The primary aim of this work is to present the available evidence that toothpastes containing >1,500 ppm fluoride (2,500-2,800 and 5,000 ppm F) provide an additional caries preventive effect on root caries lesions in elderly patients compared to traditional dentifrices (1,000-1,450 ppm F). The secondary aim of this paper is to discuss why high fluoride dentifrices in general should perform better than traditional F-containing toothpaste. When examining the few studies that have considered the preventive benefits of high fluoride products on root caries the relative risk appears to be around 0.5, and the risk can thus be halved by exchanging traditional F-containing toothpaste for toothpaste containing 5,000 ppm F. There is reasonable evidence that high fluoride dentifrices significantly increase the fluoride concentration in saliva during the day and the fluoride concentration in plaque compared to traditional F toothpaste. Furthermore, the use of toothpaste with 5,000 ppm F significantly reduces the amount of plaque accumulated, decreases the number of mutans streptococci and lactobacilli and possibly promotes calcium fluoride deposits to a higher degree than after the use of traditional F-containing toothpaste.