Is fluoride toxicity a concern in pediatric populations?

From the Guidelines

Fluoride toxicity is a concern in pediatric populations, but the benefits of appropriate fluoride use in preventing painful cavities and avoiding costly dental treatments significantly outweigh the minimal risks. The most recent and highest quality study, published in 2021, supports the use of fluorides as safe and effective for caries prevention in children 1. According to this study, all major Canadian and American dental and pediatric societies endorse the use of fluorides, and recommend that children younger than 3 years have their teeth brushed by an adult with a grain of rice–sized portion of fluoridated toothpaste, and that children 3 to 6 years of age be assisted with brushing with a green pea–sized portion of fluoridated toothpaste.

Key Recommendations

• Children under 3 years should use a rice-grain sized amount of fluoridated toothpaste
• Children 3-6 years should use a pea-sized amount of fluoridated toothpaste
• Parents should supervise young children while brushing to prevent swallowing toothpaste
• Fluoride products should be stored out of children's reach
• Parents should consult with their dentist about appropriate fluoride use based on their child's specific risk factors for cavities and their community water fluoride levels

Benefits of Fluoride Use

• Prevents tooth decay by strengthening tooth enamel
• Can reverse early signs of decay
• Provides additional protection when used in combination with fluoridated water
• Reduces the risk of dental caries, which can lead to painful cavities and costly dental treatments

Risks of Excessive Fluoride Intake

• Dental fluorosis, which appears as white spots or streaks on teeth
• Primarily a cosmetic concern that occurs during tooth development
• Can be minimized by following the recommended amount of fluoridated toothpaste and supervising young children while brushing

Overall, the benefits of appropriate fluoride use in pediatric populations outweigh the minimal risks, and parents should follow the recommended guidelines to ensure safe and effective use of fluorides in preventing dental caries.

From the Research

Fluoride Toxicity in Pediatric Populations

• Fluoride is considered an essential carioprophylactic agent, but its use raises concerns about possible negative effects of excessive intake 2
• Precautions are necessary when prescribing fluoride to children, including evaluation of all sources of fluoride, cariogenic risk, and the family's ability to follow medical advice 2
• Excessive fluoride consumption can lead to dental fluorosis in children, and limiting fluoride ingestion from various sources is recommended 3, 4

Sources of Fluoride Intake

• Fluoride intake among children can come from various sources, including water, beverages, foods, and therapeutic fluoride products 4
• Estimates of fluoride intake among young children vary widely, and controlling ingestion of fluoride from dentifrice and limiting dietary fluoride supplements are recommended 4

Topical Fluoride and Dental Fluorosis

• The use of topical fluorides in young children may be associated with an increased risk of developing dental fluorosis in permanent teeth 5
• Lower fluoride concentration in toothpaste and limiting the amount of toothpaste used may reduce the risk of developing fluorosis 5
• The evidence on the risk of fluorosis associated with topical fluoride varnish application, toothbrushing frequency, and amount of toothpaste used is low- to very low-certainty and inconclusive 5

Fluoride Toxicity and Human Health

• Fluoride can have beneficial effects on dental health in small amounts, but excessive chronic intakes can result in adverse effects, including dental fluorosis in children and skeletal fluorosis in both children and adults 6
• The adequate intake of fluoride has been set at 0.05 mg/day/kg body weight, but the threshold between beneficial and harmful effects is narrow 6
• Despite numerous studies, knowledge on fluoride toxicity is still relatively poor, and future research directions are needed to better understand the effects of fluoride on human health 6