Fluoride is particularly effective at helping to prevent and reduce dental caries, with the recommendation for twice-daily use of fluoride toothpastes well established.¹² Fluoride promotes remineralisation, and can be incorporated into the enamel crystalline structure as fluorapatite, along with calcium and phosphate, which can be stronger than hydroxyapatite.

When present at the tooth surface and in plaque following use of a fluoride toothpaste, fluoride shifts the balance of demineralisation and remineralisation towards remineralisation, even during acid attacks.

Toothpastes commonly incorporate sodium fluoride (NaF) or stannous fluoride (SnF₂). The tin ion, Sn²⁺, has been shown to inhibit key metabolic processes in bacteria, slowing bacterial growth, delaying the formation of biofilm and reducing acid secretion levels.¹⁵ Oral B data on file for a plaque glycolysis and inhibition assay demonstrated that “plaque samples, after being exposed to a slurry of stannous-based fluoride toothpaste in vivo, produce less acid upon sucrose challenge than plaque samples exposed to a regular sodium fluoride toothpaste”.

Supporting these findings, the ‘Consensus Report of the European Federation of Conservative Dentistry: Erosive Tooth Wear – Diagnosis and Management’¹⁶ concludes: “Additional to causal management options, it is possible to use specific protective products or materials. Products (eg, toothpastes or mouth rinses) containing stannous fluoride or stannous chloride have the potential for slowing the progression of ETW.”

Remineralising ingredients intended to supplement fluoride action, such as calcium phosphopeptide-amorphous calcium phosphate (CPP-ACP), have been found “to work better than placebo on early enamel lesions”, but “the effect was not significantly different from that of fluoride”. The benefit of including arginine in toothpastes to prevent caries, ostensibly by raising pH levels and helping break down plaque, has still to be proved conclusively.¹²