Toothpastes are the most universally accepted form of fluoride delivery for caries prevention. To provide anti-caries benefits, they must be able to release fluoride during the time of tooth brushing or post brushing into the oral cavity. However, there is no standard accepted procedure to measure how much fluoride in a toothpaste may be (bio) available for release. The European Organization for Caries Research proposed and supported a workshop with experts in fluoride analysis in toothpastes and representatives from industry. The objective of the workshop was to discuss issues surrounding fluoride analysis in toothpaste and reach consensus on terminology and best practices, wherever the available evidence allowed it. Participants received a background paper and heard presentations followed by structured discussion to define the problem. The group also reviewed evidence on the validity, reliability and feasibility of each technique (namely chromatography and fluoride electroanalysis) and discussed their strengths and limitations. Participants were able to reach a consensus on terminology and were also able to identify and summarize the advantages and disadvantages of each technique. However, they agreed that most currently available methods were developed for regulatory agencies several decades ago, utilizing the best available data from clinical trials then, but require to be updated. They also agreed that although significant advances to our understanding of the mechanism of action of fluoride in toothpaste have been achieved over the past 4 decades, this clearly is an extraordinarily complex subject and more work remains to be done.

Adair SM, Bowen WH, Burt BA, Kumar JV, Levy SM, Pendrys DG, Rozier RG, Selwitz RH, Stamm JW, Stookey GK, Whitford GM: Recommendations for using fluoride to prevent and control dental caries in the United States. Morb Mortal Wkly Rep 2001; 50: 1–42.
American Dental Association Council on Scientific Affairs, Acceptance Program Guidelines, Fluoride-Containing Dentifrices, 2005.
Benzian H, Holmgren C, Buijs M, van Loveren C, van der Weijden F, van Palenstein Helderman W: Total and free available fluoride in toothpastes in Brunei, Cambodia, Laos, the Netherlands and Suriname. Int Dent J 2012; 62: 213–221.
Bibby BG: A test of the effect of fluoride-containing dentifrices on dental caries. J Dent Res 1945; 24: 297–303.
Bureau of Indian Standards. Indian Standard IS 6356: 2001, Toothpaste – Specification. Manak Bhavan, 9 Bahadur Shah Zafar Marg, New Delhi 110002.
Carey CM, Holahan EC, Schmuck BD: Analysis of 1-minute Potentially Available Fluoride from Dentifrice. J Res Natl Inst Stand Technol 2014; 119: 602–609.
Carrera CA, Giacaman RA, Muñoz-Sandoval C, Cury JA: Total and soluble fluoride content in commercial dentifrices in Chile. Acta Odontol Scand 2012; 70: 583–588.
Conde NC, Rebelo MA, Cury JÁ: Evaluation of the fluoride stability of dentifrices sold in Manaus, AM, Brazil. Braz Oral Res 2003; 17: 247–253.
Cury JA, Gumaraes LO, Arbex ST, Moreira BW: [Analysis of fluoride dentifrices: concentration and chemical formula of the fluorides encountered in Brazilian products]. Rev Assoc Paul Cir Dent 1981; 35: 142–147.
Cury JA, Marín LM, Barijaona E, Tenuta LM, Tabchoury CP, Decroix B: Evaluation of total and total soluble fluoride of toothpastes from Madagascar. Caries Res 2016; 50: 258.
Cury JA, Oliveira MJL, Martins CC, Tenuta LMA, Paiva SM: Available fluoride in toothpastes used by Brazilian children. Braz Dent J 2010; 21: 396–400.
Cury JA, Tabchoury CPM, Piovano S: Fluoride concentration and stability in dentifrices sold in the autonomous city of Buenos Aires. Bol Ass Argent Odontol Ninos 2006; 35: 4–8.
Cury JA, Tenuta LM, Ribeiro CC, Paes Leme AF: The importance of fluoride dentifrices to the current dental caries prevalence in Brazil. Braz Dent J 2004; 15: 167–174.
Cury JA, Vieira-Dantas ED, Tenuta LMA, Romão DA, Tabchoury CPM, Nóbrega DF, Velo MMAC, Pereira CM: Fluoride concentration in the most sold MFP/CaCO3-based Brazilian toothpastes at the expiration time. Rev APCD 2015; 69: 248–251.
Damen JJ, Buijs MJ, ten Cate JM: Uptake and release of fluoride by saliva-coated glass ionomer cement. Caries Res 1996; 30: 454–457.
dos Santos AP, Nadanovsky P, de Oliveira BH: A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dent Oral Epidemiol 2013; 41: 1–12.
Duckworth RM, Knoop DT, Stephen KW: Effect of mouthrinsing after toothbrushing with a fluoride dentifrice on human salivary fluoride levels. Caries Res 1991; 25: 287–291.
Duckworth RM, Morgan SN, Murray AM: Fluoride in saliva and plaque following use of fluoride-containing mouthwashes. J Dent Res 1987; 66: 1730–1734.
Fresen JA, Cox FH, Witter MJ: The determination of fluoride in biological material by means of gas chromatography. Pharm Weekblad 1968; 103: 909–914.
Gedalia I: Distribution in placenta and fetus; in Fluorides and Human Health. Monograph Series. Geneva, WHO, 1970, No 59.
Giacaman RA, Carrera CA, Muñoz-Sandoval C, Fernandez C, Cury JA: Fluoride content in toothpastes commercialized for children in Chile and discussion on professional recommendations of use. Int J Paediatr Dent 2013; 23: 77–83.
Hattab FN: Analytical Methods for the Determination of Various Forms of Fluoride in Toothpastes. J Dent 1989b; 17: 77–83.
