Data sources: Medline, Cochrane Library, reference lists of identified articles and selected textbooks were used to source studies.
Study selection: Selected studies were randomized or controlled clinical trials of at least 2 years' duration with caries increment in the permanent (DMFS/T) or primary (dmfs/t) dentition as the endpoint. Reports published in Danish, English, French, German, Italian, Norwegian, Spanish or Swedish were included. For multiply reported trials the one with the longest follow-up period was included.
Data extraction and synthesis: Inclusion decisions and grading of the studies was performed independently by two of the authors. The main outcome was prevented fraction (PF). A pooled estimate was calculated for included studies.
Results: Fifty-four studies were included. There was strong evidence for a caries-preventive effect of daily use of fluoride toothpaste compared with placebo in the young permanent dentition (PF, 24.9%; standard deviation, +/-11.5%). Toothpastes containing 1500 ppm of fluoride had a superior preventive effect (additional PF, 9.7%; range 0-22%) compared with standard dentifrices of 1000 ppm fluoride. There was also strong evidence for higher caries reductions with supervised toothbrushing compared with unsupervised brushing. There was incomplete evidence regarding the effect of fluoride toothpaste in the primary dentition.
Conclusions: This review reinforces the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.