Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.
Systemically Administered Fluoride Supplements
Fluoride supplements should be considered for all children drinking fluoride-deficient (<0.6 parts per million [ppm]) water. After the fluoride level of the water supply or supplies has been determined, either through contacting public health officials or water analysis, and after evaluating other dietary sources of fluoride and assessing the infant's, child's, or adolescent's caries risk, the daily fluoride supplement dosage schedule can be determined using the Dietary Fluoride Supplementation Schedule (see table below).
Table: Dietary Fluoride Supplementation Schedule
| Age |
<0.3 ppm F |
0.3-0.6 ppm F |
>0.6 ppm F |
| Birth-6 months |
0 |
0 |
0 |
| 6 months-3 years |
0.25 mg |
0 |
0 |
| 3-6 years |
0.50 mg |
0.25 mg |
0 |
| 6 years up to at least 16 years |
1.00 mg |
0.50 mg |
0 |
Professionally Applied Topical Fluoride Treatment
Professional topical fluoride treatments should be based on caries-risk assessment ("Recommendations for using fluoride," 2001). A pumice prophylaxis is not an essential prerequisite to this treatment (Johnston & Lewis, 1995). Appropriate precautionary measures should be taken to prevent swallowing of any professionally applied topical fluoride.
Self- or Parentally-Applied Fluoride
The use of fluoride-containing toothpaste should be recommended as a primary preventive procedure. Because ingestion of fluoridated toothpaste carries an increased risk of fluorosis, this risk must be weighed against the benefit of caries prevention in determining the use of a fluoridated toothpaste by a child ("Recommendations for using fluoride," 2001). Parents/caregivers should be counseled on the frequency of tooth-brushing and use no more than a "pea-size" amount of toothpaste (Pang & Vann, 1992).
Children at high risk for caries (e.g., children with orthodontic/prosthodontic appliances, with reduced salivary function, who are unable to clean teeth properly, are at dietary risk, have mothers or siblings with caries, or have high oral levels of cariogenic bacteria) or children with active caries should be considered for additional fluoride therapy. Home fluoride programs using fluoride mouth rinses or brush-on fluoride gels should be recommended for use by school-aged child at high risk for caries. If a patient at high risk for caries cannot or will not comply with home fluoride therapy, frequent professional fluoride treatments may be substituted.
