Non-Cochrane · aetiology · PM35757442
Fluoride Intake Through Dental Care Products: A Systematic Review.
Saad Hanan, Escoube Raphaëlle, Babajko Sylvie, et al. · Frontiers in oral health · 2022 · PubMed · doi:10.3389/froh.2022.916372
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
21
current version
GRADE rated
0
No studies
2
Included studies
28
linked below
No studies 2 · 9.5%Ungraded 19 · 90.5%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
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 | Studies with human participants using topical fluoride-containing dental care products, estimating total daily fluoride intake and monitoring fluoride in urine | 28 included studies, mostly young children; only two studies in adults aged 20-35 [28,47]; conducted worldwide (~43% Brazil); tap-water fluoride 0.04-3.05 mg/L |
| Intervention | Topical use of fluoride-containing dental care products (mainly toothpaste) | Fluoride toothpaste in most studies; one study also included fluoride varnish [42] |
| Comparison | Other fluoride sources (drinking water; beverages such as juices, milk and infant formulas; meals/diet) | Dietary fluoride (drinking water, beverages, food) |
| Outcomes | Total daily fluoride intake (TDFI) from all sources and the contribution of dental care products; fluoride exposure monitored via urine (daily urinary fluoride excretion, DUFE) as biomarker | Mean contribution of dental care products to TDFI 38% (SD 27%); toothpaste 15-95% of TDFI (ug/day; 19-84% in published data); no correlation with age (R2<0.14); no correlation between DUFE and intake (R2<0.07); DUFE 65.2-691 ug/day |
| Study designs | Not specified (design not restricted; animal, in vitro, reviews and case reports excluded) | Observational fluoride-intake estimation studies (19 estimation-only, Table 1; 9 with urine monitoring, Table 2); some kinetic |
| Timing | Chronic/daily fluoride exposure; publications 1995-2021 | Peak-level / 24-h post-exposure values used; 24-h urinary collection |
Search date: Not specified. Databases: PubMed/Medline
Questions and results
Fluoride-containing dental care products (mainly fluoride toothpaste; one study also included fluoride varnish) vs Dietary fluoride sources (drinking water, beverages, food)
Population: Humans using fluoride-containing dental care products; 28 included studies, mostly young children, only two studies in adults (aged 20-35); areas with tap-water fluoride 0.04-3.05 mg/L
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Contribution of dental care products to total daily fluoride intake (TDFI) Habitual daily intake Fluoride-containing dental care products (mainly toothpaste) contributed on average 38% (SD 27%) of total daily fluoride intake, regardless of tap-water fluoride level or age (ungraded; descriptive synthesis, no meta-analysis). Source: Abstract; Results para 'When all the data were taken into consideration'; Figure 2 · same question in other reviews | Mean contribution to TDFI (%) 38 | 28 studies | Ungraded |
Daily fluoride intake from toothpaste vs Child age (across age groups)
Population: Children using fluoride toothpaste (all tap-water fluoride categories)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Association between age and daily fluoride intake from toothpaste All tap-water fluoride categories; Levy et al. [20,22,24] data excluded There was no correlation between daily fluoride intake from toothpaste and the age of children (all R2 < 0.14), across all tap-water fluoride categories (ungraded). Source: Results para 'Calculated correlations (R2) were all below 0.14'; Figure 3 · same question in other reviews | R2 (coefficient of determination) <0.14 | NR | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Low-fluoridated tap water (0.3-0.51 mg/L) Population: Children using fluoride-containing dental care products (majority of included studies) In children in low-fluoridated tap water areas, dental care products contributed on average 39% of total fluoride exposure (ungraded). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 39 | 7 studies | Ungraded |
