Caries Prevention – Fluorides

It is widely accepted that the regular use of fluoride, such as in dentifrice and drinking water, is extremely effective at preventing dental caries. In 1999, the US Center for Disease Control (CDC) issued a statement that water fluoridation is one of the 10 most important public health measures of the 20th century.7 Fluoride’s presence in low concentration and high frequency is more effective at preventing caries than high levels of fluoride used in low frequency. Because water fluoridation is not available in many countries, dentifrice is considered to be one of the most important sources of fluoride globally.8 Common environmental sources of fluoride are depicted in (Figure 1).2,9,10

Figure 1. Fluoride Sources.
Diagram showing sources of fluoride.
There are several common environmental sources of fluoride, including fluoridated drinking water and oral health care products.

Successfully formulating a fluoride dentifrice that was efficacious against caries was a significant oral health breakthrough, because fluoride is incompatible with many dentifrice ingredients or additives. In 1950, The Procter & Gamble Company formed a joint research project team headed by Dr. Joseph Muhler at Indiana University to develop and test a new dentifrice with fluoride. Results from a clinical study of this dentifrice indicated that children ages six to 16 showed an average 49% reduction in cavities, and adults showed tooth decay reduction to almost the same degree.11,12

Following the success of this study, Crest® with Fluoristan® dentifrice launched into a number of test markets in 1955, followed by national expansion in January, 1956. In 1960, and again in 1964, the American Dental Association confirmed that Crest effectively prevents tooth decay, reporting that “Crest has been shown to be an effective anticavity dentifrice that can be of significant value when used in a conscientiously applied program of oral hygiene and regular professional care” in granting its Seal of Acceptance (Figure 2).13,14 In 1976, the American Chemical Society recognized Crest with fluoride as one of the 100 greatest discoveries of the previous 100 years.15

Figure 2.
Photo showing Original Crest toothpaste, with the ADA Seal of Acceptance.
Original Crest toothpaste, with the ADA Seal of Acceptance.

The following sections will explain the mechanism of action of fluoride, and common fluorides in dentifrices will be described.