The case for eliminating the use of dietary fluoride supplements for young children

Author(s): Brian A. Burt BDS, MPH, PhD
Journal: Dental Public Health
Volume (number): 59:4
Month, Year: Fall 1999
Major topic: Fluoride Supplementation
Minor topic(s): Fluorosis
Type of Article: Systematic literature review
Main Purpose: To weigh risks vs. benefits of systemic fluoride supplementation
Overview of method of research: The author reviewed the current literature on the efficacy of systemic fluoride supplementation, and the literature on dental fluorosis. Studies were analyzed for both results, and strength of study (e.g. was the study designed well? Can results be considered valid and representative of all populations? Were there some factors not analyzed?)
Findings: Many of the studies that tout the efficacy of systemic fluoride supplementation either had design flaws (non-randomized, non-blinded), or attributed caries rate reduction to systemic effects when most effects may have been localized, topical effects of fluoride in the oral cavity. “Where fluoride supplements are concerned, only a handful of trials meet these (quality criteria) standards. The evidence from these trials is favorable, and is all from studies conducted with school-aged children in whom the supplement was essentially used topically by chewing or permitting slow dissolution in the mouth. It is concluded from these studies that while some preeruptive benefits are possible, the evidence for the efficacy of fluoride supplements when ingested from birth or early infancy is hardly strong enough to offset the disadvantages of such usage.” This study also analyzes the risk of fluorosis and notes that many of the studies that analyze fluorosis categorize it as mild, moderate, or severe. The author argues that in this day and age of increased focus on esthetics, is mild fluorosis an acceptable outcome? The author recommends that the range of 0.05 to 0.07 mg F/kg body weight be used as a maximum for daily fluoride intake to avoid the risk of fluorisis. He also notes that many of the prior fluoride regimens suggested do not take into account the many other avenues by which children are ingesting fluoride e.g. water, juices, toothpaste etc…
Key points/Summary: The topical effect of fluoride seems to be the most beneficial. We should be judicious in prescribing supplementation, and take into account both risks and benefits.
Assessment of article: umm….. Yep.