الفهرس 
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Abstract
Caries is a worldwide, highly prevalent, chronic oral disease. Fluoride has a crucial role in its prevention through its antimicrobial and remineralization effects. It is found naturally in the environment; water, milk, food and salt. There are also artificial sources of fluoride, including toothpaste, mouthwash, fluoride varnish, gel and foam.
Fluoridated toothpaste is considered the best source of fluoride, for its ease of access, low price, availability and its acceptance throughout different communities globally. Fluoride is found in different forms within toothpaste; sodium fluoride, sodium monofluorophosphate, stannous fluoride and fluoride amine.
Another important ingredient of toothpaste is the abrasive, with calcium carbonates and silica being the most commonly used abrasives. Compatibility between the form of fluoride compound and the abrasive is of paramount importance, as disharmony can lead to binding of the abrasive to fluoride and its inactivation. The anticaries effect of toothpaste depends on the amount of free (active) fluoride ions rather that its total fluoride content. Inactivation of fluoride will decrease the efficacy of toothpaste.
The misuse of fluoridated toothpaste has many risks, as it can cause acute and chronic toxicity. Acute fluoride toxicity is due to the sudden ingestion of a large amount of fluoride, leading to nausea, vomiting, diarrhea, tetany, hypotension and finally leading to cardiac arrest. chronic fluoride toxicity is more common, and can cause dental and skeletal fluorosis, renal, gastrointestinal, nervous and fetal defects.
Many studies around the world have been carried out, and have shown disharmony between the measured fluoride content of toothpaste and that claimed on its label, and significant differences between the total and ionized fluoride content of toothpastes. These studies have also shown that some toothpastes’ ionized fluoride content is insufficient for caries prevention.
Therefore, it was necessary to make sure that fluoridated toothpastes available in the Egyptian market for children contain sufficient ionized fluoride for caries prevention, and that the total fluoride content claimed on its package is consistent with that actually present within. It is also important to assess Egyptian pediatric dentists’ knowledge regarding fluoridated toothpaste guidelines, their practice regarding fluoridated toothpaste, and fluoride toxicity.
Regarding the fluoride content of toothpastes in Egypt, this study has shown that total fluoride content is not coincident with that indicated on the label of the examined toothpaste. It has also shown that the ionized fluoride content is significantly lower than the total fluoride content of the examined toothpastes.
As for pediatric dentists’ knowledge, this study shows good knowledge regarding the active ingredient in toothpaste and acute fluoride toxicity symptoms, but only fair knowledge regarding its management.
As for pediatric dentists’ practice, this study shows an apparent confusion between members of the dental community. This is due to the lack of consensus between different guidelines regarding the concentration of fluoride recommended for different age groups, and the amount of toothpaste to be used. Hence, the Dental Public Health team at the Faculty of Dentistry, Ain Shams University, Egypt, has proposed a guideline that targets populations of high caries index. This guideline is adopted from the already available guidelines and aims to provide maximum caries prevention for populations with high caries prevalence.