LAUSR

In May 1955, dentist and biochemist Joseph C. Mulher wrote ‘All of us who are interested in dental health are anxious to find effective anticariogenic agents’ and ‘I will continue to work hard on the solution of the dental caries problem until a satisfactory product is available.’1 He would later introduce what is regarded as the first commercially available fluoride-containing toothpaste.2 Fast forward sixty-five years, and the consumer market is flooded with an array of fluoride-containing toothpastes and mouthwashes as the importance of this substance in preventing dental decay is now common knowledge among the general public. Overwhelmingly, dental professionals recognise years of robust research confirming fluoride toothpaste use in children and adults as a key strategy in the prevention of caries. Strengthening this position, in 2019 a Cochrane Review3 showed that oral hygiene in the absence of fluoride fails to show a benefit in reducing the incidence of dental caries. With this in mind, a recent study carried out at the University of Canterbury (NZ) analysed self-reported data from the New Zealand Health Survey of 2017/18 to investigate the prevalence of nonfluoride toothpaste use. Corresponding sociodemographic and socioeconomic factors were explored revealing some interesting results. Overall, 6.8% of adults and 6.4% of children reported to use non-fluoride toothpaste. Individuals identifying as Asian by ethnicity were most likely to report use of non-fluoride toothpaste. Perhaps surprisingly, the nationally representative data showed that the highest prevalence of non-fluoride toothpaste use was seen in areas defined as moderately and least deprived. As such, any health intervention leading to a decline in non-fluoride toothpaste use may widen already existing health inequalities. The results hereby highlight the complexity of dental health-related behaviours and raise questions regarding the targeting and funding of public health initiatives. So why might almost 7% of the NZ population be using a non-fluoride toothpaste? A quick internet search of fluoride – alone or in relation to oral health – immediately unearths somewhat dubious claims of its numerous health ‘hazards’. It doesn’t take long to stumble across outlandish comments, conspiracy theories and controversies surrounding fluoridation. Or might consumers now be more interested in the cosmetic benefits of toothpastes for example, whitening, rather than simply preventing decay and so accept low or zero fluoride content? Considering the global burden of disease relating to caries (estimated at affecting 2.4 billion people worldwide),4 it would seem imperative to continue efforts to promote and facilitate the use of fluoride toothpaste in the general population. By Anne C. Devlin Dundee Dental Hospital, NHS Tayside