The Complex World of Toothpaste Diversity, Meeting Patient Clinical Needs. An Umbrella Review

Background: Amidst numerous recent advancements in toothpaste formulations and active ingredients, some clinicians may believe all toothpastes are similar despite differences in their active ingredients and corresponding clinical application. Aim: This umbrella review aims to provide clinicians with an overview of toothpaste ingredients and evidence of efficacy for a variety of oral conditions, including gum health issues, caries, dentine hypersensitivity, tooth surface loss, oral malodour and tooth whitening (staining). Methods: The focused question for the review was ‘What is the efficacy of common toothpaste active ingredients in preventing or treating oral conditions including gum health issues, caries, dentine hypersensitivity, tooth surface loss, oral malodour and tooth whitening (stain removal)?’. Therefore, an umbrella review design was followed focused on review articles, that is, systematic and/or narrative reviews of randomised clinical trials, observational or in vitro studies whenever available. Seventy-two reviews were identified through electronic search of OVID. Quality assessment was performed based upon the PRISMA checklist. Data was extracted according to relevance to the listed oral conditions. Results: Nineteen toothpaste ingredients were identified to treat six oral conditions, including six types of fluoride. Evidence of efficacy of active ingredients varied and with six reported to have significant benefits for the prevention or treatment of the targeted oral condition. Differences were particularly evident in the efficacy of types of fluoride. Conclusions: Toothpaste active ingredient efficacies are diverse. As such, oral healthcare providers should consider recommendation of toothpastes containing appropriate active ingredients by effectively targeting oral conditions/diseases according to each patient's needs.