Campaigns & activities The Truth About Tooth Decay High fluoride toothpaste Prescription high fluoride toothpaste can help patients effectively prevent and control caries while outside of the practice setting. 1 This is a simple, evidenced-based means for helping patients avoid additional caries onset or progression. Prescription high fluoride toothpaste can help prevent caries by inhibiting demineralisation and promoting remineralisation. 2 High fluoride toothpastes come in two strengths – a 2800ppm sodium fluoride paste can be used by those over the age of 10, and a higher strength 5000ppm sodium fluoride which may be prescribed for those aged 16 years and over. 3, 4, 5, 6 Prescription high fluoride toothpaste should be prescribed for patients with increased risk (moderate-high likelihood) of developing dental caries. 1 This helps patients to control their initial caries lesions. 7, 8 One tube of high fluoride toothpaste lasts a patient approximately one month, and dentists may prescribe up to six months at a time, in-line with their next recall appointment. These prescriptions can be time post-dated so that patients pick their prescription up in batches rather than all in one go. More information about the characteristics of high fluoride toothpaste can be found on the MHRA website. Identifying moderate-high risk caries patients There are many risk assessments available to determine a patient’s likelihood and severity of caries. This is just one example of caries risk assessment: 9 Risk Social history Medical history Dietary history Use of fluoride Plaque control Saliva Clinical evidence High caries risk Socially deprived. High presence of caries in siblings. Low knowledge of dental disease. Irregular attender. Ready availability of snacks. Low dental aspirations. Medically compromised. Physical disabilities. Xerostomia. Long-term. Cariogenic medicine. Frequent sugar intake. Drinking un-fluoridated water. No fluoride supplements. Non-fluoride toothpaste. Infrequent, ineffective cleaning. Poor manual cleaning. Low flow rate. Low buffering capacity High S mutans and lactobacillus counts. New lesions, premature extractions, anterior caries or restorations, multiple restorations. No fissure sealants. Fixed appliance. Orthodontics. Partial dentures. Moderate caries risk Individuals who do not clearly fit into high or low caries risk categories are considered to be at moderate caries risk. Low caries risk Socially advantaged. Low caries in siblings. Dentally aware. Regular attender. Work does not allow regular snacks. High dental aspirations. No medical problems. No physical problems. Normal saliva flow. No long-term medication. Infrequent sugar intake. Drinking fluoridated water. Fluoride supplements used. Fluoride toothpaste used. Frequent, effective cleaning. Good manual cleaning. Normal flow rate. High buffering capacity Low S mutans and lactobacillus counts. No new lesions. Nil extractions for caries. Sound anterior teeth. No or few restorations. Restorations inserted years ago. Fissure-sealed. No appliance. Patients at increased caries risk patients aged ten years and over, those with caries present, orthodontic appliances, a highly cariogenic diet or medication causing dry mouth, could be prescribed a 2880ppm fluoride toothpaste. 1 Patients aged 16 years and over with increased caries risk, present or potential for root caries, dry mouth, orthodontic appliances, overdentures, those with highly cariogenic diet or medication causing dry mouth, could be prescribed a fluoride 5000ppm toothpaste. 1 Sources Public Health England (2017) ‘Delivering better oral health: an evidence-based toolkit for prevention’, Third Edition, UK. Baysan A, Lynch E, Ellwood R, Davies R, Petersson L, Borsboom P. Reversal of primary root caries using dentifrices containing 5,000 and 1,100 ppm fluoride. Caries Res. 2001 Jan-Feb;35(1):41-6. doi: 10.1159/000047429. PMID: 11125195. Colgate (2020) ‘Colgate® Duraphat® 5000ppm Fluoride’, online at https://www.colgateprofessional.co.uk/products/products-list/colgate-duraphat-5000-toothpaste, accessed October 2020. Colgate-Palmolive (U.K.) Ltd (2020) ‘Summary of Product Characteristics,’ Duraphat 2800ppm fluoride toothpaste. Online at https://mhraproducts4853.blob.core.windows.net/docs/c0e452136f37b21ae14dae330bc55c62b0e931fb Colgate-Palmolive (U.K.) Ltd (2020) ‘Summary of Product Characteristics’, Duraphat 5000ppm fluoride toothpaste. Online at https://mhraproducts4853.blob.core.windows.net/docs/993ca2d10345c940c4649fd8c98042f68fe00d51 Colgate-Palmolive (U.K.) Ltd (2014) ‘Duraphat® 5000ppm Fluoride Toothpaste’, Package Leaflet: Information for the user, online at https://mhraproducts4853.blob.core.windows.net/docs/f7686217b083fc71959d19152bb6eab6ea5dad82. Schirrmeister JF, Gebrande JP, Altenburger MJ, Mönting JS, Hellwig E. Effect of dentifrice containing 5000 ppm fluoride on non-cavitated fissure carious lesions in vivo after 2 weeks. Am J Dent. 2007 Aug;20(4):212-6. PMID: 17907481. Biesbrock AR, Gerlach RW, Bollmer BW, Faller RV, Jacobs SA, Bartizek RD. Relative anti-caries efficacy of 1100, 1700, 2200, and 2800 ppm fluoride ion in a sodium fluoride dentifrice over 1 year. Community Dent Oral Epidemiol. 2001 Oct;29(5):382-9. doi: 10.1034/j.1600-0528.2001.290508.x. PMID: 11553111. FGDPUK (2016) ‘Clinical Examination and Record-Keeping: Good Practice Guidelines’, published by Faculty of General Dental Practice (UK), The Royal College of Surgeons of England. United Kingdom. This campaign is delivered by the Oral Health Foundation, a charity creating healthier communities by delivering better oral health. The campaign is sponsored by Colgate-Palmolive.