This document summarizes the results of a meta-analysis that evaluated the effectiveness of different concentrations of fluoride toothpaste in preventing dental caries in children and adolescents. The analysis found that fluoride toothpaste was more effective than placebo at preventing caries, and that higher fluoride concentrations resulted in greater prevention, with concentrations of 1000 ppm and above showing a significant effect compared to placebo. The analysis also found that the preventive effect increased with higher baseline caries levels and with supervised toothbrushing.

1. Community Dent Oral Epidemiol. 2010 Aug 5. [Epub ahead of print]
Effect of health promotion and fluoride varnish on dental caries among
Australian Aboriginal children: results from a community-randomized
controlled trial.
Slade GD, Bailie RS, Roberts-Thomson K, Leach AJ, Raye I, Endean C, Simmons B, Morris P.
Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC,
USA.
Abstract
Objectives: We tested a dental health program in remote Aboriginal communities of Australia's Northern Territory,
hypothesizing that it would reduce dental caries in preschool children. Methods: In this 2-year, prospective,
cluster-randomized, concurrent controlled, open trial of the dental health program compared to no such program,
30 communities were allocated at random to intervention and control groups. All residents aged 18-47 months
were invited to participate. Twice per year for 2 years in the 15 intervention communities, fluoride varnish was
applied to children's teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental
health was promoted in community settings, and primary health care workers were trained in preventive dental
care. Data from dental examinations at baseline and after 2 years were used to compute net dental caries
increment per child (d(3)mfs). A multi-level statistical model compared d(3)mfs between intervention and control
groups with adjustment for the clustered randomization design; four other models used additional variables for
adjustment. Results: At baseline, 666 children were examined; 543 of them (82%) were re-examined 2 years
later. The adjusted d(3)mfs increment was significantly lower in the intervention group compared to the control
group by an average of 3.0 surfaces per child (95% CI = 1.2, 4.9), a prevented fraction of 31%. Adjustment for
additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of
24-36%. Conclusions: These results corroborate findings from other studies where fluoride varnish was
efficacious in preventing dental caries in young children.
Oral Health Prev Dent. 2010;8(2):159-64.
Is titanium tetrafluoride (TiF4) effective to prevent carious and erosive
lesions? A review of the literature.
Wiegand A, Magalhães AC, Attin T.

2. Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zürich, Zürich, Switzerland.
annette.wiegand@zzmk.unizh.ch
Abstract
The present review summarises the effects of titanium tetrafluoride (TiF(4)) on the development and progression
of carious and erosive lesions. The mode of action of TiF(4) is due to the formation of an acid-stable surface
layer, which provides mechanical protection to the surface, and to an increased fluoride uptake, which might
chemically reduce demineralisation of dental hard tissues. Most in vitro studies showed that TiF(4) is effective in
reducing the formation of carious and erosive enamel and dentine lesions. Thereby, TiF(4) was equally or more
effective than sodium fluoride (NaF), amine fluoride (AmF) or stannous fluoride (SnF(2)). While clinical data
confirm the caries-preventive effect, clinical trials analysing the anti-erosive effect of TiF(4) are lacking. Few data
available from in situ studies revealed conflicting results by showing either no effect or a beneficial effect of TiF(4)
on enamel erosion. Even though research focused on TiF(4), there is also evidence to show that other metal
fluorides, such as zirconium and hafnium tetrafluorides, affect enamel and dentine demineralisation.
CONCLUSION: The potential of TiF(4) to prevent acid demineralisation requires further research to confirm the
promising in vitro results obtained by in situ studies and clinical trials
SADJ. 2010 Mar;65(2):60-4, 66-7.
Salt fluoridation: a meta-analysis of its efficacy for caries prevention.
Yengopal V, Chikte UM, Mickenautsch S, Oliveira LB, Bhayat A.
Community Dentistry, Division of Public Oral Health, University of the Witwatersrand Johannesburg, 7 York Rd,
Parktown, Johannesburg 2193, South Africa. veerasamy.yengopal@wits.ac.za
Abstract
The aim of this meta-analysis was to assess the caries preventive effect of Salt fluoridation (SF) in the permanent
dentition in children. THE OBJECTIVES WERE TO COMPARE: (1) the caries preventive effects of SF versus no
exposure in different age cohorts (6-8; 9-12; and 13-15 years old); (2) SF versus other community based
interventions (milk or water fluoridation [WF]).
METHODS: 9 English and 2 non-English databases were searched for papers that reported on the caries
preventive effect of groups (with controls) that were exposed to SF in the form of mean DMFT scores with

