Context
- Dental caries is the most common chronic disease in children in the United States.1 According to the 1999–2004 National Health and Nutrition Examination Survey, approximately 42% of children two to 11 years of age have dental caries in their primary teeth.
- The U.S. Preventive Services Task Force (USPSTF) found adequate evidence that oral fluoride supplementation, also known as dietary fluoride supplementation, in children who have low levels of fluoride in their water and application of fluoride varnish to the primary teeth of all children can provide moderate benefit in preventing dental caries.
- The USPSTF found adequate evidence of a link between early childhood exposure to systemic fluoride and enamel fluorosis, a visible change in the appearance of the enamel due to altered mineralization.
- The USPSTF concludes that there is limited evidence about the harms associated with fluoride varnish or other preventive interventions for dental caries, but that these risks are likely small.
Summary of Recommendations
- Prescribe oral fluoride supplementation starting at six months of age for children whose water supply is deficient in fluoride.
- There is a moderate net benefit of providing oral fluoride supplementation at recommended doses in children older than six months of age who reside in communities with inadequate water fluoride.
- Apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.
- There is a moderate net benefit of providing fluoride varnish application to all children starting at the age of eruption of primary teeth to five years of age.
Clinical Considerations
- This recommendation applies to children five years and younger.
- All children are at potential risk of dental caries; those whose primary water supply is deficient in fluoride (defined as containing less than 0.6 parts per million) are at particular risk.
- Although there are no validated multivariate screening tools to determine which children are at higher risk of dental caries, there are a number of individual factors that elevate risk:
- Higher prevalence and severity of dental caries are found among minority and economically disadvantaged children.
- Other risk factors for caries in children include frequent sugar exposure, inappropriate bottle feeding, developmental defects of the tooth enamel, dry mouth, and a history of previous caries.
- Maternal and family factors can also increase children’s risk, including poor oral hygiene, low socioeconomic status, recent maternal caries, sibling caries, and frequent snacking.
- Additional factors associated with dental caries in young children include lack of access to dental care; inadequate preventive measures, such as failure to use fluoride-containing toothpaste; and lack of parental knowledge about oral health.8, 9
References