Heijnsbroek M, Gerardu VA, Buijs MJ, van Loveren C, ten Cate JM, Timmerman MF, van der Weijden GA: Increased salivary fluoride concentrations after post-brush fluoride rinsing not reflected in dental plaque. Caries Res 2006; 40: 444–448.
Hashizume LN, Lima YB, Kawaguchi Y, Cury J: Fluoride availability and stability of Japanese dentifrices. J Oral Sci 2003; 45: 193–199.
International Organization for Standardization (ISO) Standard 11609. Dentistry – Dentifrices – Requirements, test methods and Marking, 2017.
Issa AI, Toumba KJ: Oral fluoride retention in saliva following toothbrushing with child and adult dentifrices with and without water rinsing. Caries Res 2004; 38: 15–19.
Kikwilu EN, Frencken JE, Mulder J: Utilization of toothpaste and fluoride content in toothpaste manufactured in Tanzania. Acta Odontol Scand 2008; 66: 293–299.
Lilienthal B: An analysis of the buffer systems in Saliva. J Dent Res 1955; 34: 516–530.
Lippert, F: An Introduction to Toothpaste – Its Purpose, History and Ingredients pages 1–14; in Toothpastes, Monographs in Oral Science: van Loveren C (ed): (Amsterdam), 2013, vol 23.
Marin LM, Castiblanco GA, Usuga-Vacca M, Cury JA, Martignon S: Fluoride concentration of the six most sold toothpaste brands in Colombia. Caries Res 2015; 49: 25.
Marin LM, Vieira Filho W, Tenuta LMA, Tabchoury CPM, Cury JA: Reproducibility and validity of fluoride dentermination in toothpastes with ion specific electrode by direct analysis. Braz Oral Res 2016; 30(suppl 1): 68. Abstract AO0090.
Marinho VC, Higgins JP, Sheiham A, Logan S: Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003; 1:CD002278.
Martínez-Mier EA, Cury JA, Heilman JR, Katz BP, Levy SM, Li Y, Maguire A, Margineda J, O’Mullane D, Phantumvanit P, Soto-Rojas AE, Stookey GK, Villa A, Wefel JS, Whelton H, Whitford GM, Zero DT, Zhang W, Zohouri V: Development of gold standard ion-selective electrode-based methods for fluoride analysis. Caries Res 2011; 45: 3–12.
Muhler JC: Effect on dental caries of a dentifrice containing stannous fluoride and dicalcium phosphate. J Dent Res 1957; 36: 399–402.
Nagata ME, Delbem AC, Hall KB, Buzalaf MA, Pessan JP: Fluoride and calcium concentrations in the biofilm fluid after use of fluoridated dentifrices supplemented with polyphosphate salts. Clin Oral Investig 2017; 21: 831–837.
Pearce EI: A laboratory evaluation of New Zealand fluoride toothpastes. N Z Dent J 1974; 70: 98–108.
Pfarrer AM, Karlinsey RL: Challenges of implementing new remineralization technologies. Adv Dent Res 2009; 21: 79–82.
Ricomini Filho AP, Tenuta LM, Fernandes FS, Calvo AF, Kusano SC, Cury JA: Fluoride concentration in the top-selling Brazilian toothpastes purchased at different regions. Braz Dent J 2012; 23: 45–48.
Santos APP, Oliveria BH, Nadanovsky P: Effects of low and standard fluoride toothpastes on caries and fluorosis: systematic review and meta-analysis. Caries Res 2013; 47: 382–390.
Sarmiento RV, Issao M, Cury JA: Study of the availability and stability of fluoride in dentifrices sold in Peru. Rev Stomatol Hered 4: 12–20.
Singer L, Armstrong WD: Regulation of human plasma fluoride concentration. J Appl Physiol 1960; 15: 508–510.
Soysa NS, Alles N, Tenuta L, Cury J: Availability of Total, Soluble and Ionic Fluoride Concentrations in Commonly Used Dentifrices in Sri Lanka. 37th Asia Pacific Dental Congress, 2015.
Tabchoury CP, Cury JA: Study of dentifrices accelerated aging conditions to foresee the fluoride behavior in normal conditions. Revista Brasileira de Farmacia 1994; 75: 67–71.
Taves DR: Separation of Fluoride by Rapid Diffusion using Hexamethyldisiloxane. Talanta 1968; 15: 969–974.
Twetman S, Axelsson S, Dahlgren H, Holm A-K, Kallestal C, Lagerlof F, Lingstrom P, Mejare I, Nordenram G, Norlund A, Petersson LG, Soder B: Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand 2003; 61: 347–355.
van Loveren C, Moorer WR, Buijs MJ, van Palenstein Helderman WH: Total and free fluoride in toothpastes from some non-established market economy countries. Caries Res 2005; 39: 224–230.
Venkateswarlu P: Evaluation of Analytical Methods for Fluorine in Biological and Related Materials. J Dent Res 1990; 69(suppl 2): 514–520.
Vogel GL: Oral Fluoride Reservoirs and the Prevention of Dental Caries; in Buzalaf MAR (ed): Fluoride and the Oral Environment: Monogr Oral Sci. Basel: Karger, 2011, vol 22, pp 146–157.
von der Fehr FR, Møller IJ: Caries-preventive fluoride dentifrices. Caries Res 1978; 12(suppl. 1): 31–37.
Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X: Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2010; 20: CD007868.
Weber JP: An interlaboratory comparison programme for several toxic substances in blood and urine. Sci Total Environ 1988; 71: 111–123.
Winston A: Personal communication with CM Carey, 2006.
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