Toothpaste recommendations to fight dental decay

The choice of toothpaste can influence how effectively dental decay is prevented, according to new advice to be issued to dental professionals.

A range of recommendations issued by the Scottish Intercollegiate Guidelines Network (SIGN), which is part of Healthcare Improvement Scotland, also recognises the effect social background has on dental health and calls for greater use of individual assessments.

However, the advice stresses that parents can play the greatest role in preventing tooth decay by ensuring rigid, daily discipline over brushing of their children’s teeth.

The latest SIGN guideline – Dental interventions to prevent caries in children – provides recommendations based on current evidence for best practice in dental interventions to prevent decay in children and young people aged 0-18 years carried out by dental care teams within dental practices in Scotland.



Tooth decay (also known as dental caries) is a preventable disease, where a build-up of plaque and other bacteria can damage the enamel on teeth.

Dental health in Scotland has shown a steady improvement since the 1980s. The proportion of primary one pupils with no obvious dental decay has risen from 42% in 1988 to 73% in 2013.

However, more than a quarter of Scottish children are still affected by dental decay. The trend is greatest in those from disadvantaged backgrounds with only 61% of primary one pupils with the most deprived backgrounds free from obvious decay, compared with 82% free from decay in least deprived primary one pupils.

The best methods for preventing tooth decay are obvious: regular toothbrushing and monitoring of young children when they clean their teeth.


Fluoride levels in toothpaste

Moreover, the SIGN guideline recommends that the level of fluoride in the toothpaste should differ depending on age and other factors linked to poor diet and hygiene. It recommends that most young people up to the age of 18 years should be advised to use toothpastes in the range 1,000 to 1,500 parts per million fluoride (ppmF).

Children who are at increased risk of developing tooth decay should use different concentrations of toothpastes with children up to the age of 10 years recommended 1,500 ppmF and, those from 10 to 16 years recommended 2,800 ppmF.

Over-the-counter toothpaste is currently available in concentrations ranging from around 700 ppmF to 1,500 ppmF, while 2,800 ppmF and 5,000 ppmF toothpastes are available on prescription. Levels of fluoride concentrations are detailed on toothpaste tubes and boxes.


The other key SIGN recommendations include:

β€’ Children should not rinse after they have brushed their teeth

β€’ Fluoride varnish should be applied by dentists at least twice a year for all children

β€’ Children under three years of age should only have a smear of toothpaste on their brush

β€’ No evidence was identified to show that powered toothbrushes are more effective than manual toothbrushes in preventing tooth decay in children.


Vital role for parents

The chair of the SIGN guideline group, which developed the report, is Derek Richards, consultant in dental public health, NHS Forth Valley and director, Centre for Evidence-based Dentistry, University of Dundee.

Speaking of the guideline, Mr Richards said: ‘The recommendations recognise that dental care is not as straightforward as most people would expect and should be managed on an individual basis, by the professionals.

‘But there is also a bigger part for parents to play as they should be aware of useful tips such as checking the level of fluoride in the toothpaste and monitor the amount they put on the brush for young children.

‘While it is important that dental healthcare professionals use these guidelines to best meet the needs of specific patients, in simple terms, parents need to be reminded that twice daily brushing of their children’s teeth with fluoride toothpaste plays a vital job in the fight against decay.’

To read the full guideline, go to:

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