Method: Guidelines reviews and large studies of water fluoridation and fluoride toothpastes are considered and international policy is compared.
Result: Australia, Ireland and the UK all commenced water fluoridation in the 1960s and introduced fluoride toothpastes in the 1970s. An estimated 70% of the population currently receive fluoridated supplies in Australia, 73% in Ireland and 10% in the UK. Epidemiological studies have illustrated the impact of fluorides over time both before and after the introduction of fluoride toothpaste, with a decline in caries prevalence and an increase in the prevalence of fluorosis. To minimise the development of enamel fluorosis, some countries have moved to lower the level of fluoride in water and provide guidance on the use of fluoride toothpastes. Wide variation exists in guidance on the age to commence tooth brushing, the method of use and the concentration of fluoride in toothpaste. Much of the difference can be attributed to contextual issues such as the availability of fluoride from other sources, for example domestic water fluoridation in the case of toothpaste and differing climate in the case of water fluoridation. Some of the variation is due to gaps in our knowledge and different interpretations of the available evidence.
Conclusion: Fluoridation is effective in preventing dental caries; guidance on the appropriate use of fluoride toothpaste for children varies. Further research is needed to address the gaps in our knowledge to improve oral health policy.