Should Low Fluoride Toothpastes Be Prescribed For Preschoolers?

Objectives: To assess the effects of low and standard fluoride toothpastes on the prevention of caries in the primary dentition of preschool children and aesthetically objectionable fluorosis in the permanent dentition. Methods: Systematic review of clinical trials and meta-analysis. Two examiners independently read 1932 records and 159 full-text articles. Data regarding characteristics of participants, interventions, outcomes, length of follow-up and potential of bias were independently extracted by two examiners on the basis of predetermined criteria. Any disagreement was solved by consensus after consulting a third examiner. Pooled prevented fractions (PF) and relative risks (RR) were estimated in order to assess the effects of low and standard fluoride toothpastes on the number of decayed, missing due to caries and filled teeth and dental surfaces, and on the number of children developing caries and fluorosis, respectively. Results: Five studies fulfilled the inclusion criteria.  Low fluoride toothpastes significantly increased the risk of caries in primary teeth (RR= 1.13; 95% CI 1.07 – 1.20; 4634 participants in three studies) and did not significantly decrease the risk of aesthetically objectionable fluorosis in the upper anterior permanent teeth (RR= 0.32; 95% CI 0.03 – 2.97; 1968 participants in two studies). There was a significant caries reduction at tooth level when standard fluoride toothpastes were compared to low fluoride toothpastes (PF= 14%; 95% CI 6 – 21; 4634 participants in three studies). However, at surface level, no significant differences were observed, even though there was a tendency favouring standard fluoride toothpastes with neutral pH (PF= 13%; 95% CI -4 – 30; 2272 participants in two studies) and low fluoride toothpastes with acidic pH (PF=  -5%; 95% CI -22 – 11; 742 participants in two studies). Conclusion: There is no evidence to support the use of low fluoride toothpastes by preschool children regarding caries and fluorosis prevention.