Contribution to total daily fluoride intake Poor fluoride in water (<0.3 mg/L) Population: Children For children in poor-fluoridated areas, the mean contribution was 45% (SD 28%). Source: Table 3 · same question in other reviews | Mean percentage contribution 45 | 10 studies | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · High-fluoridated tap water (0.78-1.5 mg/L) Population: Children using fluoride-containing dental care products (majority of included studies) In children in high-fluoridated tap water areas, dental care products contributed on average 41% of total fluoride exposure (ungraded). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 41 | 8 studies | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Medium-fluoridated tap water (0.52-0.77 mg/L) Population: Children using fluoride-containing dental care products (majority of included studies) In children in medium-fluoridated tap water areas, dental care products contributed on average 51% of total fluoride exposure (ungraded). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 51 | 14 studies | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Extreme-fluoridated tap water (>1.5 mg/L) Population: Children using fluoride-containing dental care products (majority of included studies) In children in extreme-fluoridated tap water areas, dental care products contributed on average 3% of total fluoride exposure (ungraded). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 3 | 2 studies | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Poor-fluoridated tap water (<0.3 mg/L) Population: Children using fluoride-containing dental care products (majority of included studies) In children in poor-fluoridated tap water areas, dental care products contributed on average 45% of total fluoride exposure (ungraded). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 45 | 10 studies | Ungraded |
Fluoride-containing dental care products (mainly fluoride toothpaste) vs Dietary fluoride sources (drinking water, beverages, food)
Population: Adults using fluoride-containing dental care products (two included studies [28,47]; aged 20-35)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Poor-fluoridated tap water (<0.3 mg/L) In adults in poor-fluoridated tap water areas, dental care products contributed on average 12% of total fluoride exposure (ungraded; 1-2 studies). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 12 | 1 study | Ungraded |
Contribution to total daily fluoride intake Low fluoride in water (0.3-0.51 mg/L) Population: Children For children in low-fluoridated areas, the mean contribution was 39% (SD 24%). Source: Table 3 · same question in other reviews | Mean percentage contribution 39 | 7 studies | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Medium-fluoridated tap water (0.52-0.77 mg/L) In adults in medium-fluoridated tap water areas, dental care products contributed on average 53% of total fluoride exposure (ungraded; 1-2 studies). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 53 | 1 study | Ungraded |
Contribution of dental care products to total daily fluoride intake (TDFI), by tap-water fluoride level Habitual daily intake · Low-fluoridated tap water (0.3-0.51 mg/L) In adults in low-fluoridated tap water areas, dental care products contributed on average 95% of total fluoride exposure (ungraded; 1-2 studies). Source: Table 3 · same question in other reviews | Mean contribution to TDFI (%) 95 | 1 study | Ungraded |
Total daily fluoride intake (TDFI) and daily fluoride intake from toothpaste
Population: Children and adults with 24-h urinary fluoride monitoring (9 studies reporting both intake and urine; Table 2)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Correlation between daily urinary fluoride excretion (DUFE) and fluoride intake 24-h urine collection · High-fluoride-area data from Idowu et al. [46,47] excluded Daily urinary fluoride excretion was not correlated with total daily fluoride intake or with fluoride intake from toothpaste (R2 < 0.07), based on nine studies (ungraded). Source: Results para 'To follow objectively the TDFI'; Figure 4 · same question in other reviews | R2 (coefficient of determination) <0.07 | 9 studies | Ungraded |
Contribution to total daily fluoride intake Medium fluoride in water (0.52-0.77 mg/L) Population: Children For children in medium-fluoridated areas, the mean contribution was 51% (SD 24%). Source: Table 3 · same question in other reviews | Mean percentage contribution 51 | 14 studies | Ungraded |
Fluoride-containing dental care products, primarily toothpaste vs Dietary fluoride sources in high-fluoridated areas
Population: Children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Contribution to total daily fluoride intake High fluoride in water (0.78-1.5 mg/L) For children in high-fluoridated areas, the mean contribution was 41% (SD 24%). Source: Table 3 · same question in other reviews | Mean percentage contribution 41 | 8 studies | Ungraded |
