the general dental practitioner if indicated, either as drops for the younger child or
tablets for the preschool child. It is likely that some children with impairments will
never cope with fluoride tablets and have to remain on drops. As long as the parent is
given written instructions to overrule the prescribing schedule given for younger
children on the label of the bottle, there is no reason why older children should not be
prescribed fluoride drops.
The dentist should also advise on the appropriate fluoride toothpaste to be used in
conjunction with fluoride supplementation or water fluoridation. Each case should be
considered individually taking into account the relative risks and benefits that may
occur. Paramount is consideration of the risk of developing dental caries versus the
potential for enamel opacities in the permanent dentition. As a guideline, if the risk of
caries is minimal, and if the diet is reasonably well controlled and home oral care is
generally good, then it is sensible to suggest the use of a pea-sized amount of
toothpaste containing approximately 500-600 p.p.m. of fluoride for the child under 6
years of age, provided that toothpaste can be used successfully. Older children, in the
same situation should use a toothpaste containing between 1000 and 1500 p.p.m. of
fluoride, as the risk of enamel opacities on anterior teeth is non-existent and this
formulation will provide optimal protection against caries. In the child where the
development of dental disease would pose a real hazard to their general health, and
where home care in terms of oral hygiene and diet is poorly controlled, it is advisable
to confer maximum protection by recommending the use of a toothpaste containing
1000-1500 p.p.m. of fluoride, even during the preschool years.
Because of the inability of many disabled children to hold solutions in their mouths or
to expectorate, fluoride mouthwashes are contraindicated; however, they can be used
on a toothbrush (dipped) where toothpaste is not well tolerated, to mimic the amount
of topical fluoride received from toothpaste.
Key Points
Fluoride advice:
- supplements to give optimal caries protection;
- fluoride mouthwash on a toothbrush instead of paste in cases of paste intolerance;
- low caries risk: 500-600 p.p.m. of fluoride paste (<6 years), 1000-1500 p.p.m. of
fluoride paste (>6 years); - high caries risk: 1000-1500 p.p.m. of fluoride paste (pea-sized amount) from the
time of tooth eruption onwards.
1143H
Fig. 17.10 A 'superbrush' in use in a
child with cerebral palsy.