The relation between toothpaste usage and fluorosis: a cause for concern?

Fluoride-containing toothpaste is by far the most widespread source of fluoride in the world and after fluoridated water the most cost-effective at reducing dental caries. Of the seven current issues in the development of fluoride-containing toothpaste described by Holt & Murray (1997), five are either directly or indirectly related to the risk of developing fluorosis, a phenomenon which is on the increase in the industrialised world. The purpose of this study was to evaluate fluoride-containing toothpaste available to the South African public regarding the issues described by Holt & Murray (1997) and to relate the results to the possible development of fluorosis. The amount of fluoride ingested from toothpaste was calculated using the total fluoride concentration present in toothpaste, quantity of toothpaste used per brushing, mean percentage of toothpaste ingested and the 90th percentile of body weight. Results indicate that the "threshold" level of fluoride intake of 0.05 to 0.07 mg F/kg body weight/day beyond which dental fluorosis might occur (Burt, 1992), is exceeded when a ribbon of toothpaste was placed on a child's toothbrush at ages 2-3 years. 'Threshold' levels were ingested when placing a ribbon of toothpaste on the brush at ages 4 and 5 for all toothpaste as well as for a children's formulation containing 1000 microg F/g. Of all pastes studied, 41.9% of the packaging has information for the prevention of swallowing of paste and/or the supervision of children by adults when brushing. The dental profession, manufacturers of toothpaste and government all have a role to play in the prevention of fluorosis in the toothbrushing population of South Africa.