Cochrane · intervention · CD007868
Fluoride toothpastes of different concentrations for preventing dental caries
Walsh, T, Worthington, HV, Glenny, AM, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
65
current version
GRADE rated
59
No studies
4
Included studies
96
as reported
No studies 4 · 6.2%Ungraded 2 · 3.1%Very low 3 · 4.6%Low 44 · 67.7%Moderate 10 · 15.4%High 2 · 3.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children, adolescents, or adults, irrespective of initial caries level, background fluoride exposure, receipt of dental treatment, nationality, setting, or age at recruitment; studies selecting participants on the basis of special (general or oral) health conditions were excluded. | Three placebo-controlled studies (2675 randomised; 2162 evaluated) assessed adults (18 to 93 years, mature permanent dentition); eight studies (13,856 randomised; 9055 evaluated) assessed the primary dentition (1 to 4 years); 86 studies (51,304 randomised; 42,074 evaluated) assessed the immature permanent dentition of children and adolescents (5 to 18 years). |
| Intervention | Toothbrushing with a fluoride toothpaste; proposed categories: 250 ppm F; 440 to 550 ppm F; 1000 to 1250 ppm F; 1450 to 1500 ppm F; 1700 to 2200 ppm F; 2400 to 2800 ppm F; agents NaF, SMFP, SnF2, APF, AmF singly or combined; any compatible abrasive system. | Placebo 0 ppm F (n=66); 250 ppm F (n=4); 440/500/550 ppm F (n=2); 1000/1055/1100/1250 ppm F (n=55); 1450/1500 ppm F (n=8); 1700/2000/2200 ppm F (n=5); 2400/2500/2800 ppm F (n=6) |
| Comparison | Toothbrushing with a non-fluoride toothpaste, no toothpaste, or a fluoride toothpaste of a different (lower) concentration (0 ppm F category added explicitly). | Placebo toothpaste (n=66); Fluoride toothpaste of different concentration (n=30) |
| Outcomes | Primary: caries increment - change from baseline in D(M)FS/T (permanent), change from baseline in d(e/m)fs/t (primary), change in the proportion of participants developing new caries. Secondary: adverse effects such as irritation, dental staining. | Caries increment D(M)FS (n=81); Caries increment D(M)FT (n=53); Caries increment d(m)fs (n=7); Caries increment d(m)ft (n=3); Proportion developing new caries permanent dentition (n=10); Proportion developing new caries deciduous dentition (n=3); Side effects (n=16) |
| Study designs | Parallel-group randomised controlled trials (individual or cluster), follow-up at least 1 year; split-mouth designs excluded; non-randomised studies excluded. | NR |
| Timing | Minimum duration of 1 year. | Minimum study duration 12 months; longest reported follow-up 7 years; analysis nearest to 3 years (closest to 36 months) follow-up. |
Search date: 2018-08. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; US NIH Ongoing Trials Register ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Show all 3 versions250 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.15 [-0.25, -0.05] | 3 studies | Low Downgraded: risk of bias, inconsistency |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.11 [-0.27, 0.05] | 1 study | Low Downgraded: risk of bias, inconsistency |
Proportion developing new caries Follow-up: 24 months | RR 1.07 [0.91, 1.27] 451 per 1000 vs 483 per 1000 | 2 studies · 684 participants | Low Downgraded: risk of bias, imprecision |
440 to 550 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.18 [-0.41, 0.04] | 2 studies | Low Downgraded: risk of bias, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.12 [-0.31, 0.07] | 2 studies | Low Downgraded: risk of bias, imprecision, inconsistency |
1000 to 1250 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion developing new caries Follow-up: 12 to 60 months | RR 0.9 [0.77, 1.06] 596 per 1000 vs 536 per 1000 | 7 studies · 1898 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse effects of toothpaste Closest to 36 months | 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 |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.26 [-0.31, -0.21] | 41 studies | High |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.28 [-0.32, -0.25] | 55 studies | High |
1450 to 1500 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.39 [-0.49, -0.28] | 4 studies | Moderate Downgraded: risk of bias |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.36 [-0.43, -0.29] | 4 studies | Moderate Downgraded: risk of bias, imprecision |
