Dental Caries - Fact Sheets - Community Water Fluoridation

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Centers for Disease Control and Prevention

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States

In August, 2001, the Centers for Disease Control and Prevention (CDC) issued Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. These recommendations provide guidance to health care providers, public health officials, policymakers, and the general public on how to achieve maximum protection from tooth decay while minimizing any cosmetic concerns by efficiently using fluoride products and dental care resources. These recommendations are summarized below; please refer to the document for more detailed recommendations.

A press release on the above document was issued on August 17, 2001.

Continue and extend fluoridation of community drinking water. Water fluoridation in the proper amounts (0.7–1.2 parts per million [ppm]) has been accepted as a safe, effective, and inexpensive method of preventing tooth decay. Adding fluoride to municipal drinking water is an efficient strategy to reduce dental disease among Americans of all social strata. It is the most cost-effective way to prevent tooth decay among populations living in areas with adequate community water supply systems. Community water fluoridation is the foundation for sound community caries-prevention programs.

Use small amounts of fluoride frequently. Daily and frequent exposure to small amounts of fluoride will best reduce the risk of tooth decay for all age groups. The recommendations strongly support drinking water with optimal levels of fluoride and following self-care practices such as brushing at least twice a day with fluoridated toothpaste.

Counsel parents and caregivers on the use of fluoride toothpaste by young children, especially those younger than 2 years. Fluoride toothpaste is a cost-effective way to reduce the prevalence of tooth decay. However, because they do not have a well-developed swallowing reflex and may like the taste of the toothpaste, young children often swallow a large portion of the toothpaste put on their brush. This fact presents an increased risk of enamel fluorosis (a whitish discoloration of the tooth enamel) for children younger than 6 years and especially for those children younger than age 2. Before recommending use of fluoride toothpaste for children younger than 2 years, the dentist or other health care provider should consider the fluoride level in the community drinking water, other sources of fluoride, and factors likely to affect susceptibility to tooth decay when weighing the risk and benefits of using fluoride toothpaste. In general, the recommendation is for parental supervision of the amount (small pea-size) of toothpaste that is placed on the child's toothbrush

Parents should monitor the fluoride intake of children younger than 6 years old. The first 6 years of life are an important period for tooth development. Overuse of fluoride during this period can result in enamel fluorosis, a developmental condition of tooth enamel that may appear as white lines or spots. Monitoring fluoride sources by parents can reduce the occurrence of white spots while preventing early tooth decay. Children under age 6 should use only a pea-sized amount of fluoride toothpaste; parents should consult their child’s doctor or dentist concerning use of fluoride toothpaste for children under age 2.

Use supplements and high concentration fluoride products judiciously. Fluoride supplements for children may best be prescribed for those who are at high risk for decay and who live in communities that have a low fluoride concentration in their drinking water. High concentration fluoride products, such as professionally applied gels, foams, and varnishes, also may best benefit children who are at high risk of decay.

Label bottled water with the fluoride concentration. Increased manufacturer labeling of the fluoride content in bottled waters on a voluntary basis will allow consumers to make informed decisions on their fluoride intake.

Educate health professionals and the public. Collaborative efforts by professional organizations, public agencies, and suppliers of oral care products are needed to encourage behavior change to facilitate improved, coordinated use of fluoride products and regimens currently available.

Further research. Additional studies are needed to learn more about fluoride use and evaluate the current decay prevention effectiveness of fluoride modalities (i.e., community water, toothpastes, mouth rinses, supplements, gels, and varnishes), alone and in combinations. Of particular interest are groups and persons at high risk for dental decay, including older adults.