Same question across reviews · CL0149
intervention :: Fluoride toothpaste/dentifrice -> Adverse effects/fluorosis
ProposalThis cluster groups questions by review type, intervention category and outcome domain. It is a proposal pending human validation, so questions in it may differ in population, comparator or timing.
Reviews
8
Questions
31
current versions
GRADE rated
15
Review overlap (CCA)
NR
over all included studies of these reviews, not this question only
| Question | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Fluoride mouthrinse (0.05-0.32% sodium fluoride or amine fluoride) added to daily fluoride toothpaste vs Control: fluoride toothpaste alone, placebo mouthrinse + toothpaste, or non-fluoride (chlorhexidine) mouthrinse + toothpaste Adverse effects / harms (side effects) · Children, adolescents and adults undergoing fixed (multi-bracket) orthodontic treatment · During treatment Fluoride mouthrinses for prevention of initial caries in orthodontic patients - a systematic review and… (2025) | No side- or adverse effects were reported in any of the included reports. | 7 studies · 704 participants | Ungraded |
Ate or licked fluoride toothpaste vs Did not eat or lick fluoride toothpaste Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | Nine studies investigated whether children ate or licked toothpaste; measurement subjective so not meta-analyzed (Table 1). Findings mixed: some studies found no significant difference; others (e.g. Celeste 2016 OR up… | 9 studies | Ungraded |
Used a pea-sized amount of fluoride toothpaste or less vs Used more than a pea-sized amount Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 0.92 [0.66, 1.28] | 3 studies · 2037 participants | Very low |
Started toothbrushing with fluoride toothpaste at or before 12 months (earlier start) vs Started after 12 months (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 0.83 [0.41, 1.67] | 1 study · 134 participants | Very low |
Started toothbrushing with fluoride toothpaste before 4 years (earlier start) vs Started after 4 years (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 1.60 [0.77, 3.35] | 2 studies · 1484 participants | Very low |
Fluoride toothpaste less than 1000 ppm (lower concentration) vs Fluoride toothpaste 1000 ppm or more (higher concentration) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 0.89 [0.52, 1.52] | 2 studies · 258 participants | Very low |
Started toothbrushing with fluoride toothpaste before 24 months (earlier start) vs Started after 24 months (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 2.25 [1.19, 4.23] | 6 studies · 1223 participants | Very low |
Fluoride toothpaste less than 1000 ppm (lower concentration) vs Fluoride toothpaste 1000 ppm or more (higher concentration) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 0.79 [0.62, 1.02] | 3 studies · 2037 participants | Very low |
Started toothbrushing with fluoride toothpaste at or before 24 months (earlier start) vs Started after 24 months (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | RR 0.83 [0.61, 1.13] | 1 study · 3939 participants | Very low |
Started toothbrushing with fluoride toothpaste at or before 12 months (earlier start) vs Started after 12 months (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | RR 0.98 [0.81, 1.18] | 2 studies · 260 participants | Very low |
Started toothbrushing with fluoride toothpaste at or before 24 months (earlier start) vs Started after 24 months (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 1.12 [0.89, 1.42] | 5 studies · 3592 participants | Very low |
Started toothbrushing with fluoride toothpaste before 12 months (earlier start) vs Started after 12 months (later start) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 1.22 [0.98, 1.52] | 7 studies · 4329 participants | Very low |
Fluoride toothpaste 440 ppm (lower concentration) vs Fluoride toothpaste 1450 ppm (higher concentration) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | RR 0.72 [0.58, 0.89] | 1 study · 1009 participants | Moderate |
Fluoride toothpaste 550 ppm (lower concentration) vs Fluoride toothpaste 1000 ppm (higher concentration) Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | RR 0.75 [0.57, 0.99] | 1 study · 959 participants | Moderate |
Used less than half of the brush of fluoride toothpaste vs Used half or more of the brush Fluorosis (percentage prevalence in permanent teeth) · Children exposed to topical fluoride when under 6 years old; fluorosis assessed in permanent teeth at 6 to 18 years · Fluorosis assessed when most permanent teeth of interest had erupted (6 to 18 years) Topical fluoride as a cause of dental fluorosis in children (2024) · Cochrane | OR 0.77 [0.41, 1.46] | 2 studies · 258 participants | Very low |
1400/250 ppm F (amine F/SnF2) toothpaste + mouthrinse, daily vs 1400/250 ppm F (NaF) toothpaste + mouthrinse, daily Adverse effects · Orthodontic patients of any age with fixed braces (new DLs assessed at debond) · At debond (end of orthodontic treatment) Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment (2019) · Cochrane | Additional SoF Table 2. Adverse effects: none of the trials reported this outcome. | 0 studies | No studies |
1450 ppm F toothpaste vs 440 ppm F toothpaste Adverse effects of toothpaste · Young children with primary (deciduous) dentition (aged 1 to 6 years at study start) Fluoride toothpastes of different concentrations for preventing dental caries (2019) · Cochrane | Adverse effects of toothpaste: no studies reported this outcome. | 0 studies | No studies |
