New recommendations concerning the fluoride content of toddler toothpaste - consequences for systemic application of fluoride

Abstract

A group of experts from 4 European countries who gathered at a convention at Basel in November 1998, arrived at the recommendation to increase the fluoride (= F) content of toddler toothpastes from 250 ppm to 500 ppm. It was recommended to make parents brush the children's teeth with a pea-size piece of this toothpaste once a day, starting when the first deciduous teeth were erupting. Routine application of F-tablets would no longer be routinely prescribed, but restricted to individual indications in special high caries risk cases. This recommendation did not consider previous ones and was based exclusively on new scientific, mainly epidemiological evidence. In April 2000 the recommendation was officially issued by the German scientific dental association DGZMK.A careful case-control study resulted in the analysis of the risk to develop mottling of enamel under the influence of fluoridated water (1 ppm F) and fluoride toothpaste (1000 ppm F) when used in early childhood. It was found that excessive use of the fluoride toothpaste doubled the fluorosis risk, whereas when fluoride supplements (tablets, drops) were given the risk was about 20 times higher than without a fluoride supplement. Experiments in Germany and the Netherlands had shown that remineralisation of enamel under influence of 500 ppm F is achieved much more quickly than under application of 250 ppm F. A panel of WHO experts came to the conclusion that there was no evidence for the effectiveness of toothpastes containing less than 500 ppm. Statistics from the Netherlands have shown that the amount of fluoride tablets sold there is barely sufficient for the use by a quarter of all children 0 to 4 years old. In contrast to this low level of acceptance of fluoride tablets, fluoride toothpastes is widely accepted. It is their extensive use which explains the marked improvement of dentitions among the youth in this country during the last 20 years; the influence of topical fluoride gels, varnishes and other preventive measures was much less, and a reduction of sugar consumption (by the way less than 10 % of what it was in 1970) seems to have been the least important factor. The new recommendations based on topical rather than systemic fluoride application are better for preventive, toxicological, psychological and didactic reasons and should be implemented as soon as possible.