Evidence-Based Use of Fluoride in Contemporary Pediatric Dental Practice

Resident: Swan

Article Title:

Evidence-Based Use of Fluoride in Contemporary Pediatric Dental Practice

Author: Steven M. Adair

Journal: Pediatric Dentistry 2006 28:2 pgs 133-140

Major Topic: Science-based recommendations for dentists regarding fluoride use in contemporary practice.

Article Type: Conference Paper--mainly reviews of meta-analyses and systematic reviews

Findings: The traditional view of fluoride's systemic effect is waning considerably, and there's really no direct evidence of fluoride having a pre-eruptive effect on teeth. The paradigm of fluoride's effect has shifted from systemic to topical effects on enamel, along with the biological effects fluoride has on cariogenic bacteria. With this change in mind, systemic fluoride supplements should be given following these recommendations:

1. Give supplements only to those children who live in fluoride deficient communities and are high risk for caries
2. Delay supplement use until after eruption of first permanent molars-fluorosis risk is highest from age 3-6.
3. Supplements should be chewed and swished in mouth to enhance topical effect.

Guidelines for use of:

Fluoride toothpaste:

1. Advise use in children 2 and older, due to fluorosis risk (although data are scarce to support the actual risk).
2. Brushing needs to be supervised by an adult to be effective. Use pea-sized dabs.
3. Twice daily brushing. 2x daily is more effective than 1, benefit from brushing more than 2x not well established.

Fluoride Mouthrinses:

1. Advise daily use of .05% NaF mouthrinse in moderate to high-risk children, including kids undergoing orthodontic tx and those with reduced salivary flow
2. Swish and spit rinses are as effective as those that are swallowed
3. Use with low risk kids shows little benefit.
4. Alcohol free rinses preferred

Fluoride gels/foams:

1. Consider prescribing self-applied gels for high risk kids in fluoride deficient areas (5,000 ppm)
2. Apply based on caries assessment.
3. Professionally, apply following prophy (12,300). This replaces the surface fluoride layer that is removed.
4. Use properly fitting trays, filled only enough to cover teeth, for max of 4 minutes
5. Pt can spit after application. No eating/drinking for 30 minutes

Professionally applied fluoride varnish:

1. Apply at 6 months intervals, for kids living in fluoridated and non-fluoridated areas.
2. No eating/drinking for 30 min, no brushing until next morning.
3. Apply frequently to open carious lesions in very young children (used with ART)
4. Varnish may be more effective than gels and foams

Summary/Assessment: Good article that gives the current guidelines for use of all fluoride modalities. Ironically, all the studies mentioned in this article showed fluoride’s positive effect in the permanent teeth--there’s virtually no evidence to support fluoride’s use for primary teeth, but we logically assume the same benefits exist.