AAPD Fluoride

The American Academy of Pediatric Dentistry (AAPD), affirming
that fluoride is a safe and effective adjunct in reducing the
risk of caries and reversing enamel demineralization, encourages
public health officials, health care providers, and parents/caregivers
to optimize fluoride exposure.

The adjustment of the fluoride level in community water supplies
to optimal concentration is the most beneficial and inexpensive
method of reducing the occurrence of caries.1 Epidemiologic
data within the last half-century indicate reductions in caries of
55 to 60% and recent data still shows caries reduction of approximately
25%, without significant enamel fluorosis, when domestic
water supplies are fluoridated at an optimal level.2 Evidence
accumulated from long-term use of fluorides has demonstrated
that the cost of oral health care for children can be reduced by as
much as 50%.3 These savings in health dollars accrue to private
individuals, group purchasers, and government care programs.
An even higher caries reduction can be obtained if the proper
use of fluorides is combined with other dietary, oral hygiene, and
preventive measures4,5 as prescribed by a dentist familiar with the
child’s oral health and family history.
A large body of literature supports the incorporation
of optimal fluoride levels in drinking water supplies. When
fluoridation of drinking water is impossible, effective systemic
fluoridation can be achieved through the intake of daily fluoride
supplements. Before supplements are prescribed, it is essential to
review dietary sources of fluoride (eg, all drinking water sources,
consumed beverages, prepared food, toothpaste) to determine
the patient’s true exposure to fluoride.1,6-9 Fluoride content
of ready to use infant formulas in the US and Canada ranges
from 0.1 to 0.3 mg/L10, which provides only a modest source of
fluoride. Non-milk based formulas have higher fluoride content
because the calcium that is added to formula contains fluoride.
The more important issue, however, is the fluoride content of
concentrated or powdered formula when reconstituted with
fluoridated water. Considering the potential for mild fluorosis,
caution is advised for infants consuming formula that is reconstituted
with optimally-fluoridated water.
Significant cariostatic benefits can be achieved by the use of
fluoride-containing preparations such as toothpastes, gels, and
rinses, especially in areas without water fluoridation.11 Monitoring
children’s use of topical fluoride-containing products, including
toothpaste, may prevent ingestion of excessive amounts of
fluoride.12
A number of clinical trials have confirmed the anticaries
effect of professional topical fluoride treatments, including
5% neutral sodium fluoride varnish.13,14 Fluoride varnishes can
prevent or reverse enamel demineralization.15 In children with
moderate to high caries risk, fluoride varnishes14,16 and fluoridereleasing
restorative and bonding materials have been shown to
be beneficial and are best utilized as part of a comprehensive
preventive program in the dental home.