Work

Fluoride-Free Toothpastes for Caries Prevention: A Systematic Review of Clinical Evidence on Active Ingredients

Year: 2026

Type: review

Abstract: Objective: To systematically identify and evaluate clinical trials assessing the caries-preventive efficacy of fluoride-free active ingredients in toothpaste formulations. Data: Randomized clinical trials analyzing the caries preventive effect of fluoride-free active ingredients in toothpastes. Sources: A PRISMA-related systematic review of MEDLINE and Embase was conducted. Inclusion criteria were human in vivo clinical trials on toothpastes, fluoride-free interventions, and caries-focused outcomes; exclusion criteria were in vitro or animal studies, non-toothpaste products, fluoride-only products, and non-English publications. The review followed the PICO framework: Population - participants of all ages with primary, mixed, or permanent dentition; Intervention - use of a toothpaste with a non-fluoride active ingredient; Comparison - a fluoride-containing toothpaste as control; Outcome - a measurable oral health effect based on in vivo caries estimation. Study Selection: Fifteen clinical trials met the inclusion criteria. Eleven used fluoride-free, non-therapeutic abrasive toothpastes as placebo controls. Three trials evaluated the caries-preventing efficacy of fluoride-free hydroxyapatite toothpastes across children, adolescents, and adults; one trial evaluated the caries-preventive efficacy of fluoride-free arginine toothpaste in children. Conclusion: Caries prevention relies on reducing sugar intake and thorough daily oral care, with toothpaste, containing evolving combinations of remineralizing agents, antibacterials, and abrasives, playing a central role. With growing global interest in fluoride-free options, this literature review shows that clinically proven fluoride alternatives are already in use. Clinical Significance: This review provides evidence-based guidance for dentists when recommending fluoride-free toothpastes to patients.

Source: Clinical Cosmetic and Investigational Dentistry

DOI: 10.2147/ccide.s586895

Authors: Patrick Unterbrink, Erik Schulze zur Wiesche, Bennett Amaechi, Joachim Enax

Institutions: Dr. August Wolff (Germany), The University of Texas at San Antonio Health Science Center

Language: English

Topic: Dental Health and Care Utilization

Subfield: Periodontics

Field: Dentistry

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,320