Caries Preventive Effects of High-fluoride vs Standard-fluoride Toothpastes - A Systematic Review and Meta-analysis

Oral Health Prev Dent. 2018;16(4):307-314. doi: 10.3290/j.ohpd.a40937.


Purpose: To determine the efficacy of high-fluoride toothpastes (≥ 2500 ppm) as compared to standard fluoride toothpastes (≤ 1500 ppm) in preventing dental caries.

Materials and methods: Randomised controlled trials (RCTs) and cluster-randomised trials comparing high-fluoride dentifrices (≥ 2500 ppm) with lower-concentration fluoride dentifrices (≤ 1500 ppm) with a follow-up period of at least 6 months were included. A random effects model was used to assess the mean differences in caries increment between the two types of dentifrices used. A fixed effects model was used to determine the preventive effect of high-concentration fluoride toothpastes compared with low-fluoride toothpastes. Subgroup and sensitivity analyses were conducted when results indicated heterogeneity. Statistical significance was set at p < 0.05.

Results: Eight studies met the inclusion criteria. High-fluoride toothpaste use was statistically significantly associated with lower caries increment scores (pooled mean difference: -0.52 [95% CI, -0.67, -0.37], p = 0.00001). Subgroup analysis for the included studies reflected a significant reduction in I2 values from 99% to 18%. High-fluoride toothpastes were also associated with a greater preventive effect compared with low-fluoride toothpastes (pooled odds: 52.76 [95% CI, 19.74, 141.04], p = 0.95).

Conclusion: This meta-analysis suggests that high-fluoride toothpastes are superior to low-fluoride toothpastes in reducing caries. The results of this work when used judiciously should encourage the use of high-fluoride toothpaste, specifically among the vulnerable populations, to maximise preventive benefits.

Keywords: dental caries; fluoride dentifrices; high-fluoride toothpaste; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Cariostatic Agents / administration & dosage*
  • Dental Caries / prevention & control*
  • Dose-Response Relationship, Drug
  • Fluorides / administration & dosage*
  • Humans
  • Randomized Controlled Trials as Topic
  • Toothpastes / administration & dosage*


  • Cariostatic Agents
  • Toothpastes
  • Fluorides