Only poor quality evidence available for the use of fluoride and calcium to prevent dental erosion


Dental erosion can been defined as the irreversible loss of tooth tissue by chemical processes not involving bacteria. The incidence of dental erosion is considered to be on the increase.  The aim of this review was to assess the effectiveness of calcium and fluoride in the prevention of dental erosion.

The PubMed, Cochrane Database of Systematic Reviews, Embase, FDA publications were searched electronically. The available evidence was assessed using GRADE .

  • 10 randomised controlled (in situ) trials were included, 6 investigated calcium and 4 fluoride.
  • These were all presented as mean enamel loss and measured by profilometer.
  • There was significant heterogeneity between the studies.
  • Meta-analysis did not identify any statistically significant benefit for either Calcium of Fluoride studies.
  • The GRADE assessment of the studies was – very poor.

The authors concluded

The number of studies on prevention of dental erosion maintaining standards of evidence-based dentistry remains insufficient to reach any definite conclusions.


This is an interesting review on a topic in which there is a growing level of concern, with the vast increase in sales of carbonated beverages is considered to be one of the potential reasons for the increase in incidence of dental erosion. However, while this review is of interest it is clear that the available evidence is quite limited. All the trials include were small with a maximum of 16 participants. They were also of short duration with a maximum of 21 days and used an in situ model. While the use of in situ model does allow measurement of enamel loss. It is easy to argue that this may not be representative of the typical clinical situation and to support the authors  remarks  that:-

..there is a need to perform randomized blind clinical trials. These studies should also include preventive substances other than calcium and fluoride and should encompass larger and more compatible study samples.


Zini A, Krivoroutski Y, Vered Y. Primary prevention of dental erosion by calcium and fluoride: a systematic review. Int J Dent Hyg. 2013 Jul 29. doi: 10.1111/idh.12049. [Epub ahead of print] PubMed PMID: 23889732.


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