Fluoride Therapy
Definition
Fluoride therapy is the use of fluoride products topically (applied to the tooth surface) or systemically
Purpose
Fluoride therapy may be initiated systemically before a child's teeth emerge during tooth development in order to strengthen tooth enamel (the hard outer surface of a tooth) and prevent dental caries. Fluoride may also be applied in the form of gels, foams, and varnishes to the tooth surface, which provides temporary protection. Topical methods are effective for adults and children. The use of fluoridated toothpaste and mouth rinses is another means of delivering fluoride therapy.
Precautions
Fluoride therapy is contraindicated for children who are drinking fluoridated water and/or who are also receiving the optimal fluoride dosage (about 1.0 ppm) from foods and bottled beverages. Fluoride in dentifrices (toothpastes) and mouth rinses also has the potential of being ingested. Overexposure to fluoride while a child's teeth are forming under the gums results in fluorosis, an abnormal condition that affects the appearance of tooth enamel and can be very mild (a few white spots on a tooth) to severe (etching, pitting, and brown discoloration on many teeth).
Pediatricians, oral care professionals, and dental hygienists assess the amount of fluoride in a child's natural environment and caries risk before prescribing fluoride supplements or topical fluoride therapy. Usually, if a child lives in an area where fluoride has been added to the drinking water, supplements are not necessary. A pediatrician or oral care professional may recommend supplements if the child exhibits moderate-to-high risk for dental caries. However, supplementation should be done with caution, weighing the risks of fluoride overexposure against slightly more added protection.
Description
Fluoride therapy can be administered through fluoride supplements, fluoridated water, and some bottled beverages containing fluoride. Carbonated drinks, juices, and bottled waters can contain fluoride in varying amounts. Often, the fluoride in these products is not printed on the labels. Some other foods and beverages are high in fluoride, including fish with bones, tea, poultry products, cereals, or infant formula made with fluoridated water. Food cooked in Teflon-coated pans also provides fluoride.
Breast-fed infants usually do not need supplements until after they are six months old. By that time, they may be drinking water from a cup or eating some foods that contain fluoride, so supplements still may not be necessary.
Fluoride supplements are dispensed in the United States and Canada as lozenges, oral solutions, tablets, and chewable tablets. Fluoride can also be prescribed in combination with a vitamin supplement as chewable tablets or in an oral solution. In the United States, common brand names for fluoride supplements are Fluoritab, Fluorodex, Flura, Flura-Drops, Flura-Loz, Karidium, Luride, Luirde Lozi-Tabs, Pediaflor, Pharmaflur, and Phos-Flur. The vitamin/fluoride combination is sold as Adeflor, Cari-Tab, Mulvidren-F, Poly-Vi-Flor, Tri-Vi-Flor, and Vi-Daylin/F. These supplements are available only by prescription from a pediatrician or a oral care professional.
Dosing of fluoride supplements is different for every child. When determining the amount to prescribe, pediatricians and oral care professionals should consider all fluoride exposure in the child's environment and prescribe supplements with fluoride limits in mind. Recommended total daily fluoride intake has been set at0.1 to 1.5 mg for the infant and child to three years of age, 1–2.5 mg for the four-to-six-year old, 1.5–1.5 mg for the seven-to-ten year old, and 1.5–4 mg for an adolescent and an adult.
Calcium supplements, or any products with aluminum hydroxide, should not be taken along with fluoride supplements. Each dose should be spaced at least two hours apart to achieve the maximum benefit of each.
Overexposure to fluoride is a concern to pediatricians and oral care professionals because it can result in fluorosis. Fluorosis, which is caused by exposure to excessive amounts of fluoride while the enamel is being formed, can affect both the primary (baby) teeth and permanent teeth. It does not affect the permanent teeth once they have fully developed. Most often, the fluorosis appears on the front incisors (front teeth) and less frequently on the molars. This characteristic poses a high cosmetic problem because the front teeth are most exposed when children speak or smile. There is no cure for fluorosis except cosmetic restoration, which can be costly.
Fluoride gels and foams are the most common form of topical fluoride application at the oral care professional's office. A flavored gel containing a concentration of fluoride is offered in a tray to the patient. There is one tray for the upper teeth and one for the lower teeth. The patient should sink his or her teeth into the tray and let the teeth bathe in the fluoride for a specific amount of
Finally, the use of fluoride toothpaste and fluoridated mouth rinses may also be recommended for adults and children. According to the American Dental Association, young children under six often use too much fluoride toothpaste, and consistently swallow it. This has contributed significantly to excess fluoride ingestion. Careful monitoring of toothpaste amounts by parents and encouragement to spit, instead of swallowing the toothpaste, can drastically decrease the amount of fluoride a child ingests from dentifrices.
Composite resins and adhesives with fluoride are used by oral care professionals when filling cavities and cementing crowns into place. Sufficient amounts of topical fluoride are applied to protect adjacent teeth that normally are at risk for further wear and decay due to the location of the cavity (e.g., deep pits in molars) or the stress due to bridge and crown fittings.
Dental and medical insurance usually cover fluoride therapy as "routine care."
