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Clinician’s Corner: Flouride

The risk of dental cavities is reduced due to the uptake of fluoride by enamel. This uptake of fluoride hardens the enamel and makes it more acid resistant.  Fluoride also has demonstrated antibacterial activity.

Fluoride is most beneficial from birth to age 12 because unerupted permanent teeth are mineralizing at that time.  Whether a person receives fluoride supplementation depends on the concentration of the drinking water. Adding fluoride to the water reduces dental cavities by 25%. Because of this contribution to public health, the Center for Disease Control named community water fluoridation one of 10 great public health achievements of the 20th century.  The American Dental Association, the American Academy of Pediatrics, the US Public Health Service and the World Health Organization all support fluoridation of water.

Sources of fluoride:

  • Drinking water: About 66% of the US population lives in a municipality with a fluoridated water system. The United States Public Health Service recommends an optimal fluoride concentration of 0.7 milligrams/liter (mg/L). This concentration of fluoride in drinking water is the concentration that provides the best balance of protection from dental caries while limiting the risk of excess fluoride (dental fluorosis).
    • In Blair County ONLY the Tyrone water system is fluoridated. The major municipalities in our county of Hollidaysburg and Altoona do not fluoridate their water supply.
  • Dentist applied: fluoride based varnishes and gels can be applied directly to the teeth during a dental visit.
  • OTC mouthwashes: Children under the age of 6 years should not use mouthwash, unless directed by a dentist, because they may swallow large amounts of the liquid inadvertently.
  • Rx Gels and toothpastes such as Prevident 5000 and others. Rx products deliver about four times as much fluoride as do the OTC products.

You can check your water supply at this website: https://nccd.cdc.gov/DOH_MWF/Default/Default.aspx

How to supplement patients whose water supply is not fluoridated:

Water concentration of Fluoride Age of patient Supplementation mg/day
>0.6 ppm of fluoride 6months- 3 years 0mg
  3 years- 16 years 0mg
0.3-0.6ppm of fluoride 6months-3 years 0mg
  3 years-6 years 0.25mg/day
  6 years-16 years 0.5mg/day
<0.3ppm of fluoride 6 months-3 years 0.25mg/day
  3 years -6 years 0.5mg/day
  6 years- 16 years 1.0mg/day


Patient Care tips for Fluoride supplements

  • Oral fluoride supplements are prescription only.
  • All tablet formulations MUST BE CHEWED! Chewing “pulverizes” the fluoride into the enamel of the teeth
  • Milk and other dairy products may decrease absorption.
  • Most recommend fluoride be given at bedtime after kids brush their teeth.
  • Fluoride may be ingested from bottled water or juices that have been fluoridated