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High fluoride toothpaste (HFT) refers to toothpastes containing fluoride concentrations above 1,500 ppm F, typically containing 2,800 up to 5,000 ppm F. The availability of ‘over the counter’ HFT products, such as Duraphat 5,000 ppm toothpaste, varies across country to country.
HFT is used in the same manner as regular toothpaste. Apply 1 cm of paste onto the head of a toothbrush and brush the teeth for 1-2 minutes, ideally twice daily. Spit out and do not rinse, or rinse with a minimal amount of water.
The anticaries effect of HFT has been estimated in clinical trials and summarized in systematic reviews [1,2,3]. A positive dose response benefit has been observed and HFT is superior to low fluoride toothpaste in reducing caries [1,3]. The anticaries effect of HFT (5,000 ppm F) to arrest root caries lesions is very positive, with 51% more lesions becoming inactive when compared with the use of conventional toothpaste [4].
HFT toothpaste should be kept out of reach by children and is usually not recommended for use by children under the age of 16 years. Otherwise, HFT is safe when used according to instructions.
HFT costs more than standard ‘over the counter’ toothpaste. As a self-applied preventive measure, the cost is favourable compared with professional fluoride alternatives. Further health-economic evaluations are required to establish the costs for high risk groups.
HFT is particularly recommended for preventing and controlling caries in high-risk individuals and patients with active disease. Typical cases are patients with impaired saliva functions, frail elderly with exposed root surfaces and cancer patients who have been treated with head and neck radiation.
Key Further Reading
1- High Fluoride Concentration Toothpastes for Children and Adolescents.
Pretty IA. High Fluoride Concentration Toothpastes for Children and Adolescents. Caries Res. 2016;50 Suppl 1:9-14.
Singh A, Purohit BM. 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.
3- Fluoride toothpastes of different concentrations for preventing dental caries.
Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019 Mar 4;3:CD007868.
4- Systematic review on noninvasive treatment of root caries lesions.
Wierichs RJ, Meyer-Lueckel H. Systematic review on noninvasive treatment of root caries lesions. J Dent Res. 2015 Feb;94(2):261-71.
Linked Resources
Fluoride Toothpaste