Fluoride Application for Preventing Dental Caries

Effectiveness of Fluoride Application

The American Dental Association recommends that fluoride-containing paste used during dental prophylaxis is not an adequate substitute for fluoride gel or varnish in preventing dental caries, especially for high-risk individuals 1
Fluoride paste used during dental prophylaxis typically contains 4,000-20,000 ppm fluoride and might restore the concentration of fluoride in the surface layer of enamel removed by polishing 1
The FDA and ADA do not accept fluoride paste as an efficacious way to prevent dental caries 1, 2
Professional tooth cleaning solely to prepare teeth for application of a fluoride compound is unnecessary; toothbrushing and flossing appear equally effective in improving the efficacy of high-concentration fluoride compounds 3

Daily use of fluoride toothpaste (1,000-1,100 ppm fluoride) is the primary recommendation for caries prevention, with brushing twice daily being the standard recommendation 4, 5
Persons aged >6 years can retain more fluoride in the mouth by either rinsing briefly with a small amount of water or not at all after brushing 5, 6
The combined use of fluoride toothpaste and fluoridated water offers protection above either used alone 5, 6
Professionally applied fluoride products should be targeted to persons at high risk for dental caries 7
Fluoride varnish (2.26% sodium fluoride or 0.1% difluorsilane) applied semiannually is as effective as professionally applied fluoride gel 1, 2
Fluoride gel (1.23% acidulated phosphate fluoride or 0.9% sodium fluoride) applied semiannually has been shown to decrease caries experience by an average of 26% in children residing in non-fluoridated areas 3

Parents and caregivers should consult a dentist or other healthcare provider before introducing fluoride toothpaste to children aged <2 years 8, 7
For children aged <6 years, use only a pea-sized amount (approximately 0.25 g) of fluoride toothpaste to reduce risk of enamel fluorosis 8, 6
Fluoride varnish is preferred for high-risk young children as it has no published evidence of being a risk factor for enamel fluorosis 1, 2
Standard concentration fluoride toothpaste (1,000-1,100 ppm) reduces caries experience by 15-30% 5

Know the fluoride concentration in the primary source of drinking water as this affects decisions about other fluoride modalities 8, 7
For children aged <6 years, supervise toothbrushing to minimize swallowing of toothpaste 8, 7
In areas where natural fluoride concentration is >2 ppm, children aged <8 years should use alternative sources of drinking water to reduce risk of enamel fluorosis 8

The effectiveness of combining different fluoride modalities in preventing dental caries is partially additive 1, 2
The percent reduction in caries from a combination of modalities is higher than from each modality alone, but less than the sum of the percent reductions 1, 2