Proportion developing new caries Follow-up: 36 months | RR 0.95 [0.91, 0.98] 947 per 1000 vs 900 per 1000 | 1 study · 945 participants | Low Downgraded: risk of bias, imprecision |
1700 to 2200 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.32 [-0.41, -0.22] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.33 [-0.56, -0.11] | NR | Low Downgraded: risk of bias, imprecision |
2400 to 2800 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.39 [-0.52, -0.25] | 2 studies | Low Downgraded: risk of bias, imprecision, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.41 [-0.49, -0.33] | 3 studies | Low Downgraded: risk of bias, inconsistency |
440 to 550 ppm F toothpaste vs 250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.08 [-0.32, 0.17] | 1 study | Low Downgraded: risk of bias, imprecision, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD 0.03 [-0.17, 0.23] | 1 study | Low Downgraded: risk of bias, inconsistency |
1000 to 1250 ppm F toothpaste vs 250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.15 [-0.31, 0.0] | 3 studies | Low Downgraded: risk of bias, imprecision, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.14 [-0.24, -0.04] | 7 studies | Low Downgraded: risk of bias, inconsistency |
1450 to 1500 ppm F toothpaste vs 250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.28 [-0.47, -0.09] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.21 [-0.33, -0.1] | NR | Low Downgraded: risk of bias, imprecision |
1700 to 2200 ppm F toothpaste vs 250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.23 [-0.5, 0.05] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.17 [-0.3, -0.04] | NR | Low Downgraded: risk of bias, imprecision |
2400 to 2800 ppm F toothpaste vs 250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.26 [-0.38, -0.14] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.28 [-0.48, -0.08] | NR | Low Downgraded: risk of bias, imprecision |
1000 to 1250 ppm F toothpaste vs 440 to 550 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.08 [-0.3, 0.15] | 1 study | Low Downgraded: risk of bias, imprecision, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.16 [-0.35, 0.03] | 1 study | Low Downgraded: risk of bias, imprecision |
1450 to 1500 ppm F toothpaste vs 440 to 550 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.2 [-0.45, 0.04] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.24 [-0.44, -0.04] | NR | Low Downgraded: risk of bias, imprecision |
1700 to 2200 ppm F toothpaste vs 440 to 550 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.15 [-0.46, 0.16] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.2 [-0.41, 0.01] | NR | Low Downgraded: risk of bias, imprecision |
2400 to 2800 ppm F toothpaste vs 440 to 550 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.2 [-0.46, 0.05] | NR | Low Downgraded: risk of bias, imprecision |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.29 [-0.49, -0.08] | NR | Low Downgraded: risk of bias, imprecision |
1450 to 1500 ppm F toothpaste vs 1000 to 1250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.08 [-0.14, -0.01] | 10 studies | Moderate Downgraded: risk of bias |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.13 [-0.23, -0.02] | 4 studies | Low Downgraded: risk of bias, inconsistency |
Proportion developing new caries Follow-up: 36 months | RR 1.02 [0.93, 1.11] 728 per 1000 vs 742 per 1000 | 2 studies · 4328 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
1700 to 2200 ppm F toothpaste vs 1000 to 1250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.07 [-0.3, 0.15] | 1 study | Very low Downgraded: risk of bias, imprecision, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.03 [-0.12, 0.06] | 5 studies | Low Downgraded: risk of bias, inconsistency |
2400 to 2800 ppm F toothpaste vs 1000 to 1250 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.12 [-0.2, -0.05] | 6 studies | Low Downgraded: risk of bias, inconsistency |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.12 [-0.25, 0.01] | 3 studies | Very low Downgraded: risk of bias, inconsistency |
1700 to 2200 ppm F toothpaste vs 1450 to 1500 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, surface index D(M)FS Closest to 36 months | SMD 0.04 [-0.07, 0.15] | NR | Moderate Downgraded: risk of bias |
Caries increment, tooth index D(M)FT Closest to 36 months | SMD 0.05 [-0.19, 0.3] | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