Contribution of dental care products to total fluoride exposure Population: Pregnant and lactating women No study has explored the contribution of dental care products to total fluoride exposure in pregnant and lactating women. Source: Discussion para 'we found no study that has explored the contribution of dental care products ... in pregnant and lactating women' (stated… · same question in other reviews | no estimate extracted | 0 studies | No studies |
Fluoride-containing dental care products / fluoride intake vs Male vs female
Population: Participants stratified by sex/gender (especially young children)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Sex/gender differences in fluoride intake or dental-care-product contribution No study has taken sex/gender into account when assessing fluoride intake, especially in young children. Source: Discussion para 'nor studies taking into account the gender, especially in young children' (stated evidence gap) · same question in other reviews | no estimate extracted | 0 studies | No studies |
Contribution to total daily fluoride intake Extreme fluoride in water (>1.5 mg/L) Population: Children For children in extremely fluoridated areas, the mean contribution was 3% (SD 2%). Source: Table 3 · same question in other reviews | Mean percentage contribution 3 | 2 studies | Ungraded |
Fluoride-containing dental care products, primarily toothpaste vs Dietary fluoride sources in poor-fluoridated areas
Population: Adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Contribution to total daily fluoride intake Poor fluoride in water (<0.3 mg/L) For adults in poor-fluoridated areas, the mean contribution was 12%. Source: Table 3 · same question in other reviews | Mean percentage contribution 12 | 1 study | Ungraded |
Fluoride-containing dental care products, primarily toothpaste vs Dietary fluoride sources in low-fluoridated areas
Population: Adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Contribution to total daily fluoride intake Low fluoride in water (0.3-0.51 mg/L) For adults in low-fluoridated areas, the mean contribution was 95%. Source: Table 3 · same question in other reviews | Mean percentage contribution 95 | 1 study | Ungraded |
Fluoride-containing dental care products, primarily toothpaste vs Dietary fluoride sources in extremely fluoridated areas
Population: Adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Contribution to total daily fluoride intake Extreme fluoride in water (>1.5 mg/L) For adults in extremely fluoridated areas, the mean contribution was 3%. Source: Table 3 · same question in other reviews | Mean percentage contribution 3 | 1 study | Ungraded |
Included primary studies 28
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Abuhaloob 2015 Total daily fluoride intake and the relative contributions of foods, drinks and toothpaste by 3‐ to 4‐year‐old children in the… DOI:10.1111/ipd.12108 | this review only | not stated | not extracted yet | not extracted yet |
| Amaral 2014 Longitudinal evaluation of fluoride levels in nails of 18–30‐month‐old children that were using toothpastes with 500 and 1100 μg F/g DOI:10.1111/cdoe.12103 | this review only | not stated | not extracted yet | not extracted yet |
| Cardoso 2006 Relationship between daily fluoride intake from diet and the use of dentifrice and human plasma fluoride concentrations DOI:10.1016/j.archoralbio.2005.12.003 | this review only | not stated | not extracted yet | not extracted yet |
| de Almeida 2007 Fluoride ingestion from toothpaste and diet in 1‐ to 3‐year‐old Brazilian children DOI:10.1111/j.1600-0528.2007.00328.x | this review only | not stated | not extracted yet | not extracted yet |
| Haftenberger 2001 Total Fluoride Intake and Urinary Excretion in German Children Aged 3–6 Years DOI:10.1159/000047489 | this review only | not stated | not extracted yet | not extracted yet |
| Idowu 2020 Biomarkers for the Assessment of Fluoride Exposure in Children DOI:10.1159/000504166 | this review only | not stated | not extracted yet | not extracted yet |
| Idowu 2021 Biomarkers for the Assessment of Exposure to Fluoride in Adults DOI:10.1159/000516091 | this review only | not stated | not extracted yet | not extracted yet |
