A Cochrane review of major toothpaste brands available in both the UK and global markets included 79 trials on 73,000 children aged up to 16 and clearly showed that toothpastes containing 1,000 parts per million (ppm) of fluoride were much more effective at fighting tooth decay in children.
However, the research from the non-profit healthcare research organisation found that the benefits have to be carefully balanced with the the risk of fluorosis in children under the age of six.
The findings leave manufacturers of oral care products dedicated to children in an precarious position, trying to walk the line between providing adequate protection against tooth decay, while minimising the risk posed by fluorosis.
Fluorisis risk for younger children
Dental fluorosis leads to mottling and discolouring of the teeth, side affects that are often more exaggerated in younger children because their tooth enamel is softer and consequently more vulnerable.
Currently the British Dental Health Foundation recommends that children under three should use a toothpaste with a fluoride level of at least 1,000ppm, while children above this age should use one with a level of 1,350ppm – 1,500ppm.
However, many toothpastes manufactured for children are formulated with a lower level of fluoride – often below 600ppm - as a means of tackling the risk of fluorosis.
The foundation also recommends that no more than a pea-sized amount of toothpaste should be used at any time and that teeth cleaning for younger children should be supervised in an effort to discourage swallowing.
Review underlines importance of fluoride for kids
Supporting the foundation's recommendations, the review found that high fluoride toothpaste can reduce dental decay in children by an average of 23 per cent when compared to a placebo, while the rate of decay decreased significantly when the toothpaste has a fluoride dose above 1,000ppm.
In contrast, toothpastes with levels of fluoride below 550ppm showed no statistically significant effect against dental disease when compared to the placebo, the review found.
High or low levels of fluoride for kids toothpaste?
If parents do buy separate oral care products for their children, they tend to opt for toothpastes that are marketed in a range of more interesting flavours as a means of encouraging them into an oral care routine.
However, because such toothpastes are often formulated with lower levels of fluoride as a way of tackling the fluorosis issue, this may leave children more vulnerable to tooth decay.
As the review did not specifically look at the issue of fluorosis in younger children, the researchers advise that parents should consult their dentist to determine whether or not there is a risk involved in using a toothpaste with more than 1,000pm dosage of fluoride.