A clinical report published in Pediatrics described several available fluoride modalities useful in the prevention of dental caries, as well as suggestions on minimizing the likelihood of enamel fluorosis in each approach.
According to Melinda B. Clark, MD, FAAP, of Albany Medical Children’s Hospital, dental caries are one of the most common chronic diseases found in US children; 59% of adolescents aged 12 to 19 years have at least one documented cavity. Despite public and professional debate, widespread decline in caries throughout many developed countries has been largely attributed to the preventive use of fluoride.
The only proven risk of fluoride use is fluorosis development in children aged 7 years and younger, according to researchers. Fluorosis development is influenced by both the frequency and dose of fluoride exposure during tooth development, and has been increasing in frequency over the past 2 decades as a result of increased availability and use of fluoride.
Due to the low rate of dental visitation for infants and 1-year-olds (1.5%), pediatricians should perform oral health risk assessments on all children at as early as 6 months of age. Practitioners know how to assess a child’s exposure to fluoride, understand indications for professionally applied fluoride treatments such as varnish and openly advocate for public water fluoridation in the local community.
“Because many children do not receive dental care at young ages, and risk factors for dental caries are influenced by parenting practices, pediatricians have a unique opportunity to participate in the primary prevention of dental caries,” the researchers wrote.
The report detailed three main forms of fluoride application: tap water (as well as foods and beverages processed with fluoridated water), home administered, and professionally applied.
Community water fluoridation was identified as a safe and cost-effective way to prevent tooth decay, shown to reduce tooth decay by up to 29%. The researchers recommended that 0.7 mg of fluoride be present per liter of water, and encouraged parents to add or filter fluoride to reach this concentration. Use of fluoridated water to reconstitute powdered infant formula was also approved, but bottled water could be used if there is concern about the risk of mild fluorosis.
The use of toothpaste containing fluoride was advocated for all ages upon the eruption of the first tooth. A “pea-sized” amount of toothpaste, approximately one-quarter of an inch, should be used for children aged 3 years and older. A smaller amount should be used for children younger than 3 years. It was not recommended that young children be given water to rinse due to their instinct to swallow. Further, high-concentration toothpaste should only be used by children aged 6 years and older who have a high risk for caries and are able to expectorate after brushing.
There was similar concern about the use of over-the-counter fluoride rinse, as children younger than 6 years could swallow higher than recommended levels of fluoride. Its low concentration of fluoride, however, was seen to give little benefit beyond daily use of fluoridated toothpaste.
Dietary fluoride supplements were encouraged for children whose source of drinking, cooking or brushing water is non-fluorinated. Conversely, supplement use in addition to treated water may put a child at high risk for fluorosis, according to researchers, and should not be considered.
Fluoride varnish is highly recommended due to its prolonged effect, tolerable application for young children and the variety of dental and non-dental professionals able to provide the treatment. Use of fluoride varnish should begin upon the first tooth’s eruption and be repeated at least once every 6 months.
Numerous studies demonstrate the cost-benefits of widespread fluoride use, according to members of the AAP Section on Oral Health who drafted the report. Every dollar spent toward community fluoride treatment was estimated to save $38 in dental treatment costs. A significant amount of the recorded 51 million missed hours of school per year due to dental-related illnesses was translated into missed work hours for parents or caregivers.
“Studies show that simple home and primary care setting prevention measures would save health care dollars… It is imperative that pediatricians be knowledgeable about the process of dental caries, prevention of the disease and available interventions, including fluoride,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.