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Recommendations, continued

Fluoride Dietary Supplementation
When access to community water fluoridation is limited, fluoride can be supplemented in liquid, tablet, or lozenge form.

Fluoride supplements require a prescription. A 2010 American Dental Association (ADA) evidence-based clinical guidelines recommends fluoride supplements be prescribed only to children determined to be at high risk for the development of caries whose community water source is suboptimal.

Supplementation Dosing Schedule
The AAP, ADA, and AAPD have developed the following recommendations regarding fluoride supplementation:

  1. All sources of fluoride must be considered, including primary
    drinking water, other sources of water, prescriptions from the
    dentist, fluoride mouthrinse in school, and fluoride varnish.
  2. Supplementation should be provided to high-risk children if fluoride
    access is limited. 
  3. Children younger than 6 months and older than 16 years should
    NOT be supplemented. 
  4. Children who have adequate access to (and are drinking)
    appropriately fluoridated community water should not be
    supplemented.

CDC Quality of Evidence to Support the Use of Fluoride Supplements

  • Children 6 years and younger: Grade II-3. Strength of recommendation of C with targeted effort at populations at high risk for dental caries.  
  • Children 6-16 years: Grade 1. Strength of recommendation of A with targeted effort at populations at high risk for dental caries.
  • Pregnant women: Quality of evidence against providing fluoride supplementation to pregnant women to benefit their children is Grade 1. Strength of recommendation of E (good evidence to reject the use of the modality).

The 2010 ADA guideline* recommends fluoride supplements be prescribed only to children at high risk for caries. Strength of recommendation: B

The United States Preventive Services Task Force recommends fluoride supplementation be prescribed at recommended doses to children older than 6 months whose primary water source is deficient in fluoride. Strength of recommendation: B

 
 
If it is determined that fluoride access is limited and a child is at high risk for dental caries, then fluoride supplementation should be written.
 
All possible sources of fluoride should be considered before supplementing.
 
Children at high risk for caries should be supplemented from the age of 6 months to 16 years.
 
View ADA fluoride chair-side tool.
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