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Systemic Sources of Fluoride, continued
Toothpaste
Toothpaste’s effects are mainly topical, but some toothpaste is swallowed by children and is available systemically. Consider the following strategies to minimize toothpaste ingestion in children:
 
Discourage children from swallowing toothpaste.
 
Encourage spitting of toothpaste.
 
Supervise brushing until spitting can be ensured.
 
Limit the amount of toothpaste placed on the toothbrush.

Fluoride Supplements
Supplements should be considered especially for patients at high risk for dental caries whose community water source is suboptimal. These are available in liquid, tablet, or lozenge form. The Centers for Disease Control and Prevention (CDC) concluded that the quality of evidence to support use of fluoride supplements is as follows:
 
Children aged 6 years and younger: Quality of evidence is
Grade II-3, strength of recommendation of C with targeted effort at populations at high risk for dental caries.
 
Children aged 6-16 years: Quality of evidence is Grade 1, strength of recommendation of A, with targeted effort at populations at high risk for dental caries.
In addition, the CDC concluded that the quality of evidence against providing fluoride supplementation to pregnant women in order to benefit their children is Grade 1 and gave it a strength of recommendation of E (good evidence to reject the use of the modality).

The American Dental Association published a new guideline in 2010 recommending fluoride supplements be prescribed only to children determined to be high risk for the development of caries. Strength of recommendation B.

The United States Preventive Services Task Force “recommends that primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride.” They gave this a B recommendation.

View CDC Grading and Coding Systems
View Quality of Evidence Table
 
 
Efforts should be made to minimize swallowing of toothpaste, as it is a highly concentrated source of fluoride.
 
Fluoride supplements are recommended for high-risk children 6 months to 16 years of age whose primary water source is deficient in fluoride.
 
Pregnant women should not be prescribed fluoride supplements.


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