While the clinical relevance of fluoride toothpastes per se is firmly established, the multifactorial processes involved in causation and prevention of caries render it difficult to define their exact role in an overall caries-preventive strategy. Therefore, an indirect pragmatic approach was chosen: the interpretation of secular trends in caries prevalence and other parameters is used to estimate the relative importance of this method of topical fluoride administration and to compare it with the contributions by other methods of prevention. All methods of caries prevention, with the exception of population-administered measures such as fluoridation of drinking water or domestic salt, can only work when applied regularly and conscientously. For this reason behavioural aspects such as compliance and the chances for widespread (if not universal) application have to be considered. There is indirect evidence that toothbrushing with fluoride toothpastes is a highly probable explanation for the decline of caries prevalence in developed countries since the 70s; moreover, toothbrushing, and the use of therapeutic dentrifices, is considered to meet spreading compliance because a ‘healthy mouth’ becomes more and more socially desirable in growing numbers of subpopulations.

Manifestations and treatment of caries are strongly dependent on caries risk and the severity of the attacking factors which determine the degree of caries activity. Caries activity in turn will be modified and can be minimized by effective preventive measures. Exemplary cases and events will be discussed to illustrate what has happened since the establishment of ORCA 50 years ago.