Fluoride Teeth Cleaning Recommendations for Infants in European Countries, Japan, and Korea
Major dental and pediatric organizations in North America recommend daily fluoride toothpaste use for infants starting with the eruption of the first tooth, but there is no specific evidence that European countries, Japan, or Korea have the same recommendations.
North American Recommendations
- All major Canadian and American dental and pediatric societies endorse the use of fluoridated toothpaste twice daily for all children, including infants 1.
- These organizations specifically recommend that children younger than 3 years have their teeth brushed by an adult with a grain of rice-sized portion of fluoridated toothpaste 1.
- The American Academy of Pediatric Dentistry (AAPD) recommends that children have their first dental visit by their first birthday, and 81% of U.S. dental schools teach dental students to recommend fluoridated toothpaste starting with the eruption of the first tooth or by the child's first birthday 2.
Fluoride Benefits and Risks
- Fluoride is primarily effective through its topical action when present in the saliva at appropriate concentrations, playing a crucial role in the process of remineralization and demineralization of tooth enamel 3.
- The European Academy of Paediatric Dentistry (EAPD) recommends preventive topical use of fluoride supplements because of their cariostatic effect, though this is not specifically mentioned for infants 3.
- While fluoride can be toxic in extremely high concentrations, its topical use is considered safe 3.
Considerations for Fluoride Use in Infants
- When prescribing any pharmaceutical agent, including fluoride, dentists and physicians should attempt to maximize benefit and minimize harm 1.
- For infants and children aged <6 years, both a benefit of dental caries prevention and a risk for enamel fluorosis are possible 1.
- Recent evidence suggests that fluoride ingestion is not essential for caries prevention, offers little benefit to the fetus and young infant, and can potentially cause dental fluorosis and cognitive deficits 4.
Recommendations for Oral Hygiene in Infants
- If an infant breastfeeds to sleep, the gums and erupting teeth should be wiped to minimize the risk of caries 1.
- The American Academy of Pediatric Dentistry suggests that parents gently clean infants' gums and teeth after breastfeeding 5.
- Early childhood caries (ECC) prevention is optimal if initiated prenatally, with strategies including oral hygiene education and the use of fluoride toothpaste for pregnant women 1.
Fluoride Supplements
- Dietary fluoride supplements in the form of tablets, lozenges, or liquids have been used worldwide since the 1940s, with supplements available as a liquid used with a dropper for infants 1.
- Fluoride supplements are intended to compensate for fluoride-deficient drinking water, and the dosage schedule requires knowledge of the fluoride content of the child's primary drinking water 1.
- The evidence for using fluoride supplements to mitigate dental caries is mixed, with several studies reporting benefits while others do not 1.
Caveats and Pitfalls
- Fluoride supplements should be prescribed only when the fluoride concentration of the drinking water supply has been tested and determined to be suboptimal 1.
- There is a clear association between fluoride supplement use by children aged <6 years and enamel fluorosis 1.
- In response to data on fluoride intake and enamel fluorosis prevalence, the supplement dosage schedule for children aged <6 years was markedly reduced in 1994 1.
- In environments where fluoride is available from multiple sources, community-based administration of systemic fluoride may pose an unfavorable risk-benefit ratio for pregnant women and young children 4.
While North American guidelines clearly recommend fluoride toothpaste use for infants, the available evidence does not specifically address recommendations from European countries, Japan, or Korea regarding daily fluoride teeth cleaning for infants.