FLUORIDE DENTIFRICE SALE PREMATURE, ASSOCIATION SAYS

There is no adequate evidence that any of the fluoride dentifrices now being offered to the public is effective in preventing tooth decay, Harold Hillenbrand, Association secretary, said in a formal statement issued early in February. The statement was made in reply to a large number of inquiries regarding Crest with Fluoristan the latest fluoride tooth paste to be offered to the public. The dentifrice, which is being widely advertised, is manufactured by Procter and Gamble. "The American Dental Association is not aware of evidence adequate to demonstrate the claimed dental caries prophylactic value of Crest," stated Dr. Hillenbrand. "Evidence of the value of adding a fluoride in other dentifrices is even less convincing.

Therefore, the Association believes that all fluoride dentifrices are being marketed prematurely," he said. "The evidence accumulated in the past 20 years to support community water fluoridation is overwhelming in comparison to the amount of clinical data to support the usefulness of fluoride dentifrices," the statement continued. "It would be a disservice to the dental health of the public if the promotion of fluoride dentifrices should lead to the misconception that their use is an adequate substitute for the controlled fluoridation of municipal water supplies."

The text of the Association's statement follows:

"Crest with Fluoristan" is one of the fluoride tooth pastes now being marketed throughout the United States on a regional or national basis. Crest is said to contain stannous fluoride. The American Dental Association is not aware of evidence adequate to demonstrate the claimed dental caries prophylactic value of Crest. Although clinical tests of the dentifrice are in progress, adequate in formation concerning its value may not be available for a year or more. Published evidence to support the usefulness of adding of a fluoride in other dentifrices is even less convincing. The Association therefore believes that all fluoride dentifrices are being marketed prematurely. There is no assurance of the usefulness of these preparations until further clinical tests are completed and evaluated. No evidence is available to the Association to show that a fluoride dentifrice is of any value for an individual who, during early childhood, routinely drank water containing fluoride at the optimum level. It is therefore desirable to avoid any encouragement of the indiscriminate distribution of fluoride dentifrices in areas where the water supply contains one part per million of fluoride ion or more. Use of these dentifrices for whatever topical benefit they can provide may not be objectionable in adults who received inadequate fluoride in drinking water during the years that the teeth were developing. About 1 mg. of fluoride ion is provided by the dentifrice at each brushing procedure. It is expected that nearly all of this fluoride will be discharged by rinsing the residual dentifrice from the mouth. Small children, however, might swallow an appreciable portion of the dentifrice thus contributing to the possibility of dental fluorosis, especially where adequate or excessive levels of fluoride are present in the drinking water. Since the crowns of permanent teeth are largely calcified by the age of six, the period before this age is one of greater susceptibility to dental fluorosis, that is, mottling of the enamel from excessive ingestion of fiuoride. Present labels of fluoride dentifrices therefore are required to carry a statement cautioning against the use of these dentifrices by children under six. No fluoride dentifrice is a substitute for public health programs using fluorides. In view of the uncertain value of fluoride dentifrices it is suggested that public health or office programs for topical application of fluoride solutions be continued under appropriate conditions. When drinking water with the proper level of fluoride is provided from infancy, the developing teeth acquire a resistance to decay which extends into adult life. The evidence accumulated in the past 20 years to support community water fluoridation is overwhelming in comparison to the amount of clinical data to support the usefulness of fluoride dentifrices. It would be a disservice to the dental health of the public if the promotion of fluoride dentifrices should lead to the misconception that their use is an adequate substitute for the controlled fluoridation of municipal water supplies.

 J.A.D.A. 52 (Mar.1956) 368