Fluoride ingestion from toothpaste by young children

Toothpaste ingestion-evaluating the problem and ensuring safety: systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.

Characterization of toothpastes for fluorine and other elements by INAA and ICP-OES

Fluoride toothpastes have made a significant contribution towards oral hygiene. This study proposes instrumental neutron activation analysis (INAA) as a suitable technique for determining fluorine in toothpastes. The method involved a 10 s irradiation, followed by 10–20 s decay, and counting for 10 s, using a pneumatic system and high purity germanium detector. All irradiations were performed at miniature neutron source reactor with thermal neutron flux 1 × 1012 cm−2 s−1. Since Na was present in all toothpastes, the quantification of fluorine required correction for 23Na(n,α)20F threshold reaction. Fluorine determination was validated by analysing the samples by ion chromatography. All toothpastes were also analysed for other elements by k 0-INAA and ICP-OES. Both techniques quantified 28 elements including Al, As, Ba, Ca, Ce, Cl, Co, Cr, Cu, F, Fe, Hf, K, La, Mg, Mn, Na, P, S, Sb, Sc, Si, Sm, Sn, Sr, Ta, Ti and Zn. This study, categorized toothpastes in five groups based on concentrations of Ca, P and Ti.

Prevalence and Determinants of Enamel Fluorosis in Flemish Schoolchildren

As part of an epidemiological study on the oral health of Flemish schoolchildren, fluoride use was studied together with risk factors (medical history, tap water fluoride concentration, use of fluoride supplements, toothpaste and brushing habits). Fluorosis was scored according to the Thylstrup-Fejerskov index (TFI) in children aged 11 years (4,128 children examined). Explanatory variables were recorded yearly, starting at the age of 7. Earliest toothpaste use was reported at the age of 1. By age 7, 99.7% of the children reported the use of toothpaste (90% fluoride-containing), but only 13.9% reported using a pea-sized amount. At age 7, 66% of the children had received systemic fluoride supplements during at least part of their childhood. At 11 years, 92% of the children used a fluoride-containing toothpaste and 6% still received systemic fluoride supplements. Fluorosis was present in about 10% of all the children examined, mainly TFI score 1 (7.3% in upper central incisors). Logistic regression established tooth brushing frequency and fluoride supplement use, in addition to tap water fluoride concentrations above 0.7 mg/l, as significant risk factors when the presence of fluorosis on at least one tooth was used as outcome variable. Children having fluorosis had a lower risk of caries, both in the primary (median dmft 1, range 0-10 vs. 2, range 0-12) and permanent dentition (median DMFT 0, range 0-5 vs. 0, range 0-11).

Caries risk assessment and prevention: strategies for Head Start, Early Head Start, and WIC

OBJECTIVES

This review updates the evidence regarding caries risk assessment for infants, toddlers, and preschool children and formulates recommendations for preventive strategies for WIC, Head Start, and Early Head Start.

METHODS

Literature on caries risk assessment and preventive strategies for infants, toddlers, and preschool children were reviewed and synthesized. Recommendations for WIC, Head Start, and Early Head Start were made based on the review.

RESULTS

Individual caries risk for children in WIC, Head Start, and Early Head Start should be based on: (1) previous caries experience, (2) precavity lesions, (3) visible plaque, and (4) perceived risk by examiners. Recommended preventive strategies for WIC and Head Start populations include: (1) daily toothbrushing in Head Start centers using fluoridated toothpaste; (2) fluoride varnish application to children enrolled in WIC, Head Start, and Early Head Start; (3) use of chlorhexidine gels and varnishes (following FDA approval); and (4) increased use of sealants on children with precavity pit and fissure lesions.

CONCLUSIONS

Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start populations hold a great deal of promise for preventing dental decay in high-risk children.