Fluoride Action Network

Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials

Source: International Dental Journal 70(6):418-426. | December 1st, 2020 | Danielle Clark Perry and Liran Levin
Location: International
Industry type: Toothpaste


Aim: The aim of this study was to systematically review and analyse the difference in efficacy of stannous fluoride toothpaste formulations in comparison to other fluoridated toothpastes without stannous fluoride.

Materials and methods: A systematic search of the literature was performed according to PRISMA guidelines. A search strategy was developed to answer the study question and was performed in PubMed-Medline databases. Inclusion criteria were randomised controlled clinical trials comparing stannous fluoride toothpaste formulations with other fluoridated toothpastes not containing stannous fluoride.

Results: The search in PubMed-Medline databases resulted in 384 articles; 23 articles were downloaded for review, 16 articles were included in the report and six could be used for meta-analysis. All studies were randomised controlled clinical trials that compared clinical outcomes between toothpastes with stannous fluoride combinations and toothpastes with only fluoride. The overall results of the 16 studies favoured the stannous fluoride formulations. However, in a meta-analysis of the randomised controlled clinical trials, it was demonstrated that stannous fluoride toothpaste formulations provided significantly better outcomes based on the Gingival Index (SMD –0.14, 95% CI –0.20, –0.07, P = 0.0001), but not the Modified Gingival Index (SMD –0.30, 95% CI –0.7, 0.09, P = 0.13).

Practical implications: The antibacterial properties of stannous seem to provide favourable results when formulated with a fluoridated toothpaste. This systematic review highlights the lack of homogenous research available to rigorously compare stannous fluoride toothpaste formulations with other fluoridated toothpastes without stannous fluoride.


It is well established that dental plaque (biofilm) is the main causes of the two most prominent dental diseases, caries and periodontal disease1. These oral diseases burden the population worldwide, and the association reported between oral health and overall health is continuously growing2. Fortunately, it is well understood that if biofilm is removed frequently and effectively, the occurrence of both periodontal disease and caries can be reduced or eliminated1., 3.. As a result, efforts are invested into establishing new methods and improving current methods to make biofilm removal more effective. This includes new toothbrush designs, and new products to assist in oral disease prevention and control.

One of these products is fluoridated toothpastes. Fluoride decreases caries risk and can aid in remineralisation of the enamel. As a result, it is a common and important ingredient found in toothpastes4. However, more than just a single formulation of fluoride exists on the market. The fluoride component of toothpastes may be stannous fluoride, amine fluoride with stannous chloride, sodium fluoride, sodium monofluorophosphate, etc.4. Different formulations are being developed and researched in an effort to achieve better outcomes for oral health.

Specifically, stannous fluoridated toothpaste combinations ultimately have two effective ingredients. Stannous itself has antibacterial properties, and fluoride has anticavity properties5. As a result, stannous fluoride formulations are promoted to help the treatment of gingivitis, erosion, hypersensitivity and oral malodour in addition to the anticaries benefit of the fluoride5. In consideration of the additional benefits reported for stannous fluoride formulations, the purpose of this systematic review and meta-analysis was to investigate the efficacy of stannous fluoridated toothpastes compared with other fluoridated toothpastes without stannous fluoride.


This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews and Interventions and the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines6., 7.

Focused question

The format used to develop the focused question was based on the PICO (population, intervention, comparison and outcome) structure6. Using the PICO format, the following question was used to guide the search strategy: What are the effects of using new formulations of stannous fluoride toothpaste compared with other fluoridated toothpastes without stannous on periodontal and caries parameters in the general population? The population was not restricted and included all studies of the general population; the intervention was stannous fluoride toothpaste formulations; the comparison of interest was other fluoridated toothpastes; and the outcomes included any periodontal and caries parameters.

Eligibility criteria

The following inclusion criteria were utilised.

Randomised controlled trials examining patients from the general population published from 2015 until March 2019. This date restriction was chosen due to the rapid development of new toothpaste formulations, and in order to include the recent formulations available for stannous fluoride that were introduced in recent years. Any age, gender and severity of oral health status and medical status were included. Studies comparing stannous fluoride toothpaste formulations with at least one other fluoridated toothpaste without stannous fluoride for daily oral hygiene and reported outcomes related to oral health such as, but not limited to: caries, plaque index, calculus accumulation, gingival index, sensitivity and malodour were included.


There is some evidence to suggest that stannous fluoride toothpaste formulations may have more favourable oral health outcomes than toothpastes without stannous fluoride. However, there are insufficient homogenous studies to allow for a larger meta-analysis to be conducted and for stronger conclusions to be drawn.


Dr Liran Levin has received sponsorship for lectures from Colgate, Sunstar, P&G, Adin Implants, and Dentsply Sirona. Mrs Danielle Clark-Perry has received sponsorship for lectures from Sunstar and P&G.

*Read full-text study at http://fluoridealert.org/wp-content/uploads/clark-perry-2020.pdf