Questions :

13. Fluoride Dentifrice

Contributed by:

Dr. Zubaidah Ahmad

Dental Services Division, Ministry of Health Malaysia.

Fluoride, a mineral found naturally in soil and water, strengthens the tooth enamel, making it more resistant to attack by the acids formed from sugar. It is most effective during tooth development in childhood, when it is incorporated in the tooth enamel itself. The tiny amount of fluoride put into water is harmless to health but has a major effect in preventing dental caries in children. There has been a major decline of approximately 68% in dental caries over a period of 30 years amongst Malaysian school children due to the appropriate use of Fluorides.

Fluoride's cariostatic effect is currently considered to be due primarily to its presence in the oral cavity posteruptively and its ability to decrease the rate of enamel demineralisation and enhance the remineralisation of early carious lesions. Thus, topical exposure to even low levels of fluoride confers caries protection and is beneficial for people at all ages.

As early as 1958, the World Health Organisation (WHO) supported by the International Dental Federation (FDI) and in 1986 reiterated its stand that properly formulated fluoride toothpaste are suitable for use by everyone, whether in low or optimum fluoride areas. Research has unequivocally shown significant benefits for its use in further reducing the incidences of tooth decay even in areas with fluoridated water supply.

Toothpaste containing fluoride were first introduced and have been in the market over the last 30 years and it may be concluded that the greatest advance in the last 30 years was adding fluoride to toothpaste, resulting in reductions in caries increments. Investigations into the effectiveness of fluorides in toothpaste have been carried out since 1945. Results of over 140 clinical studies published up to 1994 showed that fluoride toothpaste is safe, extremely beneficial to children and have come to play a major role in maintenance of good oral health. Fluoride is very effective in preventing cavities, especially when combined with good brushing and flossing, pit and fissure sealants and good dietary habits. They are also considered completely safe when properly used.

Some parents wonder whether there really is a need to brush with fluoride toothpaste in areas where the water supply contains fluoride. The answer is, yes! The effects of fluoride toothpastes enhance the effects of fluoride in public water supply in preventing and limiting the ravages of dental caries. In fluoridated areas, fluoride in toothpaste confers added protection against tooth decay. During the active phases of tooth eruption in children, fluoride builds up resistance to decay in newly erupted teeth.

Topical application of fluoride through brushing with fluoride toothpaste is extremely efficacious because of the high compliance and acceptance of toothbrushing habits by the public. In countries where the habit of toothbrushing is widespread, regular toothbrushing with fluoride toothpaste means continuous vigilance against tooth decay since this provides an important means of applying fluoride to teeth. Hence, parents are encouraged to begin dental care as soon as the first tooth erupts. Brushing your teeth regularly will clear away the food that encourages plaque to form. But brushing with a fluoride toothpaste will ensure that the enamel that protects your teeth remains hard and strong.

In many countries, fluoride containing toothpastes make up more than 95% of all toothpastes sales, so. provided that a person there brushes his or her teeth at all, the benefits of a topically applied fluoride will be delivered. Almost all brands of toothpaste in the Malaysian market are fluoridated. he fluoride level in toothpaste can range between 1000 - 1500 ppm. Certain brands have recently introduced levels of 550 ppm. The excellent safety record of fluoride toothpaste argues against any unnecessary regulations.

At the levels of use in toothpaste and provided the toothpaste is used in accordance with manufacturer and dentist guidance, fluoride are entirely safe. The only possible side effect is a minor flecking of tooth enamel if significant amounts of fluoride toothpaste are swallowed by small children on a regular basis, over a period of several years, while the permanent teeth are forming.

Many young children use too much toothpaste when they brush their teeth, then swallow it when they are finished. Studies conducted have found that chances are children do not spit out or rinse well after brushing. Hence, when it comes to children's toothpaste, more is not necessarily better. Parental supervision is needed for children when brushing or using any fluoridated substances.

Concerning monitoring dentifrice use, the prevention of ingestion of large quantities of fluoride dentifrice by young children should be a major emphasis of the whole dental team, professional organisation and manufacturers. Use of small, pea-sized quantities of dentifrice by young children; parental responsibility for placement of dentifrice and actual brushing, with special attention to dentifrices flavoured for children that may encourage ingestion and those with high fluoride concentration, and eliminating corporate promotion use of a full strip of dentifrice are all important components of such efforts.


  • Parents / minders should clean the teeth of children below the age of 3 years with either gauze or a toothbrush.
  • Parents / minders should help brush the teeth of their 4 - 6- year-old children.
  • Parents / minders should apply fluoride toothpaste to the toothbrush of children below the age of 6 years, until the children can do it properly themselves.
  • Only a pea-sized amount of fluoride toothpaste (5 mm) should be applied to the bristles. A pea size of a 1000 ppm fluoridated toothpaste, delivers not more than 0.1mg fluoride.
  • Parents / minders should still supervise toothbrushing activity of their 6-year-olds or younger children even if they are capable of brushing their own teeth.
  • Children should be taught to spit out and to rinse thoroughly with water after toothbrushing. This is to prevent swallowing of toothpaste.

Under European Community (EC) law, the maximum amount of fluoride which can be included in an Over The Counter (OTC) toothpaste is 1500 ppm. Many OTC toothpastes contain fluoride at this level, but there also lower dose formulations around 1000 ppm or around 500 ppm for children below seven. At seven and above, normal fluoride dose toothpastes (1000 0r 1500 ppm F) are better for children because of their greater effectiveness against tooth decay. " Fluoride free" toothpaste, or baby toothpaste with so little fluoride would not benefit the young child and this proves to be ineffective.

Regular brushing by itself will not prevent tooth decay, but there is a definite benefit from the regular brushing with a fluoride toothpaste.


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