Evidence-based Use of Fluoride in Contemporary Pediatric Dental Practice

Author(s): Steven M. Adair, DDS
Journal: Pediatric Dentistry
Volume (number): Volume 23, number 2
Month, Year: Conference Paper 2006
Major topic: Fluoride Treatment
Minor topic(s): Use of fluoride in pediatric dental practice
Type of Article: evidence based
Main Purpose: To review clinically evidence for the effectiveness of fluoride options and where possible, combinations of fluoride exposures, and to make recommendations to dental practitioners based on the available evidence for the use of these various approaches in contemporary practice, particularly regarding the use of multiple fluoride sources.
Overview of method of research: Literature Reviews
Findings: Therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Twice-daily use of a fluoridated dentifrice for children in optimally fluoridated and fluoride-deficient communities, coupled with professional application of topical fluoride gel, foam, or varnish is currently recommended. The addition of other fluoride regimens should be based on periodic caries risk assessments, and recognizing that the additive effects of multiple fluoride modalities exhibit diminishing returns. Dentifrices with 1,500ppm F had a greater effect in the young permanent dentition than those with lower F concentrations. Higher caries reduction was found in studies in which tooth-brushing was supervised. Those who began brushing with a fluoridated toothpaste prior to age 2 had significantly more severe fluorosis.
Key points/Summary: Currently supplemental fluoride is prescribed on the basis of age, not body weight. Factors to keep in mind while recommending the use of fluoride supplementation: Assay the child’s primary drinking water supply for fluoride content. Consider delaying supplementation until after the eruption of the permanent first molars (systemic fluoride supplementation prior to this age is not strong and the highest risk for fluorosis from fluoride supplements appears to be 3-6 years old). Ensure that the parents understand the risks and benefits of fluoride supplementation. As a safety factor a maximum of 120mg of fluoride supplements should be prescribed at one time (this is a lethal dose for children under 8kg and a toxic dose for children weighing 24kg or less). No good evidence exists to support fluoride supplements for pregnant women. Recommendations for fluoride containing dentifrices: Tooth-brushing should be supervised by an adult, especially once fluoridated toothpaste use has begun, tooth-brushing with fluoridated toothpaste should be done twice daily and older children who are able to expectorate should use more than a pea-sized dab to increase their salivary fluoride levels. Recommendations for fluoride mouth rinses: Should be used one children who demonstrate the ability to swish and expectorate without swallowing (generally six and older), reserved for children who are moderate or high risk or have fixed orthodontic or prosthetic devices, alcohol free preparations should be recommended over those containing alcohol, and little benefit should be expected from fluoride mouthrinses in low-caries-risk children who are already using a fluoridated dentifrice. Recommendations for use of prescription strength fluoride gels: Recommended for patients in fluoride-deficient communities who are at high risk for caries, parents of young children should supervise placement, and application regimens should be limited to the minimum time period deemed necessary for control of dental caries. Gels are recommended for patients with SECC, rampant caries in the mixed and permanent dentition, with reduced salivary flow, wearing prosthetic or orthodontic appliances, and who may be at high risk for dental caries. Recommendations for the clinical use of fluoride gels and foams include: Use caries risk to determine need and frequency, follow pumice prophylaxis with a topical fluoride application, use properly fitted trays to reduce unwanted ingestion, and allow patient to expectorate freely after application and refrain from eating or drinking for 30 minutes following the application. Recommendations for fluoride varnish use: Current recommendation for placement of fluoride varnish at 6-month intervals, have patient refrain from eating or drinking for 30 minutes after the application and have them postpone brushing until the morning after, it appears that fluoride varnish may be superior to fluoride gels and foams in caries reduction.
Assessment of article: very informative