1450 ppm F toothpaste vs 250 ppm F toothpaste Adverse effects of toothpaste · Young children with primary (deciduous) dentition (aged 1 to 6 years at study start) Fluoride toothpastes of different concentrations for preventing dental caries (2019) · Cochrane | Adverse effects of toothpaste: no studies reported this outcome. | 0 studies | No studies |
1055 to 1100 ppm F toothpaste vs 500 to 550 ppm F toothpaste Adverse effects of toothpaste · Young children with primary (deciduous) dentition (aged 1 to 6 years at study start) · 12 months Fluoride toothpastes of different concentrations for preventing dental caries (2019) · Cochrane | Adverse effects of toothpaste: not estimable. "There were no reports on adverse effects, but some children complained about the taste of the dentifrice" (Cardoso 2014); 195 participants (1 RCT); low-certainty. | 1 study · 195 participants | Low |
Zinc chloride + sodium fluoride dentifrice vs Control dentifrice (sodium fluoride) Adverse events · Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced… Interventions for managing halitosis (2019) · Cochrane | Payne 2011 reported 19 non-oral and 12 oral adverse effects. The oral effects were tingling sensation in lips, dry mouth or sore gums. | 1 study | Ungraded |
Fluoride toothpaste (any concentration; pooled across comparisons) vs Lower-concentration or non-fluoride toothpaste (pooled across comparisons) Adverse effects of toothpaste · Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start) · Closest to 36 months Fluoride toothpastes of different concentrations for preventing dental caries (2019) · Cochrane | 16 studies assessed possible side effects, principally oral (soft tissue) pathologies and tooth staining. 6 studies reported no untoward events; 6 reported greater staining in the stannous fluoride group; 1 reported no… | 16 studies | Ungraded |
1500 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste Adverse effects of toothpaste · Young children with primary (deciduous) dentition (aged 1 to 6 years at study start) · 24 months Fluoride toothpastes of different concentrations for preventing dental caries (2019) · Cochrane | Adverse effects of toothpaste: not estimable; 0 events reported (Fan 2008); 998 participants (1 RCT); low-certainty. | 1 study · 998 participants | Low |
1000 or 1100 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste Adverse effects of toothpaste · Adults with mature permanent dentition (aged 18 to 93 years at study start) Fluoride toothpastes of different concentrations for preventing dental caries (2019) · Cochrane | Adverse effects of toothpaste: no studies reported this outcome. | 0 studies | No studies |
Sodium bicarbonate toothpaste vs Control toothpaste (without sodium bicarbonate) Adverse events · Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced… · 6 weeks Interventions for managing halitosis (2019) · Cochrane | Adverse events reported by Lomax 2017 were not related to the interventions. | 1 study · 148 participants | Ungraded |
Patient-used 5000 ppm F toothpaste, daily vs 1450 ppm F (conventional) toothpaste, daily Adverse effects · Orthodontic patients of any age with fixed braces (new DLs assessed at debond) · At debond (end of orthodontic treatment) Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment (2019) · Cochrane | SoF 3. Adverse effects: none of the trials reported this outcome. | 0 studies | No studies |
0.3% triclosan + PVM/MA + sodium fluoride toothpaste vs Sodium fluoride (control) toothpaste Adverse events · Adolescents and adults aged over 16 years with clinical or self-assessed halitosis of oral origin; excluding induced… · mean 1 week Interventions for managing halitosis (2019) · Cochrane | Adverse events: listed in the Summary of findings table but no data reported. No data were reported for adverse events. | 0 studies | No studies |
Fluoride toothpaste containing 10% xylitol vs Fluoride toothpaste (fluoride-only, no xylitol) Adverse effects · Children with permanent teeth (schoolchildren) · 2.5 to 3 years Xylitol‐containing products for preventing dental caries in children and adults (2015) · Cochrane | Adverse effects: both studies reported that there were no adverse effects in either the xylitol or control group. | 2 studies · 4216 participants | Ungraded |
Triclosan/copolymer-containing fluoride toothpaste vs Fluoride toothpaste without triclosan Adverse effects (tooth staining, Meckel Stain Score, 6 months) · Children and adults (aged 16 years or less = children, over 16 = adults) without periodontitis at baseline; in… · 6 months Triclosan/copolymer containing toothpastes for oral health (2013) · Cochrane | MD -0.15 [-0.60, 0.30] | 1 study · 325 participants | Ungraded |
Fluoride toothpaste vs Placebo (non-fluoride) toothpaste Enamel fluorosis (adverse effect) · Children and adolescents aged 16 years or less · At least 1 year Fluoride toothpastes for preventing dental caries in children and adolescents (2003) · Cochrane | Fluorosis data have not been reported in any of the trials. | 0 studies | No studies |
Fluoride toothpaste vs Placebo (non-fluoride) toothpaste Acquiring extrinsic tooth staining (adverse effect; stannous fluoride toothpaste) · Children and adolescents aged 16 years or less · At least 1 year Fluoride toothpastes for preventing dental caries in children and adolescents (2003) · Cochrane | RD 0.24 [0.19, 0.30] | 5 studies · 3948 participants | Ungraded |
Fluoride toothpaste vs Placebo (non-fluoride) toothpaste Oral soft tissue lesions (adverse effect) · Children and adolescents aged 16 years or less · At least 1 year Fluoride toothpastes for preventing dental caries in children and adolescents (2003) · Cochrane | Oral soft tissue lesions reported in 3 trials, none of which with complete or useable data; all three stated "no lesions attributable to product use were noted". | 3 studies | Ungraded |