title: Total and free available fluoride in toothpastes in Brunei, Cambodia, Laos, the Netherlands and Suriname.
abstract: OBJECTIVE
  This study assessed total and free fluoride concentrations in samples of toothpaste from Brunei, Cambodia, Laos, the Netherlands and Suriname, and investigated the labelling practices of the respective manufacturers.
  
  
  METHODS
  Convenience samples were bought in the five countries and sent for analysis to the Netherlands. Levels of total and free available fluoride were measured. Details of the information declared on the packaging about type of fluoride and abrasives were recorded, and manufacturing and expiry dates were noted.
  
  
  RESULTS
  A total of 119 samples of toothpaste were analysed. With one exception, all samples from the Netherlands complied with ISO (International Organisation for Standardisation) labelling requirements and there were no differences between the fluoride content declared and that found to be present on analysis. In samples purchased in the other countries, sodium monofluorophosphate (SMFP) toothpastes predominantly showed a low percentage of free available fluoride and the majority of toothpastes did not follow standard labelling guidelines.
  
  
  CONCLUSIONS
  This study is not representative of any of the brands analysed, yet it highlights problematic discrepancies in products across countries. These may be related to the lack of a generally accepted methodology for analysing total and free fluoride content, absence of an agreement on the minimum concentration of fluoride required to ensure efficacy, weak regulating institutions that are unable to control labelling and consumer information, as well as a possible influx of counterfeit low-quality toothpaste.
  
  
  CONCLUSIONS
  Renewed international focus should be directed towards closing gaps in guidelines and standards. Consumers should use only non-expired toothpaste, which should preferably be silica-based fluoride toothpaste that does not include abrasives containing calcium and that is properly labelled.
authors.affiliation: The Health Bureau Ltd, Haversham, UK. habib.benzian@health-bureau.com
authors.forename: Habib
authors.initials: H
authors.lastname: Benzian
authors.forename: Christopher
authors.initials: C
authors.lastname: Holmgren
authors.forename: Mark
authors.initials: M
authors.lastname: Buijs
authors.forename: Cor
authors.initials: C
authors.lastname: van Loveren
authors.forename: Fridus
authors.initials: F
authors.lastname: van der Weijden
authors.forename: Wim
authors.initials: W
authors.lastname: van Palenstein Helderman
mesh_terms: D002010:Brunei; D002160:Cambodia; D002327:Cariostatic Agents / Q000032:analysis* / Q000592:standards; D005459:Fluorides / Q000032:analysis* / Q000592:standards; D005460:Fluorides, Topical / Q000032:analysis* / Q000592:standards; D007812:Laos; D009426:Netherlands; D011356:Product Labeling / Q000592:standards*; D013532:Suriname; D014100:Toothpastes / Q000737:chemistry* / Q000592:standards
chemical_list: D002327:Cariostatic Agents; D005460:Fluorides, Topical; D014100:Toothpastes; D005459:Fluorides