A Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose fluoride toothpaste in preventing and treating dental Caries in high-risk older adults (Reflect trial)

Recent research has found that many more people are keeping their own teeth for longer. Although this is a good thing it also means that when people begin to suffer with decay, the treatments required are more complex and expensive and may be very costly. There is a need to help people keep their own teeth free from decay as long as possible.

Since the 1970’s fluoride toothpaste has been widely used to prevent tooth decay. Standard fluoride toothpaste, available to buy on the high street, contains around 1400 parts per million (ppm) of fluoride. High dose fluoride toothpaste, containing 5000ppm fluoride, is available by prescription from the dentist and is increasingly provided to patients judged to be at risk of decay.

In 2016 prescriptions of high dose fluoride toothpaste cost the NHS over £20 million and these costs are increasing rapidly. However, there is a lack of evidence to demonstrate that this toothpaste benefits patients and is cost-effective for the NHS.

The Reflect study is a multicentre randomised controlled trial funded by the NIHR HTA Programme. The trial will compare prescription of 5000 ppm fluoride toothpaste, used as advised by the participant’s dentist, plus usual care, with usual care only (any advice given by the dentist will be to use standard, off-the-shelf, fluoride toothpaste). The study will run for 3 years and aims to recruit approximately 1200 people aged 50 years and over, who have a high risk of caries, from NHS dental practices in Northern Ireland, Scotland and England. 

The primary clinical outcome is the number and proportion of individuals requiring restoration or extraction or endodontic treatment due to caries evaluated at 36 months.

Professor Jan Clarkson, based at the Dundee Dental School, is leading the study upon the retirement in 2020 of the previous lead Professor Martin Tickle at the University of Manchester. 

For more information please see the REFLECT Study Website



Ongoing - Data Collection/Follow Up


Tickle,  et al. Protocol for a Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose Fluoride toothpaste in preventing and treating dEntal Caries in high-risk older adulTs (reflect trial). BMC Oral Health (2019) 19:88