What concentration of fluoride toothpaste should dental teams be recommending?

Data sources A total of 96 studies reported in peer reviewed journals between 1955 and 2014 Study selection The systematic review selected randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least one year. The primary outcome was caries increment measured by the change from baseline in all permanent or primary teeth. Data extraction and synthesis Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. They graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference or standardised mean difference caries increment. Where it was appropriate to pool data, they used random-effects pairwise or network meta-analysis. Results In the primary dentition of young children, 1500 ppm fluoride toothpaste was found to reduce caries increment when compared with non-fluoride toothpaste. In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste was found to reduce DMFS increment when compared with non-fluoride toothpaste in adults of all ages, however, the evidence for DMFT was of low certainty. Conclusions This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations was found to be more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and the confidence in these effect estimates are uncertain and could be challenged by further research.