Fluoride Therapy
Purpose
The American Academy of Pediatric Dentistry (AAPD) intends this guideline to help practitioners and parents make decisions concerning appropriate use of fluoride as part of the comprehensive oral health care for infants, children, adolescents, and persons with special health care needs.
Methods
A thorough review of the scientific literature in the English language pertaining to the use of systemic and topical fluoride was completed to revise and update this guideline. Database searches were conducted using the terms fluoride, fluoridation, fluoride gel, fluoride varnish, fluoride toothpaste, fluoride therapy, and topical fluoride. Because over two million papers were identified through electronic searches, alternate strategies such as appraisal of references from recent evidence-based reviews and meta-analyses, as well as hand searches, were performed. This strategy yielded 105 manuscripts, primarily related to randomized clinical trials and evidence-based reviews, that were evaluated further by abstract. Of those, 45 manuscripts each had full examination and analysis in order to revise this guideline. Expert opinions and best current practices also were relied upon for this guideline.
Recommendations
1. There is confirmation from evidence-based reviews that fluoride use for the prevention and control of caries is both safe and highly effective in reducing dental caries prevalence.
2. There is evidence from randomized clinical trials and evidence-based reviews that fluoride dietary supplements are effective in reducing dental caries and should be considered for children at caries risk who drink fluoride-deficient (less than 0.6 ppm) water.
3. There is evidence from randomized controlled trials and meta-analyses that professionally applied topical fluoride treatments as five percent NaFV or 1.23 percent F gel preparations are efficacious in reducing caries in children at caries risk. Table. DIETARY FLUORIDE SUPPLEMENTATION SCHEDULE Age 0.6 ppm F Birth to 6 months 0 0 0 6 mo to 3 years 0.25 mg 0 0 3 to 6 years 0.50 mg 0.25 mg 0 6 to at least 16 years 1.00 mg 0.50 mg 0 178 CLINICAL PRACTICE GUIDELINES REFERENCE MANUAL V 37 / NO 6 15 / 16
4. There is evidence from meta-analyses that fluoridated toothpaste is effective in reducing dental caries in children with the effect increased in children with higher baseline level of caries, higher concentration of fluoride in the toothpaste, greater frequency in use, and supervision. Using no more than a smear or ricesize amount of fluoridated toothpaste for children less than three years of age may decrease risk of fluorosis. Using no more than a pea-size amount of fluoridated toothpaste is appropriate for children aged three to six.
5. There is evidence from randomized clinical trials that 0.2 percent NaF mouthrinse and 1.1 percent NaF brush-on gels/pastes also are effective in reducing dental caries in children.
