Smiles For Tomorrow
Fluoride

Course Author(s): American Academy of Pediatric Dentistry, Chicago, IL

Fluoride

Fluoridation of community water supplies began in 1945 and has been proven to be the most cost effective way to reduce caries rates. Fluoridated water provides a brief topical effect followed by systemic effects of increased fluoride in saliva and plasma surrounding developing teeth. Epidemiologic data within the last half-century indicate initial reductions in caries rates of 55 to 60% and recent data still shows caries reduction of approximately 25%. About three-quarters of the United States population currently has access to fluoridated tap water. Importantly, most brands of bottled water do not contain optimal fluoride levels.

In areas where the water does not contain optimal levels of fluoride, and after careful consideration of the other dietary sources of fluoride and the child's age (i.e., stage of dental development), fluoride supplements may be prescribed for children at high risk of caries. Decisions concerning the administration of additional fluoride should be based on the unique needs of each patient.

The table shows the current fluoride supplement recommendations. Although infants can be given fluoridated water from birth, systemic fluoride supplements are not recommended for any infant younger than 6 months of age.

Table 1. AAPD Recommended Supplemental Fluoride Dosage Schedule.
Clinical Recommendations for the Use of Dietary Fluoride Supplements

The expert panel convened by the American Dental Association Council on Scientific Affairs developed the following recommendations. They are intended as a resource for dentists and other health care providers. The recommendations must be balanced with the practitioner's professional judgment and the individual patient's needs and preferences.

Children are exposed to multiple sources of fluoride. The expert panel encourages health care providers to evaluate all potential fluoride sources and to conduct a caries risk assessment before prescribing fluoride supplements.

Recommendation Strength of Recommendations
For children at low risk of developing caries, dietary fluoride supplements are not recommended and other sources of fluoride should be considered as a caries-preventive intervention. D
For children at high risk of developing caries, dietary fluoride supplements are recommended according to the schedule presented in the table below. D
When fluoride supplements are prescribed, they should be taken daily to maximize the caries-preventive benefit. D
RECOMMENDED AMERICAN DENTAL ASSOCIATION DIETARY FLUORIDE SUPPLEMENT DOSING SCHEDULE FOR CHILDREN AT HIGH RISK OF DEVELOPING CARIES
Age (years) Amount of Fluoride Supplementation and Strength of Recommendations, According to Fluoride Concentration in Drinking Water (Parts per Million*)
< 0.3 0.3 - 0.6 > 0.6
Fluoride
supplement-
ation
Strength of
recommend-
ations
Fluoride
supplement-
ation
Strength of
recommend-
ations
Fluoride
supplement-
ation
Strength of
recommend-
ations
Birth to 6 mo. None D None D None D
6 mo. to 3 yrs. 0.25 mg/day B None D None D
3 to 6 yrs. 0.50 mg/day B 0.25 mg/day B None D
6 to 16 yrs. 1.00 mg/day B 0.50 mg/day B None D
* 1.0 part per million - 1 milligram per liter
Source: ADA/JADA, TABLE 3 Clinical recommendations for the use of dietary fluoride supplements.

When fluoride is ingested in quantities exceeding the recommended systemic dose, a condition known as fluorosis (primarily a cosmetic concern) may result. Fluorosis represents an alteration in the formation of tooth enamel caused by excessive systemic fluoride.

The characteristic clinical appearance can range from mild white discoloration of the enamel to severe brown and white malformation of the enamel. Careful monitoring of all sources of systemic fluoride can prevent fluorosis.

Fluoride supplements are available as drops, chewables, tablets, and combined with vitamins. All forms come in 0.25 mg, 0.5 mg, and 1.0 mg doses.

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Fluorosis