INTERVENTION: FLUORIDE SUPPLEMENTATION
INDICATIONS: Children 6 months to 16 years of age living in areas with less than optimally fluoridated water, for example, home or "primary" water supply is fluoride deficient.
ADA Council on Scientific Affairs Recommendations, new dosage Schedule approved April 1994:
ADVANTAGES: Permits early exposure, which maximizes protection. Fluoride supplements are sold in two forms: drops for infants age 6 months and up, and chewable tablets for children and adolescents. Systemic and topical benefits when chewed, swished and swallowed. Caries protection from 6 months of age when used as recommended.
LIMITATIONS: All sources of fluoride must be evaluated with a thorough fluoride history. If fluoride level is unknown, drinking water must be tested for fluoride content before supplements are prescribed. For testing of fluoride content, contact the local or state health department. Requires long-term compliance on a daily basis. Ingestion of higher than recommended levels of fluoride by children has been associated with an increase in mild dental fluorosis in developing unerupted teeth. Patient exposure to multiple sources can make proper prescribing complex.
TOOTH: Caries reduction benefits must be balanced with risk for mild and very mild fluorosis.
PATIENT: Home water filtration systems may remove fluoride, therefore, treated water should be tested. Other sources of fluoride need to be determined, including fluoride prescribed by a physician.
REFERENCES: American Dental Association, Council on Scientific Affairs, Association Report on Dietary Fluoride Supplements. JADA 1995 (In press).
COMMENTS BY ZWA:
The dosage schedule above represents "Mission Impossible" for health professionals. They cannot take a "complete fluoride history" as recommended above, due to the prevalence of artificially fluoridated water in an unknown number of beverage and food products. These products are not labeled for fluoride content. More than 60% of the U.S. water supply is now fluoridated.