If an individual's caries risk level is uncertain, treating this person as high risk is prudent until further experience allows a more accurate assessment.
Systemically Administered Fluoride Supplements
Fluoride supplements should be considered for all children drinking fluoride-deficient (<0.6 parts per million [ppm]) water. After determining the fluoride level of the water supply or supplies (either through contacting public health officials or water analysis), evaluating other dietary sources of fluoride, and assessing the child's caries risk, the daily fluoride supplement dosage can be determined using the Dietary Fluoride Supplementation Schedule (see the table below). To optimize the topical benefits of systemic fluoride supplements, the child should be encouraged to chew or suck fluoride tablets.
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. A pumice prophylaxis is not an essential prerequisite to this treatment. Appropriate precautionary measures should be taken to prevent swallowing of any professionally-applied topical fluoride. Children at moderate caries risk should receive a professional fluoride treatment at least every 6 months; those with high caries risk should receive greater frequency of professional fluoride applications (i.e., every 3-6 months). Ideally, this would occur as part of a comprehensive preventive program in a dental home. When a dental home cannot be established for individuals with increased caries risk as determined by caries risk assessment, periodic applications of fluoride varnish by trained non-dental healthcare professionals may be effective in reducing the incidence of early childhood caries.
Fluoride-Containing Products for Home Use
Therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Fluoridated toothpaste should be used twice daily as a primary preventive procedure. Twice daily use has benefits greater than once daily brushing. Parents should be counseled on their child's caries risk, dispensing an appropriate volume of toothpaste onto a soft, age-appropriate sized toothbrush, frequency of brushing, and performing/assisting brushing of young children. A 'smear' of fluoridated toothpaste for children less than 2 years of age may decrease risk of fluorosis. A 'pea-size' amount of toothpaste is appropriate for children aged 2 through 5 years. To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether.
Additional at-home topical fluoride regimens utilizing increased concentrations of fluoride should be considered for children at high risk for caries. These may include over-the counter or prescription strength formulations. Fluoride mouth rinses or brush-on gels may be incorporated into a caries-prevention program for a school-aged child at high risk.
