Fluoride for children

Hardly any subject in paediatric dentistry is discussed as contentiously as this one, and hardly any is as well studied professionally. The effectiveness of fluoride against caries is among the best-established findings in dentistry. The sensible question is therefore not whether but how much and and by which route.

How fluoride works

What matters is local contact with the tooth surface. Fluoride is deposited in the outer layer of enamel and makes it more resistant to acid; it promotes the re-deposition of minerals into incipient decalcification; and it inhibits the metabolism of the bacteria in the plaque.

This insight has changed the recommendations. It used to be assumed that fluoride had to be taken into the body during tooth formation — hence the tablets. Today the local route is considered the more effective one, and that is why toothpaste has moved into first place.

The standard route: toothpaste

• From the first tooth to 12 months: a rice-grain-sized amount with 1,000 ppm, once a day.
• 12 months to 2 years: rice-grain-sized, twice a day.
• 2 to 6 years: pea-sized with 1,000 ppm, twice a day.
• From 6 years: adult toothpaste with 1,000 to 1,500 ppm.

In addition there is, at the practice, the fluoride varnish: at the early-detection appointments, at individual prevention, and more often where the risk is increased.

And the tablets?

Fluoride tablets have not been abolished, but they are no longer the standard route. They come into consideration if there are no teeth yet in the first year of life and the paediatrician prescribes them together with vitamin D, or if toothpaste is ruled out for practical reasons.

What matters is coordination: toothpaste and tablets are not given alongside each other without someone keeping an eye on the total amount. Because the recommendations of paediatrics and dentistry diverged on this point for years, many parents are uncertain. The workable way: raise it once — at the paediatric practice and at the dental practice — and settle on one route.

Fluoridated table salt

Fluoridated table salt used in the household is a sensible addition for the whole family once the child takes part in family meals. It supplies small amounts spread across the day — exactly the kind of intake that is effective. It combines with toothpaste without any problem.

How much is too much?

A persistently excessive intake during tooth formation — that is, in the first years of life — can lead to dental fluorosis: white spots, or in more pronounced form brownish ones, on the permanent teeth. They are a cosmetic problem and not a health one; the tooth is not weakened.

In Germany this is rare and practically only arises when several sources come together uncontrolled: too much toothpaste, tablets as well, plus mineral water rich in fluoride. Hence the three practical rules:

• Keep to the age-appropriate amount of toothpaste and apply it yourself.
• Keep the tube out of reach — children's toothpaste tastes sweet.
• Do not use several sources of fluoride at the same time without coordinating it.

From about the eighth year of life the formation of the permanent teeth (apart from the wisdom teeth) is largely complete. Fluorosis can no longer arise after that.

Fluoride-free children's toothpaste

It is available and is deliberately chosen by some parents. Anyone deciding on it should know that the most effective ingredient is thereby missing and that fluoride should be supplied by another route. That belongs in a discussion — and the check-up intervals should then be short, so that incipient caries is found early.