Objective: To determine the clinical effectiveness of low fluoride (F) toothpastes, containing 600 ppm or less, with toothpaste containing 1,000 ppm or more fluoride in preventing dental caries. Design: Systematic review of randomised controlled trials comparing low fluoride toothpastes containing 600 ppm F or less with toothpastes containing 1,000 ppm or more in children or adults. Results: Seven randomised controlled trials were included. These were categorised into two groups depending on the fluoride concentration in the low fluoride group (250 and 500 ppm) and analysed separately. 250 ppm: Results of the meta-analysis were statistically significant (p = 0.002 and 0.0005) and in favour of the control group (1,000 ppm). DFS increments in the 250-ppm group were 0.6–0.7 greater than the 1,000-ppm group. 500 ppm: Only two studies were in this category, and one of them failed to present the baseline caries levels, so a meta-analysis was not carried out. Conclusion: 250 ppm fluoride dentifrice was not as effective in caries prevention in permanent dentition as dentifrice containing 1,000 ppm F or more. More studies have to be carried out to test the anticaries efficacy of 500 against 1,000 ppm and above.

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