Should I Use Fluoride Toothpaste? We Answered Some Common Questions About Fluoride
Should I Use Fluoride Toothpaste? We Answered Some Common Questions About Fluoride
Are you confused about fluoride? How much do you need? Do you even need it? This article is based on some excellent questions from one of our lovely patients. He was interested in an approach for his family based on the current evidence/ recommendations for fluoride use in Australia. Please see some questions and answers below.
Some online articles recommend fluoride levels of 1500ppm in toothpaste. However, when I checked the toothpaste we use at home, I found they were lower. Why is this?
Most fluoride toothpaste targeted at adults in Australian supermarkets has 1000-1450ppm fluoride unless otherwise specified. So, there is a fair chance you are getting the recommended dose of fluoride from these products. However, there could be an issue with the w/w% to ppm conversion as below. There are also some common examples below to demonstrate some of the more popular options.
How can I convert w/w% into ppm (parts per million)?
Many toothpastes list their fluoride contents with w/w% rather than parts per million (ppm). Unfortunately, the conversation of w/w% to ppm is not straightforward for toothpaste. The outcome will depend on the type of fluoride used, as this will determine the conversion ratio. The following table may be helpful when approximating the ppm if you only have access to mg/g or % concentrations in fluoride.
If you’re unsure, please don’t hesitate to ask us. We’re happy to help you with this calculation so you can ensure the specific products you are using are appropriate for your needs.
Commonly fluoride concentration on products are expressed as percentages or parts per million (ppm). The following table shows how ppm, mg/g and % concentrations of fluoride toothpaste relate to each other.
Fluoride Compound Fluoride Ion
In Toothpastes % mg/g mg/g ppm
Sodium Monofluorophosphate (MFP) 0.76 7.6 1 1000
Sodium Fluoride (NaF) 0.1 1 0.45 450*
Sodium Fluoride (NaF) 0.11 1.1 0.5 500
Sodium Fluoride (NaF) 0.22 2.2 1 1000
Sodium Fluoride (NaF) 0.243 2.43 1.1 1100
Sodium Fluoride (NaF) 0.32 3.2 1.45 1450
Sodium Fluoride (NaF) 1.1 11 5 5000
Stannous Fluoride (SnF) 0.4 4 1 1000
*This can be combined with 1000ppm MFP to make 1450ppm i.e. 0.76% MFP + 0.1 NaF = 1450ppm FluorideSource: https://www.colgateprofessional.com.au/content/dam/cp-sites/oral-care/professional/en-au/general/pdf/student-Fluoride-Conversions.pdf
What is the general approach of the Ethical Dental Team when it comes to the use of fluoride toothpaste?
We support our patients in making informed health choices based on their individual circumstances. Dental care involves an interplay between environmental, behavioural and genetic factors. The use of fluoride aims to modify the environment by making the tooth structure less susceptible to demineralisation (acid attack), which leads to cavities.
So, like any health choice, using fluoride is a question of risk and reward. If you have both very low environmental risks (such as a low sugar, low acid diet) and low behavioural risks created through daily hygiene and professional maintenance rituals this may influence your decision. When paired with very low genetic risks that can influence things like the size, shape and location of teeth, there is a fair chance that you wouldn’t experience decay regardless of fluoride exposure. However, if any of these areas becomes problematic, decay is a risk that can be simply and cost-effectively mitigated by fluoride-containing oral care products.
For this reason, our individual recommendations for fluoride use are typically based on a discussion of the evidence of environmental, behavioural or genetic risks a person may have. Some general advice that is based on the established evidence is:
We don’t usually use fluoride toothpaste in kids under the age of 17 months. However, we do recommend cleaning the teeth by an adult with just water and a brush. Alternatively, if you want to get your child used to the feel of brushing with paste, you could use a fluoride-free product like Jack n Jill or Colgate 0%.
Between 18 months - 5 years, clean the teeth twice a day using 500-550ppm (0.5-0.55mg/g) toothpaste. Spit out the excess but don’t rinse. Let the toothpaste sit on the teeth.
Some examples of options that contain 500ppm are:
After six years of age, you can use standard fluoride toothpaste twice a day. This typically ranges between 1000-1500ppm in Australia. Supermarkets aren’t allowed to sell toothpaste beyond 1500ppm. Again, spitting, not rinsing, is advocated.
Which toothpaste do you recommend for someone who wants to meet the recommended guidelines?
Many of the toothpaste options targeted at adults on the supermarket shelf are 1450ppm. These include:
Colgate Total is 1450ppm
Colgate Sensitive Pro Relief is 1450ppm
Oral B Gum Care is 1450ppm
Grant’s natural toothpaste with fluoride is 1450ppm
Sensodyne Sensitive Teeth Pain Repair and Protect is 1426 ppm
What about the toothpaste below 1350ppm? Should we avoid them? Which brands, if any, should be avoided?
There is moderate-certainty evidence that 1450-1500ppm toothpaste is more effective at preventing cavities than 1000-1250ppm toothpaste. For this reason, we don’t recommend using 1000-1250ppm options if there are any environmental, behavioural or genetic risk factors for decay. Some options that are less likely to be effective for people aged 6+ include:
Jordan Step 2 Kids Toothpaste Fruity Flavour 6+ years (1000 ppm)
Neem Active Toothpaste (1000ppm)
When to use high fluoride toothpaste?
For some patients at increased risk of developing cavities, we prescribe a higher fluoride toothpaste (about 5000ppm or 5mg/g). The most common one we use is Colgate Neutraflour 5000ppm, which is available through dentists or pharmacies.
Why don’t mouth rinses contain fluoride?
Some of them do, such as Colgate Neutrafluor220ppm. However, more prominent mouth rinses such as Listerine, Plax, etc., don’t tend to contain fluoride. This is due to the assumption that mouth rinse is always used IN ADDITION to brushing with a fluoride-containing toothpaste. Not as an alternative to toothbrushing. These mouth rinses work their magic by acting against the bacteria in plaque rather than strengthening the tooth itself. This approach can be complementary and particularly useful in people who have difficulty removing bacteria manually through brushing for any reason.
In some circumstances, such as teenagers with braces and problematic hygiene, a fluoride-containing mouth rinse may be specially prescribed to reduce the risk of decay. However, the temptation to replace brushing with mouthwash must be avoided. This can be a tricky challenge if compliance is already a concern. For this reason, we usually prefer to put in place good brushing habits as the first priority, then use mouth rinse to address particular issues such as bad breath caused by certain types of bacteria.
If you decide to use a mouth rinse, it’s worth considering when you use your mouth rinse. If you use it straight after brushing, you may be washing away the fluoride. For this reason, the National Health Service recommends using mouth rinse at a different time of the day, for instance, after lunch.
To learn more about toothpaste read our article Our Five Favourite Toothpastes or if you are interested in dental hygiene find out how often you should change your toothbrush.
To book an appointment with our team at Ethical Dental call 6652 3185 or book online.
Key references:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398117/
https://www.nhs.uk/live-well/healthy-teeth-and-gums/how-to-keep-your-teeth-clean/
