Remarkable decline and sustained low levels of caries in the Nordic populations—Explanations and implications for public oral health

Community water fluoridation has been acclaimed as an effective mode of caries control at the population level. However, a recent review has concluded that in high-income populations with widespread access to topical fluorides, water fluoridation (0.7 ppm F) has a minor effect on the development of caries. It may therefore be relevant to take a historical look at the benefits of an oral health intervention that does not rely on the use of systemic fluorides, such as toothbrushing with fluoride toothpaste. We summarize the evidence from large population studies in the Nordic countries during the past 50-yr and show that it is possible to obtain and sustain low caries levels over decades by self-performed use of fluoride toothpaste. Topical fluoride at low concentrations treats/arrests active/progressing caries lesions by controlling mineral loss in dental hard tissues, thereby reducing the development of cavities. Toothbrushing with fluoride toothpaste shifts the entire caries distribution to the left, including the right-hand tail end of the distribution, ensuring that also the more disadvantaged groups may benefit. Daily brushing with fluoride toothpaste should be promoted and trained through school-based oral health programs for children. It is time for a reappraisal of fluoride toothpaste for public oral health.