High fluoride toothpastes and their role in dental hygiene

toothpaste on a toothbrush

In the UK, toothpastes are regulated by their fluoride composition. Very large quantities of fluoride can cause a form of cosmetic damage to teeth called fluorosis. In actuality, the role of fluoride in protecting our teeth comes from an exploratory study into a small population who were consuming well water. Due to its high fluoride content, this resulted in them developing very severe cases of fluorosis which gave their teeth a brown-grey shade, but among this group cavities and enamel weakness was unheard of. From then on, fluoride has had a transformative effect in dentistry, as prevention takes centre stage, rather than treatment or reconstruction, as the foundation of dentistry.

In order to prevent fluorosis the concentration of fluoride in toothpaste is carefully regulated and, in groups who are likely to swallow their toothpaste accidentally or on purpose (like children) low fluoride percentages are standard.  Children under 6 are recommended to use the toothpaste with 1000 parts per million of fluoride or less; most adult toothpastes have between 1300 and 1500 parts per million of fluoride. Assuming sensible use, it is possible to have toothpastes with much higher concentrations of fluoride; these are known as POM or prescription only medication toothpastes. With 5000 parts per million of fluoride, they are three times as concentrated as standard adult toothpaste and if you use them inappropriately, there is a significant risk of fluorosis.

If you wish to make use of high fluoride toothpaste, you are going to have to get a prescription from your local dentist Liverpool, as it can be used preventively. But it is normal to prescribe these toothpastes with high fluoride levels to high-risk groups, as in those with a history of extensive tooth decay or current recurring decay. Also, it is often prescribed to those at risk of cavities due to their age, the prescriptions that they may be on for other health conditions, or those who are experiencing low saliva turnover commonly referred to as dry mouth as a side effect of other treatments or being a diabetes sufferer.

woman brushing teeth

There have been some suggestions that the use of high fluoride toothpaste during the pandemic related restrictions to local dental surgeries could be a viable preventive strategy, allowing people to reduce their attendance to clinics while significantly decreasing the chances of dental emergencies. This has not been supported by the General Dental Council and is considered an inappropriate application of a prescription medication.

As attending an assessment in order to receive a prescription creates additional tasks on the local dentist, the use of high fluoride toothpaste as a band-aid to reduce waiting times post lockdown has not been welcomed by the General Dental Council. The General Dental Council has supported an increase in the standard definitions of high fluoride toothpastes to allow such products to be available without prescription, relying on individual responsibility and safe use to avoid any harm that such high fluoride products could result in. In the USA, the definition of high fluoride content is significantly different as fluorides exist in significant quantities in the American water table and have been added artificially to US water supplies for many decades, so in the UK, it is probable that these toothpastes will often be lower in fluoride than their US equivalents.


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