p.p.m. fluoride may be used. Toothpastes with a lower fluoride concentration are
available, but there is some question about their efficacy. Many authorities now
support the prescribing of toothpastes containing higher concentrations of fluoride
(around 1000 p.p.m.) to preschool children deemed to be at higher risk of developing
caries, irrespective of their age. In children at highest risk, toothpastes with higher
concentrations (i.e. 1400-1500 p.p.m. F-) may even be justified, especially in children
aged 6 and above. Where higher concentration toothpastes are prescribed for
preschool children, parents should be counselled to ensure that brushing is supervised
(see 285HSection 7.6.4), small amounts of toothpaste are applied to the brush ('small pea
size blob' or 'thin smear'), and that children spit out as well as possible after brushing.
Key Point
- In areas without optimum levels of fluoride in the water supply, fluoride toothpaste
is the most important method of delivering fluoride to preschool children.
FLUORIDE SUPPLEMENTS
Supplementary fluoride, in the form of either drops or tablets, should be considered in
those at high risk of caries and in children in whom dental disease would pose a
serious risk to general health (e.g. children at increased risk of endocarditis). Such
supplementation is only maximally effective if given long term and regularly.
Unfortunately, studies have shown that long-term compliance with daily fluoride
supplement protocols is poor. Parental motivation and regular reinforcement are
essential for such measures to be effective. Dosage should follow the protocol advised
by the British Society of Paediatric Dentistry (286HTable 7.1). No supplements should be
prescribed if the water fluoride level is greater than 0.7 ppm. The European view on
supplements is that the maximum dose should be 0.5 mg/day.
FLUORIDE MOUTHRINSES
Fluoride mouthrinses are contraindicated in children less than 6 years of age, because
of the risk of excessive ingestion.
Professionally applied fluorides
Site-specific application of fluoride varnish can be valuable in the management of
early, smooth surface and approximal carious lesions (287HFig. 7.5). However, the most
popularly used varnishes contain 5% sodium fluoride (i.e. 22, 600 p.p.m. of fluoride).
Hence, when using these products in young children great care should be taken to
avoid overdosage (see below).
Fluoride overdosage
A dose of 1 mg of F/kg body weight can be enough to produce symptoms of toxicity
and a dose of 5 mg of F/kg is considered to be potentially fatal. Symptoms of toxicity
include nausea, vomiting, hypersalivation, abdominal pain (production of hydrogen
fluoride, HF), and diarrhoea. Subsequently, depression of plasma calcium levels
results in convulsions, and cardiac and respiratory failure. The appropriate
management of fluoride overdosage is detailed in 288HTable 7.2.
Some of the terms used when describing fluoride toxicity are given in 289HTable 7.3. In a
10-kg, 18-month-old child, the ingestion of 0.5 ml of a 2.26% fluoride varnish can