Table 3 Consensus statements on post-brushing rinsing behaviour

Rinsing with water after brushing with fluoride toothpaste can reduce the benefit of fluoride toothpaste.

There is a theoretical benefit in keeping the intra-oral levels of fluoride elevated by replacing a post-brushing water rinse with a fluoride rinse.

Non-fluoride rinses should preferably be used before brushing or at a different time to brushing with fluoride toothpaste.

Mouth rinses containing fluoride can be used after brushing with fluoride toothpaste.

The panel endorsed the promotion of the positive messages from the research by Sjögren et al.^9,47 concerning use of a slurry of fluoride toothpaste.

All three documented methods of increasing post-brushing fluoride retention – (a) 'spit don't rinse', (b) rinsing with a slurry of fluoride toothpaste and saliva and (c) rinsing with a mouth rinse containing fluoride – could be beneficial for caries control at the individual level.

There is a need to tackle the risk profile for dental caries in populations. To this aim, the panel supported Sir Michael Marmot's strategy of 'proportionate universalism'.⁵² This approach advocates improving the oral health of all by flattening the social gradient of disease, with a focus on seeking the greatest improvement in those with highest need while still achieving improvements in other population groups.

On the basis of balancing risks and benefits, the panel recommended:

For children at high risk of caries:

• Rinsing should be supervised until an age where parents/carers are confident that children will not drink the rinse

• Mouth rinses should not be used before the age of 6 years. (However, studies in Japan have indicated that 4–5-year-olds can rinse under supervision. In addition, children with newly erupting teeth may gain a long-term benefit from using mouth rinses)⁵³

• Use 10 ml twice daily of mouth rinse up to 100 ppm fluoride, or 10 ml once daily of mouth rinse up to 226 ppm fluoride

• Avoid the risk of approaching the lethal dose of fluoride by using an appropriate bottle size.

For the general population, including children aged 12 years and above:

• Brush twice daily with a fluoride toothpaste; do not rinse excessively with water; use one of the three recognised post-brushing approaches to enhance fluoride retention.

The panel also encouraged future research with a range of mouth rinse products to explore the effects of the interplay between the frequency of use of mouth rinse agents and fluoride concentration.