2.3 Mineral and Antimicrobial Agents

Fluoride Supplements

Fluoride supplements may be prescribed for patients ages 6 months or older at high risk for developing dental caries. For patients at low risk for developing caries, dietary fluoride supplements are not recommended, and other sources of fluoride should be considered as a caries-prevention intervention.12 Before health professionals prescribe fluoride supplements, they need to ask patients where they get their drinking water and must also assess their caries risk level. Patients may drink bottled water, filtered water, well water, or water from other sources. All water sources as well as any other sources of ingested fluoride must be tested for fluoride content.13 Risk-assessment forms from the American Academy of Pediatric Dentistry and the American Dental Association (from birth to age 6 and over age 6) can help clinicians determine risk.

The following table provides fluoride dosage schedules as recommended by the American Dental Association.

Table 1. Systemic Fluoride Supplements: Recommended Dosage

a 1.0 ppm = 1 mg/L.
b 2.2 mg sodium fluoride contains 1 mg fluoride ion.

Adapted with permission from Rozier GR, Adair S, Graham S, Iafolla T, Kingman A, Kohn W, Krol D, Levy S, Pollick H, Whitford G, Strock S, Frantsve-Hawley J, Aravamudhan K, Meyer DM. 2010. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: A report of the American Dental Association Council on Scientific Affairs. Journal of the American Dental Association 141(12):1480–1489. Table 3 on p. 1485. Available at http://jada.ada.org/content/141/12/1480.full.

©2010 American Dental Association. All rights reserved. Reproduced by permission.

Fluoride supplements may be of limited value for children from birth to age 6, and they carry risks, such as the potential for overdose and fluorosis. In addition, compliance with recommended protocols is often difficult to sustain, as the supplement must be given daily, and prescriptions must be refilled. The primary benefit of fluoride supplements arises from their topical effects, which can be obtained more safely via other sources, such as toothpaste.

Use of systemic fluoride (e.g., fluoridated water, tablets, drops) can result in fluorosis if children swallow excessive amounts of fluoride during the period in which teeth are developing. Topical fluoride does not contribute to the risk for fluorosis unless it is regularly swallowed during this period. It is important to prescribe, use, and recommend fluoride products properly to maximize their caries-prevention properties and minimize unwanted side effects.

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