113 studies in 23 countries over the last 60 years showing that dental caries is
reduced by 50%. It is cheap and cost-effective but there are opponents to its use.
Fluoride supplements
These are in the form of tablets and drops. Caries reductions vary from 20% to 80%.
There is usually very poor patient compliance especially for high-caries risk groups.
A 'Catch 22' situation is the case in that those patients that are compliant do not need
supplements whereas those that will benefit will not take them. The doses vary
worldwide and are being increasingly held responsible for the rise in fluorosis. The
fluoride supplement doses depend on the age of the patient and the level of fluoride in
the drinking water. No supplements should be prescribed if the water fluoride level is
greater than 0.7 ppm. The European view on supplements is that they have no role as
a public health measure, and when they are prescribed 0.5 mg per day should be the
maximum dose. The tablets should be allowed to dissolve slowly in the mouth, thus
providing a topical application of fluoride to the teeth.
Other methods for providing systemic fluoride
There are of course other systemic methods for providing fluoride to the community.
These are:
(1) salt⎯50% caries reductions in Switzerland and Hungary;
(2) milk⎯15-65% caries reductions;
(3) mineral Water⎯46% caries reductions in Bulgaria.
Are we therefore receiving more than the optimum daily amount of fluoride and
therefore at increased risk of fluorosis? Are there other hidden sources of fluoride?
Mineral waters are used extensively as the main source of household drinking water.
The fluoride levels of bottled waters vary considerably from 0.0 to 2.0 ppm mainly,
but can be as high as 10.0-13.0 ppm in some countries. Therefore, before prescribing
fluoride supplements we must first determine the fluoride level of the patient's
drinking water, be that tap or bottled water. In addition some baby milk formulas have
high amounts of fluoride themselves, and if made up with a high fluoride bottled
water the infant may be at increased risk of developing dental fluorosis. The
maxillary permanent central incisors are most susceptible to fluorosis at about 2 years
of age. On the continent fluoride chewing gum is available providing 0.25 mg fluoride
per stick of gum. Some foods, for example, fish and tea have high fluoride contents.
We also ingest fluoride from sources without realizing it. The 'Halo Effect' is the term
used to describe the ingestion of fluoride from hidden sources. For example, fizzy
drinks like 'pepsi' or 'coca-cola' may contain fluoride if the bottling plant is in a
fluoridated area and therefore uses fluoridated water. The 'fluoridated' drinks may be
transported to non-fluoridated areas. The same applies to foods that are processed and
canned or packaged in plants using fluoridated water.
Toothpastes
A dramatic decrease in worldwide caries levels has been seen since their introduction
in the early 1970s. They usually contain 1000 or 1450 ppm fluoride. The fluoride is
either sodium fluoride or sodium monofluorophosphate (MFP) or a combination of