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

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ABSTRACT

Background

This article presents evidence-based clinical recommendations for the prescription of dietary fluoride supplements. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following questions: when and for whom should fluoride supplements be prescribed, and what should be the recommended dosage schedule for dietary fluoride supplements?

Types of Studies Reviewed

A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry, conducted a MEDLINE search to identify publications that addressed the research questions: systematic reviews as well as clinical studies published since the systematic reviews were conducted (June 1, 2006).

Results

The panel concluded that dietary fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is deficient in fluoride.

Clinical Implications

These recommendations are a resource for practitioners to consider in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences. Providers should carefully monitor the patient's adherence to the fluoride dosing schedule to maximize the potential therapeutic benefit.

Section snippets

SCOPE AND PURPOSE OF THE RECOMMENDATIONS

This report focuses on the prescription of dietary fluoride supplements for infants and children aged 6 months to 16 years who live in communities without fluoridated water or with water of low fluoride content. In July 2008, the ADA CSA convened an expert panel to develop recommendations addressing the following questions:

  • When and for whom should fluoride supplements be prescribed?

  • What should be the recommended dosage schedule for dietary fluoride supplements?

The clinical recommendations that

Expert panel

The ADA CSA convened a panel of 10 experts to evaluate systematically the collective scientific evidence related to the clinical questions listed above and develop evidence-based clinical recommendations for the prescription of dietary fluoride supplements.

The Council selected panelists on the basis of their expertise in the relevant subject matter. The expert panel convened at a workshop held July 16–18, 2008, at the ADA Headquarters in Chicago. The panelists continued their work by means of

Published evidence

The panel included in its evaluations three systematic reviews and two clinical studies related to the clinical questions.39, 40, 41, 45, 47 Appendix 4 in the supplemental data to the online version of this article (found at “http://jada.ada.org”) presents a summary of these publications, along with a critical appraisal of the strengths and weaknesses of the evidence they offer.

The panelists also analyzed the individual studies in the systematic reviews in which investigators addressed caries

DISCUSSION

Dental caries can be controlled by several strategies used either alone or in combination. These strategies include approaches that involve altering the bacterial flora in the mouth, modifying the diet, increasing the resistance of tooth enamel to acid attack or reversing the demineralization process. The use of fluorides has reduced the incidence of dental caries. On the other hand, ingestion of fluoride during critical periods of tooth development may result in enamel fluorosis. Therefore, as

CONCLUSION

The panel concluded that fluoride supplements are effective in preventing caries. Owing to known increases in exposure to fluoride from multiple sources and the increased prevalence of enamel fluorosis, the panel recommended fluoride supplement use for children at high risk of developing caries. These recommendations emphasize the need for caries risk assessment and judicious prescription of dietary fluoride supplements with consideration of total fluoride intake.

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    • Cited by (0)

    Disclosures. Dr. Adair is the chief dental officer, FORBA Dental Management, Nashville. None of the other authors reported any disclosures.

    *

    Dr. Rozier is the chair and a professor of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

    *

    Dr. Adair is a professor emeritus, Department of Pediatric Dentistry, School of Dentistry, Medical College of Georgia, Augusta; and the chief dental officer, FORBA Dental Management, Nashville, Tenn.

    *

    Dr. Graham maintains a private practice in orthodontics in Teaneck, N.J.; and is a senior attending dentist in orthodontics, Department of Dentistry, Montefiore Medical Center, Bronx, N.Y. He also is the immediate past chair, American Dental Association Council on Dental Practice, and represented the council on the expert panel.

    *

    Dr. Iafolla is a public health analyst, Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md.

    *

    Dr. Kingman is the chief biostatistician, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md.

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    Dr. Kohn is the director, Division of Oral Health, Centers for Disease Control and Prevention, Atlanta.

    *

    Dr. Krol is the team director and the senior program officer, Human Capital, Robert Wood Johnson Foundation, Princeton, N.J.

    *

    Dr. Levy is the Wright-Bush-Shreves Endowed Professor of Research, Department of Preventive and Community Dentistry, College of Dentistry, and a professor, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City.

    *

    Dr. Pollick is a clinical professor, Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California San Francisco.

    *

    Dr. Whitford is a Regents Professor, Department of Oral Biology, School of Dentistry, Medical College of Georgia, Augusta.

    *

    Dr. Strock is the senior manager, Council on Access, Prevention and Interprofessional Relations, American Dental Association, Chicago.

    *

    Dr. Frantsve-Hawley is the director, Research Institute, and the director, Center for Evidence-based Dentistry, Division of Science, American Dental Association, Chicago.

    *

    Dr. Aravamudhan is the assistant director, Center for Evidence-based Dentistry, Division of Science, American Dental Association, Chicago.

    *

    Dr. Meyer is the director, Division of Science, and the senior vice president, Science and Professional Affairs, American Dental Association, Chicago.

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