Fluoride in various forms is the most popular and effective active ingredient in toothpaste to prevent cavities. Fluoride is present in small amounts in plants, animals, and some natural water sources. The additional fluoride in toothpaste has beneficial effects on the formation of dental enamel and bones. Sodium fluoride (NaF) is the most common source of fluoride, but stannous fluoride (SnF2), and sodium monofluorophosphate (Na2PO3F) are also used. At similar fluoride concentrations, toothpastes containing stannous fluoride have been shown to be more effective than toothpastes containing sodium fluoride for reducing the incidence of dental caries and dental erosion, as well as reducing gingivitis. Some stannous fluoride-containing toothpastes also contain ingredients that allow for better stain and calculus removal. A systematic review revealed stabilised stannous fluoride-containing toothpastes had a positive effect on the reduction of plaque, gingivitis and staining, with a significant reduction in calculus and halitosis compared to other toothpastes. Furthermore, numerous clinical trials have shown gluconate chelated stannous fluoride toothpastes possess superior protection against dental erosion and dentine hypersensitivity compared to other fluoride-containing and fluoride-free toothpastes.
Much of the toothpaste sold in the United States has 1,000 to 1,100 parts per million fluoride. In European countries, such as the UK or Greece, the fluoride content is often higher; a sodium fluoride content of 0.312% w/w (1,450 ppm fluoride) or stannous fluoride content of 0.454% w/w (1,100 ppm fluoride) is common. All of these concentrations are likely to prevent tooth decay, according to a 2019 Cochrane review. Concentrations below 1,000 ppm are not likely to be preventive, and the preventive effect increases with concentration. Clinical trials support the use of high fluoride (5,000 ppm fluoride) dentifrices, for prevention of root caries in elderly adults by reducing the amount of plaque accumulated, decreasing the number of mutans streptococci and lactobacilli and possibly promoting calcium fluoride deposits to a higher degree than after the use of traditional fluoride containing dentifrices.
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