Fluoride in toothpastes for children: suggestion for change.

Abstract

Fluoridated toothpastes were designed to produce a topical caries-preventive effect. Many studies have shown their effectiveness. Recently, researchers have expressed concern that fluorosis may be increasing in the American population. There is speculation that fluoride (F) from fluoridated toothpastes might be a contributing factor when the toothpaste is accidentally swallowed by small children. The objective of this paper is to evaluate the clinical and epidemiological evidence in regard to the relationship between the swallowed fluoride from toothpaste and the presence of fluorosis. In regard to the epidemiological evidence, the reports in the literature show only a slight increase in the fluorosis index in communities that use fluoridated toothpastes with one or more type of systemic fluoride. However, these are limited, not excluding studies. The concentration ofF in most toothpastes, 1000 ppm, is a best estimate, empirically derived rather than based on precise scientific study. The clinical studies concerning ingestion of toothpaste showed that children are ingesting between 0.12 and 0.38 mg of toothpaste per brushing, which represents 0.12-0.38 mg F for the 1.0 mg Fig toothpastes. Children younger than 3 years of age may be ingesting high levels of fluoride from toothpastes. It was clear that the risk of fluorosis increases when children receive systemic fluoride~simultaneously from different sources. It is concluded that small children may accidentally swallow enough fluoride to reach levels considered adequate for the development .of fluorosis. Two approaches are recommended to reduce the hazard of fluorosis from ingested toothpastes: (1) manufacture of low-concentration toothpastes for children’s use; or (2) encourage parents to supervise children’s toothbrushing using a small amount of toothpaste. It is generally accepted that the presence of fluoride (F) in the enamel, dental plaque, and saliva helps protect teeth against carious attack. At the same time, there is some concern that fluorosis may be increasing in American children as a result of ingestion of excessive amounts of F from a number of sources, during the dentition’s formative years. One potential source of swallowed F is fluoridated toothpaste. In many developed countries, F-containing toothpastes comprise 80-95% of all dentifrice sales (Dowell 1981; Horowitz 1984). In the United States, the American Dental Association publication, A Guide to the Use of Fluorides, recommends the use of F dentifrices as soon as the first primary teeth erupt (ADA 1986). The objective of this paper is to evaluate the evidence for a relationship between the swallowed F from toothpaste and its potential effect on dental fluorosis.