3. standard deviations. Differences in exposed and nonexposed groups were computed on the basis of weighted
mean differences (WMDs) with 95% confidence intervals (CIs).
RESULTS: For 6-8 year olds, the pooled reduction in DMFT scores was -0.98 [95% CI: -1.68 to -0.29]; for 9-12
year olds, it was -2.13 [95% CI: -2.55 to -1.70] and for the 13-15 year old groups, -4.22 [95% CI: -6.84 to -1.55].
All the analyses favoured the SF groups (p <0.001). For SF versus WF, there was no difference (-0.11 reduction
[95% CI: -0.29 to +0.07]).
CONCLUSION: Within limitations, the pooled estimates of the WMDs for the different age cohorts favoured SF
versus no exposure
Int Dent J. 2010 Apr;60(2):85-93.
Essential health care package for children--the 'Fit for School' program in
the Philippines.
Monse B, Naliponguit E, Belizario V, Benzian H, van Helderman WP.
Department of Education, Health and Nutrition Centre, Cagayan de Oro, Philippines, Philippines.
bella.monse@gmail.com
Abstract
High prevalence of poverty diseases such as diarrhoea, respiratory tract infection, parasitic infections and dental
caries among children in the developing world calls for a return to primary health care principles with a focus on
prevention. The 'Fit for School' program in the Philippines is based on international recommendations and offers a
feasible, low-cost and realistic strategy using the principles of health promotion outlined in the Ottawa Charter.
The cornerstone of the programme is the use of school structures for the implementation of preventive health
strategies. 'Fit for School' consists of simple, evidence-based interventions like hand washing with soap, tooth
brushing with fluoride toothpaste and other high impact interventions such as bi-annual de-worming as a routine
school activity for all children visiting public elementary schools. The programme has been successfully rolled-out
in the Philippines covering 630,000 children in 22 provinces and it is planned to reach 6 million children in the next
three years. The programme is a partnership project between the Philippine Department of Education and the
Local Government Units with support for capacity development activities from the German Development
Cooperation and GlaxoSmithKline

4. Caries Res. 2010;44(2):127-34. Epub 2010 Apr 2.
Effects of carboxymethyl cellulose-based saliva substitutes with varying
degrees of saturation with respect to calcium phosphates on artificial
enamel lesions.
Meyer-Lueckel H, Cölfen H, Verch A, Tschoppe P.
Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University,
Kiel, Germany.
Abstract
The aim of the present study was to evaluate the effects of experimental saliva substitutes based on
carboxymethyl cellulose (CMC) differing in degrees of saturation with respect to calcium phosphates on the
mineral loss of enamel in vitro. Demineralized bovine specimens (subsurface lesions) were exposed to one of six
experimental CMC-based solutions with theoretical degrees of saturation with respect to octacalcium phosphate
(S(OCP)) of S0, S0.5, S1, S2, S4, and S8 for 10 weeks. A previously studied saliva substitute (Glandosane) and
two aqueous solutions (C0 and C1) served as controls. Mineral losses and lesion depths before and after storage
were evaluated from microradiographs. Free and bound calcium as well as phosphate and fluoride concentrations
were determined. According to these measurements, S(OCP) of S2, S4, and S8 was 0.3, 1.1, and 3.4,
respectively. Storage in Glandosane and both negative controls resulted in significant demineralization (p < 0.05).
Only S2 significantly remineralized the specimens (p < 0.05). All other solutions showed neutral effects. No
significant differences in mineralization between S0 and C0 as well as between S1 and C1 could be observed (p
> 0.05). It can be concluded that a CMC-based solution actually unsaturated with respect to octacalcium
phosphate (S2) shows most pronounced remineralization capability under the conditions chosen. This might be
explained by a more favorable balance between calcium bound to CMC in an adsorbed layer at the enamel-liquid
interface and heterogeneous nucleation of calcium phosphates within a solution compared to solutions either
supersaturated or having lower levels of saturation.
Am J Dent. 2009 Oct;22(5):315-20.
Comparing the effects of brushing with a new gel-to-foam dentifrice to
brushing with regular fluoride control dentifrices on viable bacteria levels in
saliva.
Santos D, Schaeffer L, Du-Thumm L, Vandeven M, Cummins D.

