Use of Fluoride Supplements

Fluoride treatment of the dental surfaces is one of the most effective means of dental caries prevention. A preventive level of fluoride can be acquired through consumption of fluoridated water, use of fluoride-containing toothpastes, and application of fluoride varnish during regular preventative dental cleanings. However, for children and adolescents who do not live in fluoridated-water communities, do not have access to topical fluorides, and may be at high risk of developing dental caries, AADOCR supports the recommendations of the American Dental Association (ADA), American Academy of Pediatric Dentistry (AAPD), and the Indian Health Service to administer fluoride supplements according to the supplementation schedule recommended by ADA.^1-4

Dental caries is the destruction of the dental hard tissues by the acidic byproducts of bacterial fermentation of sugar. The consequences of tooth decay include pain, infection, and tooth loss.^5,6 Dental caries is the most common chronic disease in children and is fives times more common than asthma, the second most common chronic childhood ailment. Racial minorities and children from socioeconomically disadvantaged families disproportionately suffer from dental caries and are less likely to be treated for it.⁷

This highly preventable disease is especially disturbing in children because of studies showing that children with toothaches and generally poor oral health are more likely to miss school and exhibit poor academic performance. Specifically, caries is known to cause parents to miss school or work to attend to their child’s dental needs.^8,9 Children with caries may experience embarrassment, exhibit withdrawal, have difficulty eating and sleeping, and limit facial expressions and behaviors that facilitate social interaction.^{7, 10, 11} Furthermore, treatment of caries can be expensive in very young children who may require sedation due to their inability to remain still or manage the stress of the procedure.¹² Given the health, quality of life, and economic impacts of dental caries, prevention is the best approach to addressing the epidemic of dental caries in children and adolescents.

The recommended fluoride supplementation schedule was created to maximize the caries-preventive effect of fluoride while minimizing the risk of fluorosis. A systematic review of fluoride supplement research by a panel of experts convened by ADA showed that dietary fluoride supplements are effective in preventing dental caries in children and adolescents, and when used correctly, do not cause severe fluorosis.⁴

Fluoride supplements are only available by prescription. Before prescribing supplements, providers should estimate the patient’s total fluoride intake and risk of caries development. The supplementation schedule provided by ADA is according to the level of fluoridation of the child’s primary drinking water source. Providers can find water fluoride levels from the water supplier, health departments, the Environmental Protection Agency (https://www.epa.gov/ccr), and the Centers for Disease Control and Prevention (https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx). Providers can assess caries risk development by using any one of the risk assessment tools recommended by the ADA or AAPD.^{3, 4, 9, 13-16}

This policy statement is primarily concerned with the use of fluoride supplements in children. It was previously thought that dietary fluorides exerted their effects systemically in developing teeth. Current evidence suggests that the primary caries preventive effect of fluorides occurs post-eruptively (after teeth have entered the mouth) and that the mechanism is primarily topical.¹⁷ Therefore, adults at high risk of developing caries could benefit from the topical application of fluorides.

(adopted 2017)