High-fluoride Toothpaste (5000 ppm) in Caries Prevention

Abstract: Abstract High-fluoride Toothpaste (5000 ppm) in Caries Prevention Anna Nordström, Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Box 450, SE-405 30 Göteborg, Sweden. Dental caries is a common disease in a large number of individuals. Fluoride (F) toothpaste plays an essential role in any programme designed to prevent caries. Objective: This thesis focuses on the effect of high-fluoride toothpaste (5,000 ppm) compared with a standard dentifrice (1,450 ppm) in caries prevention. The aims were to investigate: 1) the F retention in proximal plaque and saliva, 2) the effect of post-brushing water rinsing on F retention, 3) the effect on de novo plaque formation, 4) the effect on caries incidence and progression in caries-active adolescents and 5) the effect of a third application of toothpaste on F retention and the pH drop in plaque. Design: Papers I, II and IV were randomised, cross-over studies with 12-26 individuals. Paper III was a 2-year, single-blind, longitudinal study of 279 caries-active adolescents. Results: High content of F in toothpaste increased the F retention in both plaque and saliva. High-fluoride toothpaste without post-brushing water rinsing increased the fluoride concentration in proximal saliva more than two times, compared with standard toothpaste also without rinsing. Water rinsing immediately after brushing with high-fluoride toothpaste reduced the F concentration in proximal saliva more than two times, which supports the recommendation to refrain from post-brushing water rinsing. Toothpaste slurry with 5,000 ppm F reduced the formation of new dental plaque on tooth surfaces. Caries-active adolescents (14-16-year-olds) using high-fluoride toothpaste during two years had 40% lower progression of caries compared with those using standard toothpaste. Twenty-eight per cent of the adolescents had “poor compliance” and brushed irregularly. Brushing with high-fluoride toothpaste resulted in 42% less new caries lesions among caries-active adolescents with “poor compliance” compared with those with “excellent compliance”. Thus, high-fluoride toothpaste is an excellent home care treatment for individuals with high caries risk. Brushing with high-fluoride toothpaste three times a day resulted in almost four times higher F concentration in saliva compared with standard toothpaste twice a day. The retention of fluoride in plaque increased significantly as well. Brushing with 5,000 and 1,450 ppm toothpastes, twice a day plus the “massage” once a day, resulted in the same F concentration in saliva and plaque as brushing 3 times a day with the same paste. Using toothpaste as a “lotion” to massage the buccal surfaces with the fingertip may be a simple and inexpensive way of delivering F a third time during the day, tentatively at lunch time. Main Conclusions: High-fluoride toothpaste has a clear role in prevention of dental caries; targeting those at the greatest risk, reducing and arresting caries lesions and thereby reducing the need for operative treatment in caries-active adolescents.