fluoride used in U.S. dentifrices are sodium fluoride (NaF), sodium monofluorophosphate (SMFP) and stannous fluoride (SnF₂). Mixtures of NaF and SMFP, NaF and SnF₂ and amine fluoride (AmF) are also recognized as safe and effective forms of fluoride in over-the-counter therapeutic dentifrices in markets outside of the United States.

Figure 2. Common forms of Fluoride

Figure 2. Common forms of Fluoride