Fluoride dietary supplements, first introduced in the late 1940s, provides an alternative for providing systemic fluoride in areas where community water fluoridation is not feasible due to lack of a central water supply or other reasons. The cariostatic effect ranges from 30-70% depending on dosage and degree of compliance.
These are available in the form of:
- Fluoride Tablets : To be chewed and swallowed.
- Fluoride Lozenges : To be sucked slowly in the mouth for 1-2 minutes.
- Fluoride Drops : Suitable in young children, until they are old enough to swallow.
Compounds
- Sodium fluoride (NaF) is the most commonly used compound. Supplements typically contains 0.25 mg, 0.5 mg or 1 mg fluoride. 2.2 mg NaF contains 1 mg fluoride ion.
- Other compounds such as acidulated phosphate fluoride (APF), potassium fluoride or calcium fluoride may also be used.
- APF tablets : Considerably more expensive than sodium fluoride and have same effectiveness. Also, the low pH of APF tablets leads to greater salivary flow, which can reduce the concentration of fluoride around the teeth and hasten its clearance from the mouth.
Dosage
Fluoride supplements are taken on a daily basis from 6 months to 16 years. The recommended dosage schedule for children as per AAPD:
- Birth - 6 months : None.
- 6 months - 3 years : 0.25 mg/day (Fluoride level < 0.3 ppm).
- 3-6 years : 0.50 mg/day (Fluoride level < 0.3 ppm), 0.25 mg/day (Fluoride level 0.3-0.6 ppm).
- 6-16 years : 1.0 mg/day (Fluoride level < 0.3 ppm), 0.50 mg/day (Fluoride level 0.3-0.6 ppm).
- 1.0 ppm = 1 mg per liter.
Points to Note
- All sources of fluoride should be evaluated with a thorough history, before prescribing fluoride supplements.
- Fluoride supplements should be recommended only for individual children who are at risk and living in areas with less than optimal water fluoride levels.
- Fluoride can cross the placental barrier and enter fetal circulation. However, prenatal fluoride have little effect and hence, prenatal fluoride supplements are generally not recommended.
- Fluoride supplements require long-term compliance on a daily basis.
- Daily administration of fluoride tablets at home requires high level of parental motivation and cooperation.
- It is believed that if the fluoride tablets are taken at night, a higher saliva fluoride level is possible than if taken during the day. This is probably due to fluoride saliva concentrations are higher in unstimulated saliva and glomerular filtration is reduced during sleep, resulting in higher blood levels.
- Prescribed supplements should be used in childproof container and the fluoride tablets issued at one time should not exceed 120 mg of fluoride.
References
- C. M. Marya - A Textbook of Public Health Dentistry, Jaypee Brothers Medical Publishers (P) Ltd (2011). https://amzn.to/3SHP36G
- S. S. Hiremath - Textbook of Public Health Dentistry, Elsevier India (2016). https://amzn.to/49mh2jw
- The image used is available in public domain (Source : Wikimedia Commons, Author : Mysid).
*This article is an excerpt from the above mentioned books and Medical Sutras does not make any ownership and affiliation claims.