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“Topical Benefits” Fluoride Toothpaste
Dentistry describes the regular use of fluoridated toothpastes as the "major factor in the observed decline in caries prevalence in industrialized countries during the last 20 to 25 years". However, no real scientific evidence for this claim exists. First of all, NO single factor has ever been identified for the decline in caries observed in any of the industrialized countries (i.e. Kallestal et al, 1999; Nadanosky & Sheiham, 1995; Einarsdottir, 1996). What this means is that nobody can exactly tell if it was the fluoride, just brushing, education campaigns, or any other preventative measure. Few know that only indirect evidence exists to support the claims of “benefits” of fluoride toothpaste at all, consisting of very limited clinical data and mostly supportive laboratory (in-vitro) data. Even fewer know about the fact that most of the early studies in humans with toothpaste containing fluoride showed mostly increased caries, not reduced caries. As fluoridated toothpaste is the basic fluoride regimen recommended for everybody in the world (Ogard, 1994), one would think that surely SOME clear evidence should exist - from humans - which can document a decline in caries due to fluoridated toothpaste use, and identify fluoridated toothpaste as a "major factor"? This evidence simply does not exist. Nordic Countries: Iceland To find out if fluoride toothpaste has any of its proclaimed “benefits”, one merely needs to look at data from otherwise “unfluoridated” Nordic countries such as Iceland, where fluoridated toothpaste has long been considered the main source of fluoride (Bjarnason, 1997). In Iceland, ninety-five percent of the children brush their teeth regularly and 97% report using a fluoride dentifrice (Bjarnason, 1993). In Iceland, 1.17 kg of fluoridated toothpaste is consumed per person each year, the highest consumption rate of any country, according to the World Health Organization (WHO, 1999). However, besides this widespread use of F- toothpaste, NO single factor has ever been identified as cause for the reduction of cavities in Iceland, which some could only explain as being "multifactorial" (Einarsdottir et al, 1996), a finding echoed by many other Nordic investigators (i.e. Kallestal et al, 1999; Haugejorden, 1994). ICELAND: DELAYED CARIES In 1989 Bjarnason published longitudinal data obtained from 1161 children, participating in a large three-year dentifrice trial in Iceland, comparing toothpastes of different F- strength, lamenting the fact that "the use of fluoride dentifrice has not been able to limit caries development." By 1997 Bjarnason found out even more. He observed that there is NO real reduction in cavities AT ALL after years of using fluoridated toothpaste - mean caries scores and frequency distributions had merely shifted and were now delayed by three years. The values of 15-year-olds in 1994 closely resembled those of 12-year-olds a decade earlier, suggesting a three-year-delay in caries from fluoride for this age group (Bjarnason et al, 1997). Haugejorden et al (1990) in Norway had reported similar findings after evaluating results from a 11-year follow-up study:
Recently, further strong evidence of caries delay emerged from Norway. A strong association in caries prevalence was found between the ages of 5 and 12 years. The less caries was seen at age 5, the more was seen at age 12. Likewise, the more caries at age 5, the less at age 12 (Haugejorden & Birkeland, 2002). (Note: Most fluoridation studies claiming benefits are conducted on 5-year-olds, NOT 12 -year-olds! see UK’s BFS.) Of course this "delay" in caries occurrence (caused by fluorides bringing about delayed eruption of teeth) had been shown already decades ago - with regards to water fluoridation - in a 10-year study by Weaver in the UK (1944, 1948), and can be further witnessed in many others studies. As thyroid hormones control tooth eruption, the delayed eruption of teeth caused by fluoride is a sign that thyroid function was disturbed at the time of enamel formation. SEE TABLES: DELAYED CARIES: NEWARK BRANTFORD GRAND RAPIDS EVANSTON ================================== Birkeland JM, Haugejorden O - "Caries decline before fluoride toothpaste was available: earlier and greater decline in the rural north than in southwestern Norway" Acta Odontol Scand 59(1):7-13 (2001) Bjarnason S, Finnbogason SY, Kohler B, Holbrook WP - "Trends in dental health among Icelandic urban children" Eur J Oral Sci 105(3):189-95 (1997) Bjarnason S, Finnbogason SY, Holbrook P, Kohler B - "Caries experience in Icelandic 12-year-old urban children between 1984 and 1991" Community Dent Oral Epidemiol 21(4):195-7 (1993) Bjarnason S - "High caries levels: problems still to be tackled" Acta Odontol Scand 56(3):176-8(1998) Bjarnason S - "On dental health in Icelandic children. Observations during a clinical dentifrice trial" Swed Dent J Suppl 57:1-40 (1989) Einarsdottir KG, Bratthall D - "Restoring oral health. On the rise and fall of dental caries in Iceland" Eur J Oral Sci 104(4 ( Pt 2)):459-69 (1996) http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retr