A systematic review [Abstract] 1 included 25 studies; 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Most of the available studies focused on mild fluorosis. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months (OR 0.70, 95% CI 0.57 to 0.88, 4 observational studies). Inconsistent associations were found regarding beginning to brush teeth with fluoride toothpaste after the age of 24 months and fluorosis; data from 2 case-control studies showed significant reductions (OR 0.29, 95% CI 0.15 to 0.53) when not starting until after 24 months but data from 5 cross-sectional surveys did not (OR 0.92, 95% CI 0.71 to 1.18). No significant association between the frequency of toothbrushing or the amount of fluoride toothpaste used and fluorosis was found.
Two RCTs with a total of 2 108 children (in non-fluoridated areas) compared the effect of giving children different levels of fluoride toothpaste. One study compared 550 with 1000 ppm fluoride and the other compared 440 with 1450 ppm fluoride. Both studies found statistically significant differences (RR 0.75, 95% CI 0.57 to 0.99 and RR 0.59, 95% CI 0.44 to 0.79), indicating a higher level of fluoride toothpaste was associated with an increased risk of fluorosis. Three cross-sectional studies (n=3 867) found no statistically significant difference (OR 0.79, 95% CI 0.61 to 1.02) between different levels of fluoride in the toothpastes.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).
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