5. Colgate-Palmolive Technology Center, 909 River Road, PO Box 1343, Piscataway, NJ 08855-1343, USA.
Abstract
PURPOSE: To compare the effects of a new gel-to-foam dentifrice to two standard fluoride control dentifrices on
foam generation, levels of total viable anaerobes and total viable volatile sulfur compound (VSC)-producing
bacteria in expectorate after brushing.
METHODS: 36 subjects participated in this investigator-blind, randomized, crossover study. After a 1-week wash-
out period prior to each product use, participants reported to the test site having refrained from oral hygiene,
eating and drinking on the morning prior to the visit. Subjects brushed with a full ribbon of assigned dentifrice
(Aquafresh Iso-active, Aquafresh Extreme Clean or Aquafresh Fresh & Minty), then expectorated the slurry into a
collection vessel after 30 and 60 seconds of supervised brushing. Total foam volume was immediately measured.
Subjects then rinsed with sterile water for 10 seconds and expectorated into the same vessel, which was
processed for microbiological analysis. Total viable anaerobes and total viable VSC-producing bacteria were
enumerated using appropriate selective media.
RESULTS: No statistically significant difference was indicated between the gel-to-foam dentifrice and either of the
control dentifrices with respect to the level of total viable anaerobes (P > 0.05). The level of total viable VSC-
producing bacteria was statistically significantly lower for the gel-to-foam dentifrice (Aquafresh Iso-active) than for
one of the control dentifrices (Aquafresh Fresh & Minty) (P < 0.05), and numerically lower for the gel-to-foam
dentifrice than for the other control dentifrice (Aquafresh Extreme Clean) (P = 0.0526). Use of the gel-to-foam
dentifrice resulted in statistically significantly greater (P < 0.05) foam generation than the two control dentifrices
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007868.
Fluoride toothpastes of different concentrations for preventing dental caries
in children and adolescents.
Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X.
School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.
Comment in:
• Evid Based Dent. 2010;11(1):6-7.
Abstract

6. BACKGROUND: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over
time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly
sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries.
OBJECTIVES: To determine the relative effectiveness of fluoride toothpastes of different concentrations in
preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline
caries level and supervised toothbrushing.
SEARCH STRATEGY: A search was undertaken on Cochrane Oral Health Group's Trials Register, CENTRAL,
MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent
searches: 8 June 2009.
SELECTION CRITERIA: Randomised controlled trials and cluster-randomised controlled trials comparing fluoride
toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a
follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous
dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline.
DATA COLLECTION AND ANALYSIS: Inclusion of studies, data extraction and quality assessment were
undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by
discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the
caries increment of the control group minus the caries increment of the treatment group, expressed as a
proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-
analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were
specified a priori and examined through random-effects meta-regression analysis where appropriate.
MAIN RESULTS: 75 studies were included, of which 71 studies comprising 79 trials contributed data to the
network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to
the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride
toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23%
(95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to
36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of
440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some
evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from
the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased
with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six
studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results
dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment

7. regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential
compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.
AUTHORS' CONCLUSIONS: This review confirms the benefits of using fluoride toothpaste in preventing caries in
children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000
ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase
with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be
balanced with the risk of fluorosis