A Cochrane review [Abstract] 1 included 75 studies, of which 71 studies comprising 79 trials (73 000 children) contributed data to the network meta-analysis, network meta-regression or meta-analysis. For the 66 studies that contributed to the network meta-analysis of decayed, (missing), filled tooth surfaces (D(M)FS) in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations; D(M)FS prevented fraction (PF) compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm, but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There was some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.
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