tain fl uoride with a minimum concentration of 1,000 parts per million (ppm) to prevent tooth decay in their children, according to a new study. Researchers for the Cochrane Oral Health Group, based at the School of Dentistry, The University of Manchester, have previously shown that fl uoride toothpastes reduce dental decay by 24% on average compared to non-fl uoride products. Now the authors, in a second related study, suggest that parents concerned about the risk of fl uorosis should consult their dentist to discuss the benefi ts and risks. The research looked at 79 trials on 73,000 children worldwide to examine the effect of different children’s toothpastes and found that those with fl uoride concentrations less than 1,000 parts per million were only as effective as nonfl uoride toothpastes at preventing tooth decay. Children’s toothpastes range from 100 ppm to 1,400 ppm fl uoride concentration. The study suggests that brushing a child’s teeth with a toothpaste containing fl uoride before the age of 12 months may be associated with an increased risk of developing mild fl uorosis. Swa l low i ng large amounts of toothpaste may still cause fl uorosis in children up to the age of six years when the permanent teeth are still developing, but using a small amount, carefully, will reduce these risks. After the age of six years, the teeth are fully developed and toothpaste can be used without fear of fl uorosis. Dr Anne-Marie Glenny, an author on the review, said, ‘It is very confusing for parents to know how to strike the right balance, which is not helped by the fact that different companies use different concentrations of fl uoride in their toothpastes aimed at children. From a public health point of view, the risk of tooth decay and its consequences such as pain and extractions is greater than the small risk of fl uorosis. Children would have to swallow a lot of toothpaste over a long period of time to get the severe brown mottling on the teeth, as opposed to the more typical mild white patches.’ She added that for children that are considered to be at a high risk of tooth decay by their dentist, the benefi t to health of preventing decay is likely to outweigh the risk of fl uorosis. In such cases, careful brushing of their children’s teeth by parents with a small amount of toothpaste containing higher levels of fl uoride would be benefi cial. The review will be published in the Cochrane Library, which is available on the Cochrane website: www. cochrane.org.