Fluoride

Dental Health Fact Sheet Dietary Fluoride Supplements

Fact: The administration of dietary fluoride supplements has been shown to be an effective procedure for preventing dental cavities.

Preventive benefits approach those derived from consuming optimally fluoridated drinking water over similar time periods. However, fluoride supplementation is not a substitute for community water fluoridation because the latter is far more economical and feasible for benefiting large numbers of children. Some communities fail to add fluoride to fluoride deficient systems, and many children live in rural areas off public water systems. These children in these communities and on private wells deficient in fluoride should receive dietary-fluoride supplements.

Fact: It is essential that the fluoride content of the patient's drinking water be determined prior to prescribing fluoride supplements.

Supplemental Fluoride Dosage Schedule
Age in Yrs	Concentration of Fluoride in Drinking Water (ppm)
Age in Yrs	< 0.3	0.3 to 0.6	> 0.6
6 months to 3 yrs	0.25*	0.00	0.00
3 to 6	0.50	0.25	0.00
6 to 16	1.00	0.50	0.00

mg F per day (2.2 mg tablet of sodium fluoride contains 1 mg of fluoride)
Fluoride supplements are commercially available in the form of drops or tablets. A sample prescription may read:
Sodium fluoride tablets 2.2 mg
Sig. One tablet each day to be chewed and swished before swallowing
Caution: Store out of reach of children
Supplements provide a topical as well as systemic effect. The tablets should be thoroughly chewed and swished between the teeth before swallowing. The child should not eat or drink for 30 minutes after supplement ingestion
Fluoride levels in human breast milk are less than 0.05 ppm regardless of drinking water and maternal plasma levels. The practitioner may wish to consider suggesting fluoride supplementation in solely breast fed infants in optimally fluoridated areas.

The widespread use of fluorides in various forms (water, milk, salt, dentifrices, gels, rinses, tablets, drops, etc.) is in large part responsible for the significant declines in tooth decay. It is important for children to receive appropriate levels of dietary and topical fluorides for the prevention of dental decay. However, excessive levels of dietary fluoride result in an increased risk of dental fluorosis which can be an aesthetic problem.

What is Dental Fluorosis
Dental fluorosis is a hypoplasia or hypomineralization of the dental enamel caused by the consumption of excessive amounts of fluoride during the years of tooth calcification. Long-term intake of fluoride during enamel formation results in a continuum of clinical changes of the enamel varying from fine white lines in the enamel to severely chalky, opaque enamel which breaks apart soon after tooth eruption. The severity of changes depends on the amount of fluoride ingested during the long-lasting period of tooth formation.

Prevention of Dental Fluorosis
Prudent public health practice dictates using no more fluoride than the amount necessary to achieve the desired effect of tooth decay prevention. The public should avoid excessive and inappropriate fluoride exposure. Recommendations for prevention include:

Health professionals and the public should be informed about the fluoride concentration of their communities' drinking water.
A patients' home source of drinking water should be determined. If bottled water or well water is consumed, the fluoride levels need to be documented. If the fluoride level in the water is greater than 2.0 mg/1, alternative sources of water should be recommended for children younger than age 8.
If the fluoride level in the home water supply is known to be deficient (less than 0.7 mg/l), then fluoride dietary supplements should be prescribed for children through adolescence, in accordance with the dosage schedule of the American Dental Association and the American Academy of Pediatrics. The dosage varies according to the age of the child and the concentration of fluoride in the drinking water.
Commercially prepared infant formulas are made with water that contains negligible amounts of fluoride. If infant formulas are mixed with fluoridated water from the home supply, then no fluoride supplementation is needed; whereas, if infant formulas are mixed with water that contains less than 0.3 mg/l of fluoride, the fluoride supplement schedule should be followed.
Parents should be encouraged to teach children who are younger than 6 years to minimize swallowing of toothpaste and to use only a pea-sized amount an the brush.
Dental professionals who apply fluoride treatment gels or solutions should be judicious in the amount used and should apply suction to minimize swallowing of gels.

For-additional information contact:
Oral Health Consultant
Bureau of Public Health
1414 East Washington Avenue
Madison, WI 53703
(608) 266-5152

References:

Public Health Service. Department of Health and Human Services. Review of fluoride benefits and risks. February 1991.
Ekstrand J, Fejerskov O, and Silverstone L. Fluoride in dentistry. Copenhagen: Munksgaard, 1988.
Mason J. A message to health professionals about fluorosis. JAMA 1991, Vol 266, No 22.

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