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Current Theories Regarding Fluoride Use

Daily use of fluoride-containing dentifrices has significantly reduced the dental caries level in the United States. Other sources of fluoride include: added fluoride to city water sources; naturally occurring water fluoride in well water; over-the-counter mouthrinses; processed food and beverages at manufacturing plants that utilize fluoridated city water; rinses, gels, pastes, and tablets; professional fluoride varnish applications; and both in-office and at-home topical fluorides. This consistent application of fluoride to enamel and exposed cementum has reduced dental caries and has significantly changed how dentistry is practiced today.

By current convention, dental providers administer professional topical fluoride treatments to patients at their preventive maintenance appointments. However, is this routine procedure necessary for every patient? Although concentrated topical fluoride treatments usually are intended for annual or semiannual prophylaxis visits, a decline in caries prevalence in some patient populations brings into question the continuing need for such treatment in individuals who are diagnosed as a low-risk caries patient. Patients who are diagnosed as a low caries risk would be caries-free after a current examination, no new caries in the last three years, use a fluoridated toothpaste, and ingest fluoridated water. The decision to use a professionally applied topical fluoride should be based on a recent clinical examination, as well as scientific evidence.

Since current practice is to deliver a professional topical fluoride application to every young patient, the dental profession is faced with an ethical quandary when dealing with this issue. With exposure to so many outside sources, the patient may be receiving adequate amounts of fluoride to maintain a caries-free condition without routinely scheduled professional fluoride applications. These frequent exposures to low concentrations of fluoride as received from toothpastes, are effective in the prevention of caries. The ADA utilizes evidence-based research when making clinical recommendations and states that “patients whose caries risk is lower may not receive additional benefit from professional topical fluoride.” Recommendations to use topical fluoride applications should be determined by whether or not the patient is exposed to multiple sources of fluoride or has other caries risk factors.