2022: Fluoride Intake Through Dental Care Products: A Systematic Review

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2022: Fluoride Intake Through Dental Care Products: A Systematic Review

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Hanan Saad, Raphaëlle Escoube, Sylvie Babajko, Sophia Houari - Fluoride Intake Through Dental Care Products: A Systematic Review" Front Oral Health (2022) https://doi.org/10.3389/froh.2022.916372
https://www.frontiersin.org/articles/10 ... 16372/full


Fluoride (F) is added to many dental care products as well as in drinking water to prevent dental decay. However, recent data associating exposure to F with some developmental defects with consequences in many organs raise concerns about its daily use for dental care. This systematic review aimed to evaluate the contribution of dental care products with regard to overall F intake through drinking water and diet with measurements of F excretion in urine used as a suitable biomarker. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using keywords related to chronic exposure to F in the human population with measurements of F levels in body fluids, 1,273 papers published between 1995 and 2021 were screened, and 28 papers were finally included for data extraction concerning daily F intake. The contribution of dental care products, essentially by toothbrushing with kinds of toothpaste containing F, was 38% in the mean regardless of the F concentrations in drinking water. There was no correlation between F intake through toothpaste and age, nor with F levels in water ranging from 0.3 to 1.5 mg/L. There was no correlation between F intake and urinary F excretion levels despite an increase in its content in urine within hours following exposure to dental care products (toothpastes, varnishes, or other dental care products). The consequences of exposure to F on health are discussed in the recent context of its suspected toxicity reported in the literature. The conclusions of the review aim to provide objective messages to patients and dental professionals worried about the use of F-containing materials or products to prevent initial caries or hypomineralized enamel lesions, especially for young children.


Without acknowledging age or F concentration in water, total F intake was between 340 and 3,320 μg/day. Based on those concentrations, toothpaste F represented 15–95% of the TDFI reported in μg/day (Figures 2A,B); in the published percentages, its variation ranged from 19 to 84% (19 publications). This discrepancy is caused by the fact that the authors did not calculate all the toothpaste contribution percentages.

Due to their better practice, adults should not be exposed to F through dental care products (Supplementary Figure 2) [28, 47]. However, Cardoso et al. (2006) reported high percentage values of toothpaste contribution that varied between 26 and 95% (Supplementary Figure 2) [28]. This high contribution for adult subjects was linked to their dental care practices. In this study, the authors actually reported that some subjects brushed their teeth three or four times a day. Another study also showed a non-negligible contribution of toothpaste to the TDFI, with an F ingestion from toothpaste of ~12 and 3% for 31 and 29 adults in poor and high-fluoridated areas, respectively [47].


In conclusion, our review highlights the major F contribution from dental care products regardless of the area or F concentration in drinking water. This additional source presents a large variability depending on the concentration, chemical forms, and amount of the dental product used. However, the good usage of these products also seems to be determinant for the contribution to TDFI. Therefore, the contribution of F intake through toothpaste can be easily controlled and adapted to the patient. Consequently, the future studies on F exposure and toxicity need to take into consideration exposure to F-containing dental care products, habits of use, and individual features (gender, age, diet, caries, etc.). Furthermore, considering the contribution of dental care products to the TDFI, the “optimal daily F intake” estimated approximately 50–70 μg/kg bw/day by EFSA could be reevaluated to determinate the optimal DDFI depending on each individual. The contribution of ~39–51% due to dental care products suggests that the optimal daily dietary F may be half of the EFSA values.
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