Objective: This paper reviews current issues in the development of fluoride toothpastes as a public health measure. Design: The issues examined included low concentration formulations, delivery systems, dispensing instructions and labelling, oral clearance, effect on root caries, additional therapeutic agents and marketing and manufacturing issues. Results: Lower fluoride formulations may carry a lower risk of fluorosis but this must be balanced against a higher risk of caries. Risk factors for fluorosis include inappropriate fluoride supplements but the age at which toothbrushing began, frequency of brushing and residence in an optimum fluoride area have also been implicated. Conclusions: The dental profession should: clarify the most appropriate fluoride concentration in toothpastes used for children; ensure that other sources of fluoride do not increase the risk of dental fluorosis; investigate the effectiveness of fluoride toothpaste in inhibiting root surface caries in adults. Manufacturers should: continue to improve the performance of fluoride toothpaste; ensure that all pastes maximise fluoride bioavailability; develop active agents to help reduce oral disease; label products clearly with ppm F; review the delivery systems so as to reduce the risk of dental fluorosis.
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