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Restorative Dentistry

Advice on fluoride supplements for children in non-fluoridated areas

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The following question was submitted by a practicing dentist: As I now practice in a newly “non-fluoridated” area I am looking at my recommendations for supplemental fluoride for my pediatric population. Are there any universally adopted guidelines available?

JCDA Editorial Consultants Drs Felicity Hardwick of Nanaimo and Sarah Hulland of Calgary provided this initial response for consideration:

Since the question relates to a newly non-fluoridated area we would firstly recommend that the dentist check that water fluoride status is indeed below the recommended optimal level of 0.7 ppm.

Before prescribing fluoride supplements, a thorough clinical examination, dental caries risk assessment and informed consent from patients/caregivers are required.

The dentist should also review the use of fluoridated dentifrice and all home and child care water sources. Approximately 30% of the Canadian population does not drink tap water, so even in a fluoridated zone this does not translate into sufficient fluoride exposure.

The CDA position paper on fluoride use is an excellent resource for the practitioner, detailing the use of fluoride supplements., water fluoridation as well as other sources of fluoride. There is also an excellent resource on fluoride supplementation that has been created by the Province of Alberta.

The dentist should revisit, at least annually, with the parents/caregivers, the child’s consumption of fluoride from all sources. Parents/caregivers may also ask for advice about non-fluoride caries preventive agents. The American Dental Association produced a report about the evidence underpinning the efficacy of such agents in 2011.

Follow-up: Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Leave a reply“ below. Comments come directly to me for approval prior to posting. You are welcome to remain anonymous. We will never post your email address in any response. John

1 Comment

  1. Phu-My Gep November 4, 2012

    Fluoride supplementation continues to be underprescribed perhaps of the understanding and fear of causing “flourosis”. I am a pediatric dentist and my patients come from fluoridated and non-fluoridated communities. I have to admit that I am not certain which of the communities are not fluoridated but based on the “repeat offenders” living in particular communities despite what the local dentists claim, I am pretty convinced that there are certain communities do not have fluoridated water. Unfortunately I do not have the inclination to follow through and confirm it with the Public Health departments.

    My recommendations though may not be absolutely evidence-based, they are based on clinical experience and amalgamation of guidelines from various associations.

    First and foremost, caries risk assessment. Review oral hygiene practices, diet and sibling and parental caries activity history. Reinforce more frequent recalls (do not be a slave to the insurance recall frequency particularly in patients who are caries active).

    Review with the parents if the child DRINKS water (not just whether they live in a fluoridated community). Confirm what type of water do they use (bottled, filtered, reverse osmosis, etc.). Confirm what type of beverages they drink (premade juices, etc.).

    If the parents confirm that the child does drink water often and they live in a fluoridated community, I advise them that the simplest thing is to have the child drink tap water and re-evaluate the caries activity at subsequent recalls.

    If the parents report that the child does not drink water often or they live in a non-fluoridated community or they have well water supply, fluoride supplementation is necessary.

    I prescribe low dose fluoride (0.25mg daily) initially no matter what the child’s age (generally 3 years of age and older) especially since fluoride can come from multiple sources. I advise the family that the child must be on the supplements for at least 2 years. At hygiene recalls, if the child continues to be caries susceptible, I then decide to increase the dosage to 0.5 mg daily. Parents and children are familiar with taking vitamins and I explain to them that fluoride supplements are vitamins for the teeth.

    There have been some suggestions for families to make their own fluoridated water but that is harder to implement and monitor. It may be a practical suggestion for patients who have low caries risk but for those individuals who you are contemplating fluoride supplementation, the daily tablets is more practical and easier to monitor.

    I choose the low dosage approach since you can never be certain if the child is not receiving fluoride from other sources and also it will lessen the chance of the dreaded fluorotic mottling in permanent teeth.

    But then you may also come across the family whereby the parents refuse radiographs and are against any form of fluoride yet cannot understand why their child still gets “cavities.” That should be another blog entirely….

    Reply

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