From the Guidelines
Fluoride supplementation should be prescribed for children at high risk for dental caries and whose primary drinking water has a low fluoride concentration, with consideration of the child's other sources of fluoride and the potential for enamel fluorosis, as recommended by the Centers for Disease Control and Prevention 1. The prescription dosage of fluoride supplements should be consistent with the schedule established by ADA, AAPD, and AAP. When determining the need for fluoride supplementation, healthcare providers should weigh the risk for caries without fluoride supplements, the caries prevention offered by supplements, and the potential for enamel fluorosis, especially for children aged <6 years 1. Key factors to consider when prescribing fluoride supplements include:
- The child's age and risk for dental caries
- The fluoride concentration in the primary drinking water
- The child's other sources of fluoride, such as toothpaste and mouthwash
- The potential for enamel fluorosis, which can be caused by excessive fluoride intake Supplements can be prescribed for persons as appropriate or used in school-based programs, and when practical, supplements should be prescribed as chewable tablets or lozenges to maximize the topical effects of fluoride 1. It is essential for parents and caregivers to be informed of both the benefit of protection against dental caries and the possibility of enamel fluorosis, to ensure proper use and minimize potential risks.
From the Research
Fluoride Supplementation Recommendation
- The use of fluoride supplements has been associated with a reduced risk of dental caries, but the benefits may be small in populations with low-fluoride areas 2.
- The American Dental Association recommends that dietary fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is deficient in fluoride 3.
- Fluoride intake from diet, supplements, and dentifrice ingestion should be estimated at an individual level when recommendations for fluoride use are being considered, especially for infants living in fluoridated areas 4.
- Excessive fluoride intake may lead to dental fluorosis, and the risk of fluorosis should be considered when prescribing fluoride toothpaste for infants in areas with high fluoride content 5.
- The optimal dosage schedule for fluoride supplements should be aimed at identifiable high caries-risk individuals, with a maximum fluoride ion content of 0.50 mg per tablet to reduce the chances of fluorosis and overconsumption 2.
Key Considerations
- Fluoride supplements should be used judiciously, taking into account the individual's risk of caries, fluoride intake from other sources, and the potential risks of excessive fluoride exposure 3, 6.
- The fluoride content in drinking water, mineral waters, and vegetables should be considered when estimating an individual's total daily fluoride intake 5, 4.
- Providers should carefully monitor the patient's adherence to the fluoride dosing schedule to maximize the potential therapeutic benefit 3.