How can the risk of dental fluorosis be minimized?

From the Guidelines

To minimize the risk of dental fluorosis, parents should supervise children under age 6 during toothbrushing, using only a pea-sized amount of fluoride toothpaste for children ages 3-6 and a rice grain-sized smear for children under 3, as recommended by the Centers for Disease Control and Prevention 1. The risk of dental fluorosis can be minimized by following these guidelines:

• Using a pea-sized amount (approximately 0.25 g) of fluoride toothpaste less than 2 times per day by children aged less than 6 years, as reported to sharply reduce the importance of fluoride toothpaste as a risk factor for enamel fluorosis 1
• Children should spit out toothpaste rather than swallowing it to avoid excessive fluoride intake
• In areas with naturally high fluoride levels in drinking water (above 2 parts per million), families should consider using alternative water sources for drinking and cooking, especially for infants and young children
• Parents should avoid giving fluoride supplements to children who already receive adequately fluoridated water, as the benefits of reduced dental caries and the risk for enamel fluorosis are linked 1
• Fluoride mouth rinses should not be used by children under 6 years old Dental fluorosis occurs when excessive fluoride is consumed during tooth development, particularly between birth and 8 years of age, causing white spots or streaks on teeth, and while mild fluorosis is primarily cosmetic, these preventive measures help balance the benefits of fluoride for cavity prevention while avoiding excessive exposure during critical developmental periods 1.

From the Research

Rates of Dental Fluorosis

• The risk of dental fluorosis can be minimized by maintaining optimal levels of fluoride in drinking water, as recommended by the U.S. Public Health Service (USPHS) 2.
• The USPHS recommends a fluoride level of 0.7 mg/L in drinking water to achieve oral health benefits while minimizing the risk of dental fluorosis 2.
• A study found that more than 80% of population-weighted fluoride measurements from community water systems were above 0.6 mg/L, which is still effective for caries prevention 2.
• The Environmental Protection Agency (EPA) sets a safety standard of 2.0 mg/L to prevent mild or moderate dental fluorosis 2.

Minimizing the Risk of Dental Fluorosis

• The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis 3.
• A daily intake of fluoride above the recommended level of 0.05-0.07 mg F/Kg/day leads to an increased risk of dental fluorosis 4.
• Topical fluoride can be a cause of dental fluorosis in children, and the risk can be minimized by using lower fluoride concentrations in toothpaste 5.
• Evidence suggests that lower fluoride concentration in toothpaste (550 ppm or 440 ppm) reduces the risk of developing fluorosis compared to higher concentrations (1000 ppm or 1450 ppm) 5.

Prevention and Management

• Dental fluorosis can be prevented by having adequate knowledge of fluoride sources and managing exposure to avoid overexposure 4.
• Recommended procedures for diagnosis of fluorosis should discriminate between symmetrical and asymmetrical and/or discrete patterns of opaque defects 4.
• The risk period for esthetic changes in permanent teeth is between 20 and 30 months of age, and excessive fluoride consumption during this period can lead to dental fluorosis 4.