Dietary fluoride is available in fluoridated water. In areas where the water does not contain optimal levels of fluoride, after careful consideration of the other dietary sources of fluoride and the child’s age (i.e., stage of dental development), fluoride supplements may be prescribed.
Fluoridation of community water supplies began in 1945. Water fluoridation has been proven to be the most cost effective way to reduce caries rates. Epidemiologic data within the last half-century indicate reductions in caries of 55 to 60% and recent data still shows caries reduction of approximately 25%. Over half of the United States population drinks fluoridated water.
Optimal exposure to fluoride is important to all dentate infants and children. Caution is indicated in the use of all fluoride-containing products. Decisions concerning the administration of additional fluoride are based on the unique needs of each patient.
Local or state departments of health or a local water authority can determine the fluoride concentration of community supplied water. Private water sources, such as wells, should be analyzed for fluoride content. The optimum fluoride concentration in drinking water is approximately 0.7 to 1.2 milligrams of fluoride per liter of water.
The table shows the current fluoride supplement recommendations. Although infants can be given fluoridated water from birth, fluoride supplements are no longer recommended for any infant less than age 6 months.
Table 1. ADA Recommended Supplemental Fluoride Dosage Schedule.
|Clinical Recommendations for the Use of Dietary Fluoride Supplements|
The expert panel convened by the American Dental Association Council on Scientific Affairs developed the following recommendations. They are intended as a resource for dentists and other health care providers. The recommendations must be balanced with the practitioner’s professional judgment and the individual patient’s needs and preferences.
Children are exposed to multiple sources of fluoride. The expert panel encourages health care providers to evaluate all potential fluoride sources and to conduct a caries risk assessment before prescribing fluoride supplements.
|Recommendation||Strength of Recommendations|
|For children at low risk of developing caries, dietary fluoride supplements are not recommended and other sources of fluoride should be considered as a caries-preventive intervention.||D|
|For children at high risk of developing caries, dietary fluoride supplements are recommended according to the schedule presented in the table below.||D|
|When fluoride supplements are prescribed, they should be taken daily to maximize the caries-preventive benefit.||D|
|RECOMMENDED AMERICAN DENTAL ASSOCIATION DIETARY FLUORIDE SUPPLEMENT DOSING SCHEDULE FOR CHILDREN AT HIGH RISK OF DEVELOPING CARIES|
|Age (years)||Amount of Fluoride Supplementation and Strength of Recommendations, According to Fluoride Concentration in Drinking Water (Parts per Million*)|
|< 0.3||0.3-0.6||> 0.6|
|Birth to 6 months||None||D||None||D||None||D|
|6 months to 3 years||0.25 mg/day||B||None||D||None||D|
|3 to 6 years||0.50 mg/day||B||0.25 mg/day||B||None||D|
|6 to 16 years||1.00 mg/day||B||0.50 mg/day||B||None||D|
|* 1.0 part per million - 1 milligram per liter|
|Source: ADA/JADA, TABLE 3 Clinical recommendations for the use of dietary fluoride supplements.|
When fluoride is ingested in quantities exceeding the recommended systemic dose, a condition known as fluorosis (primarily a cosmetic concern) may result. Fluorosis represents an alteration in the formation of tooth enamel caused by excessive systemic fluoride.
The characteristic clinical appearance can range from mild white discoloration of the enamel to severe brown and white malformation of the enamel. Careful monitoring of all sources of systemic fluoride can prevent fluorosis.
Fluoride supplements are available as drops, chewables, tablets, and combined with vitamins. All forms come in 0.25 mg, 0.5 mg, and 1.0 mg doses.