Recommended Use of Fluoride Toothpaste by Four Japanese Dental Academic Societies
January 1st, 2023
The Japanese Society for Oral HealthJapanese Society of Pediatric Dentistry
The Japanese Society of Conservative Dentistry
Japanese Society of Gerodontology

Dental caries in Japan remains a problematical and persistent disease. Success in combating caries in children’s
teeth is offset by the prevalence of caries in adults: one in three adults has untreated caries, and the number of
elderly suffering from the disease, especially root caries, is increasing worryingly1).
The best tool in the fight to prevent caries is fluoride, the safety and efficacy of which has been tested andconfirmed over more than 75 years, and which is widely used in toothpastes. Over the last few years,research, nationally and internationally, has opened the possibility of new and practical applications of the use offluoride, in the clinic, as well as in toothpastes and daily settings.
To keep up with the best research, the four leading Japanese dental academic societies specializing in caries
prevention and treatment have jointly summarized the best recommendations for use of fluoride toothpaste
throughout life in daily Japan.
Recommended Use of Fluoride Toothpaste by Four Japanese Dental Academic Societies（Jan.2023)（The Japanese Society for Oral Health・Japanese Society of Pediatric Dentistry・The Japanese Society of Conservative Dentistry・Japanese Society of Gerodontology）

Age

How much to use(Photo shows a toothbrush of approx. 2 cm 2)）

From
tootheruption
to age 2

A grain of riceAge 3～5

Green pea

（Approx.1-2mm）（Approx.5mm）

Age 6～
Adult・
Elderly

Whole of brush（Approx.1.5cm~2cm ）Fluoride density

Usage rules

1000 ppmF・Brush teeth twice a day, including before bedtime.
・Use a very small amount of 1000 ppmF toothpaste.
After brushing, a tissue may be used gently to wipe off
remainig toothpaste
・Keep toothpaste out of the reach of children.
・Get professional advice on tooth brushing.

（900-1000
ppmF in typicalJapanesetoothpaste)
1000 ppmF（900-1000
ppmF in typicalJapanese
toothpaste)
1500 ppmF（1400-1500
ppmF in typicalJapanese
toothpaste)・Brush teeth twice a day, including before bedtime.
・After brushing, lightly spit out toothpaste. If necessary,rinse, but only once with a small amount of water.
・If the child cannot put the proper amount on the toothbrush, the parent or guardian should do it.
・Brush teeth twice a day, including before bedtime.
・ After brushing, lightly spit out toothpaste. If necessary,rinse only once with a small amount of water.
・Patients with natural teeth should use fluoride toothpaste,even if they also have titanium dental materials.

＊When deciduous teeth begin to erupt, begin practicing oral care using gauze and cotton. When children become older,parents can help them by introducing toothbrushes.
＊Take extreme care that children do not accidentally eat the entire tube of toothpaste or swallow large quantities.
＊For adults in need of root surface caries prevention, 5000 ppmF toothpaste has been shown to inhibit caries. Such
concentration is currently not commercially available in Japan, we are recommending that the government should approve it.
＊If the patient requires nursing care and has difficulty swallowing, there is a risk saliva or toothpaste may be aspirated during
brushing. In that case, suction with absorbent material ex. gauze or an aspirator may also be used. If excess toothpaste
obscures the sight of debris, remove it before brushing. The frequency of brushing should also be considered depending on
the situation.
＊In Japan, where systemic applications, such as fluoridation of tap water are not available, a combination of fluoride rinses
and applications, in addition to toothpaste, is important.
＊The width of the bristles on the toothbrush in Photo2) is approx. 2 cm.

<Comments and recommendations>
We should use fluoride toothpaste after considering both advantages 3, 4) and disadvantages 5), as we should dofor any pharmaceutical indication or healthcare intervention. Current international recommendations that take
both into account include those of the World Dental Federation (FDI) 6, 7) and the World Health Organization(WHO) 8) for fluoride toothpaste, and we are following FDI and WHO guidelines adopted for the Japanesesituation.
The higher the concentration of fluoride in toothpaste, the more effective it is in preventing dental caries.
However, given the risks associated with swallowing, age-specific recommendations should be considered. For
infants and children in the period of tooth formation, it is important to consider the balance between the risk ofdental fluorosis 5) and the benefits of caries prevention 4, 9, 10) ; to toothpaste with benefits that overweight therisks is recommended. This recommendation follows the WHO report on the selection and use of essential
medicines. 8)
Above all, it is vital that toothpaste is stored and used carefully to prevent infants from accidentally eating or
swallowing large amounts. Toothpaste manufacturers produce and sell toothpastes for infants and young
children in tubes with a total volume that is safe to swallow; even so, it is prudent to ensure that children do notto ingest large quantities. Many commercially available toothpastes do not list the concentration of fluoride in
the formulation, which is a big problem. The international standard for toothpaste (ISO 11609) requires that thetype and concentration of fluoride be indicated on the container. In line with these international standards,
Japanese companies should specify the fluoride concentration on their packets or tubes. Furthermore, Japanesecompanies are advised to produce 1450 ppmF toothpastes with child-friendly flavors.
The use of toothpaste containing a high concentration of 5000 ppmF fluoride is recommended for high-risk
individuals although it not currently available in Japan. There is clear evidence that the progression of early
active root surface caries can be arrested by the use of a 5000 ppmF toothpaste. Such a 5000 ppmF toothpaste isespecially useful in cases of aggressive root surface caries in elderly patients, who have multiple root surfaces
exposed to the oral cavity 11, 12). For this reason, the use of a 5000 ppmF toothpaste is strongly recommended forarresting root surface caries in Japanese clinical practice guidelines13). In many developed countries, dentists canprescribe toothpaste containing 5000 ppmF, and a growing number of countries allow the sale of 5000 ppmF
toothpaste without a prescription. In Japan, toothpastes with 5000 ppmF should urgently be approved by thegovernment.
The use of fluoride toothpaste is particularly recommended for the prevention of dental caries, including root
surface caries, in the elderly 3,14). In Japan, because of concern about the damage that fluoride may cause totitanium implants, there is a product containing chlorhexidine but no fluoride marketed for implant patients.
Although highly concentrated and acidic fluoride toothpastes may corrode titanium implants, lowconcentrations of neutral fluoride toothpastes do not cause such damage15). Therefore, fluoride toothpaste isrecommended even for implant patients to prevent dental caries on natural teeth15).
Internationally, the use of fluoride toothpaste for all people is recommended 6-8). Following these proposals
would bring Japan into line with globally accepted international standards.

＜References＞
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2) 高柳篤史： フッ化物配合歯磨剤によるう蝕予防. 小児歯科臨床 27:16-23,2022.
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5,000 compared to 1,450 ppm fluoridated toothpaste on root caries lesions in elderly disabled
nursing home residents. Caries Res 47:391-398,2013.
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controlled trial in adults. Community Dent Oral Epidemiol 42:333-340,2014.
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15) 日本口腔衛生学会：フッ化物配合歯磨剤の利用はチタン製歯科材料使用者にも推奨すべきである：[http://www.kokuhoken.or.jp/jsdh/statement/file/statement_20150508.pdf]