| Levy 1995 Infants&apos; fluoride ingestion from water, supplements and dentifrice DOI:10.14219/jada.archive.1995.0110 | this review only | not stated | not extracted yet | not extracted yet |
| Levy 2001 Patterns of Fluoride Intake from Birth to 36 Months DOI:10.1111/j.1752-7325.2001.tb03369.x | this review only | not stated | not extracted yet | not extracted yet |
| Levy 2003 Patterns of Fluoride Intake from 36 to 72 Months of Age DOI:10.1111/j.1752-7325.2003.tb03502.x | this review only | not stated | not extracted yet | not extracted yet |
| Levy 2010 Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during… PMID:20884921 | this review only | not stated | not extracted yet | not extracted yet |
| Lima 2015 Total Fluoride Intake by Children from a Tropical Brazilian City DOI:10.1159/000442029 | this review only | not stated | not extracted yet | not extracted yet |
| Lima-Arsati 2010 Fingernail may not be a reliable biomarker of fluoride body burden from dentifrice DOI:10.1590/s0103-64402010000200001 | this review only | not stated | not extracted yet | not extracted yet |
| Maguire 2007 Fluoride intake and urinary excretion in 6‐ to 7‐year‐old children living in optimally, sub‐optimally and non‐fluoridated areas DOI:10.1111/j.1600-0528.2006.00366.x | this review only | not stated | not extracted yet | not extracted yet |
| Martinez-Mier 2003 Fluoride intake from foods, beverages and dentifrice by children in Mexico DOI:10.1034/j.1600-0528.2003.00043.x | this review only | not stated | not extracted yet | not extracted yet |
| Miziara 2009 Fluoride ingestion from food items and dentifrice in 2–6‐year‐old Brazilian children living in a fluoridated area using a semiquantitative… DOI:10.1111/j.1600-0528.2009.00477.x | this review only | not stated | not extracted yet | not extracted yet |
| Murakami 2002 Fluoride Intake in Japanese Children Aged 3–5 Years by the Duplicate-Diet Technique DOI:10.1159/000066537 | this review only | not stated | not extracted yet | not extracted yet |
| Oliveira 2018 Is the fluoride intake by diet and toothpaste in children living in tropical semi-arid city safe? DOI:10.1590/1807-3107bor-2018.vol32.0026 | this review only | not stated | not extracted yet | not extracted yet |
| Omena 2006 Fluoride intake from drinking water and dentifrice by children living in a tropical area of Brazil. PMID:19089062 | this review only | not stated | not extracted yet | not extracted yet |
| Paiva 2003 Fluoride intake by Brazilian children from two communities with fluoridated water DOI:10.1034/j.1600-0528.2003.00035.x | this review only | not stated | not extracted yet | not extracted yet |
| Pessan 2003 Evaluation of the total fluoride intake of 4-7-year-old children from diet and dentifrice DOI:10.1590/s1678-77572003000200012 | this review only | not stated | not extracted yet | not extracted yet |
| Pessan 2005 Analysis of Fingernails and Urine as Biomarkers of Fluoride Exposure from Dentifrice and Varnish in 4- to 7-Year-Old Children DOI:10.1159/000086842 | this review only | not stated | not extracted yet | not extracted yet |
| Rojas-Sanchez 1999 Fluoride intake from foods, beverages and dentifrice by young children in communities with negligibly and optimally fluoridated water: a… DOI:10.1111/j.1600-0528.1998.tb02023.x | this review only | not stated | not extracted yet | not extracted yet |
| Villa 2000 The fractional urinary fluoride excretion in young children under stable fluoride intake conditions DOI:10.1034/j.1600-0528.2000.028005344.x | this review only | not stated | not extracted yet | not extracted yet |
| Zohoori 2013 Fractional urinary fluoride excretion of 6–7-year-old children attending schools in low-fluoride and naturally fluoridated areas in the UK DOI:10.1017/s0007114512003583 | this review only | not stated | not extracted yet | not extracted yet |
| Zohoori 2013 Total fluoride intake and excretion in children up to 4 years of age living in fluoridated and non‐fluoridated areas DOI:10.1111/eos.12070 | this review only | not stated | not extracted yet | not extracted yet |
| Zohoori 2014 Fluoride intake of infants living in non-fluoridated and fluoridated areas DOI:10.1038/sj.bdj.2014.35 | this review only | not stated | not extracted yet | not extracted yet |
| Zohoori and Rugg-Gunn 2000 Total fluoride intake and urinary excretion in 4–year–old Iranian children residing in low-fluoride areas DOI:10.1017/s0007114500000040 | this review only | not stated | not extracted yet | not extracted yet |