2400 to 2800 ppm F toothpaste vs 1450 to 1500 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD 0.0 [-0.16, 0.17] | NR | Low Downgraded: risk of bias, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.05 [-0.14, 0.05] | 2 studies | Moderate Downgraded: risk of bias |
2400 to 2800 ppm F toothpaste vs 1700 to 2200 ppm F toothpaste
Population: Children and adolescents with immature permanent dentition (aged 5 to 16 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index D(M)FT Closest to 36 months | SMD -0.05 [-0.27, 0.17] | NR | Very low Downgraded: risk of bias, inconsistency |
Caries increment, surface index D(M)FS Closest to 36 months | SMD -0.09 [-0.2, 0.02] | 1 study | Low Downgraded: risk of bias |
1500 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Young children with primary (deciduous) dentition (aged 1 to 6 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index d(m)ft 12 months | No studies reported poolable d(m)ft increment; Cahen 1982 reported a df-rate of 18.25% (n=708) in the 0 ppm group vs 13.64% (n=632, 1500 ppm SMFP) and 9.37% (n=668, amine fluoride) groups. | 1 study | Ungraded |
Caries increment, surface index d(m)fs Follow-up: 24 months | MD -1.86 [-2.51, -1.21] | 1 study · 998 participants | Moderate Downgraded: risk of bias |
Adverse effects of toothpaste 24 months | Adverse effects of toothpaste: not estimable; 0 events reported (Fan 2008); 998 participants (1 RCT); low-certainty. | 1 study · 998 participants | Low Downgraded: risk of bias, imprecision |
1450 ppm F toothpaste vs 250 ppm F toothpaste
Population: Young children with primary (deciduous) dentition (aged 1 to 6 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries increment, tooth index d(m)ft Follow-up: 22 months | MD -0.4 [-1.14, 0.34] | 1 study · 172 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects of toothpaste | Adverse effects of toothpaste: no studies reported this outcome. | 0 studies | No studies |
Caries increment, surface index d(m)fs Follow-up: 22 months | MD -1.2 [-2.92, 0.52] | 1 study · 172 participants | Low Downgraded: risk of bias, imprecision |
Proportion developing new caries 22 months | RR 0.92 [0.54, 1.57] 455 per 1000 vs 418 per 1000 | 1 study · 172 participants | Low Downgraded: risk of bias, imprecision |
1055 to 1100 ppm F toothpaste vs 500 to 550 ppm F toothpaste
Population: Young children with primary (deciduous) dentition (aged 1 to 6 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects of toothpaste 12 months | 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 Downgraded: imprecision |
Caries increment, surface index d(m)fs Follow-up: 20 to 36 months | MD -0.05 [-0.38, 0.28] | 2 studies · 1958 participants | Moderate Downgraded: imprecision |
Proportion developing new caries 36 months | RR 0.86 [0.74, 0.99] 484 per 1000 vs 416 per 1000 | 1 study · 905 participants | Low Downgraded: risk of bias, imprecision |
Caries increment, tooth index d(m)ft Follow-up: 36 months | MD -0.27 [-0.6, 0.06] | 1 study · 905 participants | Low Downgraded: risk of bias, imprecision |
1450 ppm F toothpaste vs 440 ppm F toothpaste
Population: Young children with primary (deciduous) dentition (aged 1 to 6 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects of toothpaste | Adverse effects of toothpaste: no studies reported this outcome. | 0 studies | No studies |
Proportion developing new caries 60 months | RR 0.87 [0.81, 0.94] 577 per 1000 vs 502 per 1000 | 1 study · 2362 participants | Moderate Downgraded: imprecision |
Caries increment, tooth index d(m)ft Follow-up: 60 months | MD -0.34 [-0.59, -0.09] | 1 study · 2362 participants | Moderate Downgraded: imprecision |
1000 or 1100 ppm F toothpaste vs Non-fluoride (0 ppm F) placebo toothpaste
Population: Adults with mature permanent dentition (aged 18 to 93 years at study start)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion developing new caries | Proportion of adults developing new caries: no studies reported this outcome. | 0 studies | No studies |
Caries increment, tooth index DMFT 24 months | MD -0.46 [-0.93, 0.01] | 1 study · 247 participants | Low Downgraded: risk of bias, imprecision |
Adverse effects of toothpaste | Adverse effects of toothpaste: no studies reported this outcome. | 0 studies | No studies |
Caries increment, surface index DMFS 12 to 24 months | MD -0.53 [-1.02, -0.04] | 3 studies · 2162 participants | Moderate Downgraded: risk of bias |