During the last three decades a significant worldwide reduction - of dental caries has been observed. Experts agree that fluoride in its multiple presentations has played an important role, together with changes in oral hygiene habits among different populations. Fluoride toothpastes has gained interest as a relevant strategy in prevention because of its important role in dental caries reduction, that can reach up to 40% (7,8,14). However, at the same time, they have contributed to an increase in the prevalence of dental fluorosis in children. There is concern about dental fluorosis related to the chronic intake of excessive quantities of fluoride in children under 6 years of age. Some authors have reported that the early use of fluoridated toothpastes in young children is a very important risk factor (13,17,22,33,34). Beside fluoride concentration, the duration and age of exposure are important factors in fluorosis prevalence (2).
In order to reduce the risk of dental fluorosis, the use of toothpaste with 440 to 550 ppm F in children less than six years old has been recommended (5). The efficacy of these toothpastes in reducing dental caries is still unknown and controversialy among the scientific community (1,3). In Colombia, the fluoride concentration of toothpastes for preschool children below the age of 6 years was limited several years ago to 500 ppm in order to control dental fluorosis.
According to the Oral Health National Study (NSOH III)(13), the prevalence of dental fluorosis in Colombian children between 6 and 7 years old is 25.7%. The highest prevalence of moderate and severe dental fluorosis was found in Bogotá with 4.5% of the children being affected. Another study carried out in 2002 in four Colombian cities, to evaluate fluoride intake in 2 to 4 year olds from meals, beverages and toothpastes reported that in all cities except one, the total fluoride intake was above optimal limits (0.07 mgF/Kg of body weight) and even some were above the risk limit (0.1 mgF/Kg of body weight). From the three studied sources, the lowest fluoride intake was from beverages at 4.3%, followed by meals at 26%. The highest fluoride intake came from toothpastes which comprised 69% of the total ingested fluoride (15).
The use of 500 ppm fluoride pastes raised the question of how effective this toothpaste is compared with the 1000 or more ppm F toothpastes, in the prevention of dental caries.
Therefore, the aim of this study was to carry out a quantitative systematic review assessing the efficacy of toothpastes with low fluoride concentrations between 440 and 550 ppm in the reduction of dental caries in children under 14 years old compared to toothpastes that contain 1000 or more ppm F.
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