ieve&db=PubMed&list_uids=8930598&dopt=Abstract Haugejorden O, Lervik T, Birkeland JM, Jorkjend L - "An 11-year follow-up study of dental caries after discontinuation of school-based fluoride programs" Acta Odontol Scand 48(4):257-63 (1990) " Analyses of variance showed that the benefits of participation in school-based F programs seem to have been lost. It appears that these caries-preventive programs have delayed rather than prevented caries and that F toothpaste and other caries-preventive efforts have been insufficient to avert a substantial caries activity during the follow-up period." Haugejorden O, Birkeland JM - "Evidence for reversal of the caries decline among Norwegian children" Int J Paediatr Dent 12(5):306-15 (2002) Haugejorden O - "Changing time trend in caries prevalence in Norwegian children and adolescents" Community Dent Oral Epidemiol 22(4):220-5 (1994) Irigoyen M, Szpunar S - "Dental caries status of 12-year-old students in the state of Mexico" Community Dent Oral Epidemiol 22(5 Pt 1):311-4 (1994) Kallestal C, Wang NJ, Petersen PE, Arnadottir IB - "Caries-preventive methods used for children and adolescents in Denmark, Iceland, Norway and Sweden" Community Dent Oral Epidemiol 7(2):144-51 (1999) Moller P - "Caries prevalence in Icelandic children in 1970 and 1983" Community Dent Oral Epidemiol 13(4):230-4 (1985) “Although considerable increase was noted in number of filled teeth with a corresponding decrease in carious and missing teeth, a statistically significant change in caries prevalence, (dft, dfs, DMFT, DMFS) did not manifest itself. The dfs and DMFS in 1983 was 8.9 and 9.5, respectively, compared to 8.5 and 10.4 in 1970. Over 90% of the toothpaste used in Iceland during the 1970's contained fluoride.” Nadanovsky P, Sheiham A - "Relative contribution of dental services to the changes in caries levels of 12-year-old children in 18 industrialized countries in the 1970s and early 1980s" Community Dent Oral Epidemiol 23(6):331-9 (1995) Neves Ad Ade A, Castro Rd Rde A, Coutinho ET, Primo LG - Microstructural analysis of demineralized primary enamel after in vitro toothbrushing” Pesqui Odontol Bras 16(2):137-43 (2002) Ogard B, Seppa L, Rolla G - “Professional topical fluoride applications--clinical efficacy and mechanism of action.” Adv Dent Res 8(2):190-201 (1994) “No dose-response effect to concentrated fluoride agents is apparent, and the benefit of frequent application is not clearly established.” (Ogard et al, 1994) Petersson LG, Edwardsson S, Koch G, Kurol J, Lodding A - "The effect of a low fluoride containing toothpaste on the development of dental caries and microbial composition using a caries generating model device in vivo" Swed Dent J 19(3): 83-94 (1995) Rajan BP, Gnanasundaram N, Santhini R - “Serum and urine fluoride levels in toothpaste users” J Indian Dent Assoc 59(6,7,8,9):137-42 (1987) Rock WP - "Young children and fluoride toothpaste" Br Dent J 177(1):17-20 (1994) Tijmstra T, Brinkman-Engels M, Groeneveld A - "Effect of socioeconomic factors on the observed caries reduction after fluoride tablet and fluoride toothpaste consumption" Community Dent Oral Epidemiol 6(5):227-30 (1978)
Weaver R -"Fluorine and dental caries: further investigations on Tyneside and in Sunderland" Br Dent J (77):185-193 (1944) Weaver R - "The Inhibition of Dental Caries by Fluorine" Proc Roy Soc Med (41) 284-290 (1948) West NX, Addy M, Jackson RJ, Ridge DB - "Dentine hypersensitivity and the placebo response. A comparison of the effect of strontium acetate, potassium nitrate and fluoride toothpastes" J Clin Periodontol 24(4):209-15 (1997) “All 3 toothpaste groups showed reductions in sensitivity over the 6 weeks; however, no significant differences were found between the three products at any given time. Interestingly, there was no significant change in sensitivity between wash-in baseline and treatment baseline for the cold air stimulus with the fluoride-only-based paste. However, for the group using the same fluoride toothpaste, there was significant improvement between wash-in baseline and week 6, and treatment baseline and week 6 for this stimulus, suggesting a substantial placebo effect occurred.” Winter GB, Holt RD, Williams BF - "Clinical trial of a low-fluoride toothpaste for young children" Int Dent J 39(4):227-35 (1989) "More than 3000 2-year-old children were enrolled in the study and after 3 years of toothpaste use, 2177 (72 per cent) were examined. From a clinical and radiographic assessment, more than half the children were found to be caries free and only 32 (1.5 per cent) had evidence of rampant caries. There appeared to be little or no difference between children who had used test or control pastes, either in caries or in plaque levels....Differences were seen in relation to sex of the child and to social class. Girls had lower levels of plaque than boys but more carious teeth. Children from families in higher social classes had fewer carious teeth and lower levels of plaque." WHO Oral Health Country/Area Profile Programme, Department of Noncommunicable Diseases Surveillance/Oral Health WHO Collaborating Centre, Malmö University, Sweden |
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