Investigating the prevalence of non-fluoride toothpaste use in adults and children using nationally representative data from New Zealand: a cross-sectional study. Br Dent J 2020; 228: 269-276.

We saw anecdotal evidence from the New Zealand Dental Association (NZDA) and British Dental Association (BDA) that the rise of non-fluoride or natural toothpastes pose a threat to good oral health. However, it soon became clear there was a lack of contemporary evidence internationally that used large nationally representative samples to examine the prevalence of non-fluoride toothpaste use in both adults and children.

Two results stood out. First, we did not expect the prevalence to be so high. Approximately one in fifteen adults and children use non-fluoride toothpaste in New Zealand. This is concerning as a recent review showed that personal oral hygiene in the absence of fluorides fails to show a benefit in terms of reducing the incidence of dental caries. Second, in health-related research, we often see a social gradient in health, such that, those in the most deprived areas exhibit the unhealthy behaviours and poorer health relative to those most affluent areas. In contrast, this study showed that the highest prevalence of non-fluoride toothpaste use was in the moderately and the least deprived areas. Moreover, for children, those in the most deprived areas had the lowest use of non-fluoride toothpaste. This highlights the complexity of dental health-related behaviours. They are certainly not as simple as we first thought and require some careful thought around intervention.

Oral health promotion strategies involving fluoride, such as fluoride toothpaste, have consistently been shown to provide benefit and are supported by high-quality evidence. It will be important for public health to translate these findings into policy to improve population health. We all need to be aware of the benefits of using fluoride and the risks of using non-fluoride or naturally marketed toothpastes. This is especially important in an era of miscommunication, fake news, and clever marketing techniques.