Fluoride Toothpastes, Rinses, and Tablets

Abstract

Only from the mid-1950's has therapeutic benefit been obtained via dentifrices, initially with stannous fluoride-then monofluorophosphate-containing products which remained stable and efficacious. Altered abrasive systems followed, and both sodium fluoride and monofluorophosphate/ sodium fluoride mixtures were introduced as active anti-caries agents, with recent meta-analysis indicating that sodium fluoride > monofluorophosphate/sodium fluoride > monofluorophosphate. With respect to fluoride levels, clear dose-response relationships have been demonstrated. However, at < 1000 ppm F, the situation is less certain. Since the mid-1980's, anticalculus fluoride dentifrices have been marketed, and have been shown to have similar caries-reducing potential as their non-calculus-inhibiting control formulae. Finally, one study has been described where a sodium fluoride dentifrice successfully reduced root caries. Of the many fluoride formulations used for caries-inhibiting mouthrinsing [ e.g., acid phosphate fluoride (100- 3000 ppm F), sodium fluoride (45-3000 ppm F), stannous fluoride (100-250 ppm F), ammonium fluoride (1000 ppm F), and amine fluoride (250 ppm F)], sodium fluoride would seem to be the preferred agent. Furthermore, rinse frequency is deemed more important than fluoride ion concentration, but caution is urged re the volumes and concentrations to be used by children, no rinsing being recommended below 4 years. Combination of a 440-pp-F sodium fluoride and 0.05% chlorhexidine school-administered rinse appears to have increased the caries-inhibiting benefit as compared with sodium fluoride alone. Fluoride supplements have reduced deciduous caries from 14 to 93%, and in the permanent dentition, from 20 to 81%. For maximum benefit, slow intra-oral dissolution is recommended, but unfortunately, compliance, whether school- or home-based, is problematic. However, fluorosis is not a necessary outcome of their early usage.