Toothpaste has come a long way from its beginnings as pastes made from things like mashed eggshells and bones mixed with myrrh. The first clinically proven fluoride toothpaste was introduced in 1955 by Crest; it contained 0.4% stannous fluoride (SnF2). Each decade after that brought further advancements: In the 1960s, gel products hit the markets; in the 1970s antiplaque claims were introduced; tartar control products were first marketed in the 1980s; and the 1990s were marked by specialty products on the market, such as antigingivitis, whitening agents, and changes in the type of container used to deliver the dentifrice, such as pumps and dual chambers.1
Today, most over-the-counter dentifrice products in the United States contain between 850 ppm to 1150 ppm fluoride. Clinical trials indicate a dose-dependent relationship between fluoride concentration and caries prevention, with a 6% increase in efficacy and 8.6% reduction in caries for every 500 ppm fluoride increase.1,17 To recap the caries-reducing benefits of fluoridated dentifrice: Research has documented that a regular low-dose source of fluoride is the most efficient means to prevent demineralization of teeth and to enhance remineralization. Fluoride becomes incorporated with the enamel apatite crystal, rendering the enamel more resistant to acid dissolution. Fluoride in saliva and plaque also promotes remineralization. And finally, fluoride also has a modest antimicrobial effect on plaque bacteria, with stannous fluoride being particularly effective against Streptococcus mutans.1
The most common forms of fluoride used in U.S. dentifrices are sodium fluoride (NaF), sodium monofluorophosphate (SMFP) and stannous fluoride (SnF2). Mixtures of NaF and SMFP, NaF and SnF2 and amine fluoride (AmF) are also recognized as safe and effective forms of fluoride in over-the-counter therapeutic dentifrices in markets outside of the United States.
There are also prescription fluoridated gels that contain 5000 ppm fluoride that are intended for limited use in high caries risk patients. One 6-month study conducted in adults found that 57% of root caries lesions became hard in subjects using a 5000-ppm gel, compared to 29% for subjects who used a 1100-ppm toothpaste.18