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JADA Continuing Education

A systematic review

Background. In this review, the authors examine evidence regarding the effectiveness of fluoride supplements in preventing caries and their association with dental fluorosis.

Methods. Using tested search filters, the authors searched MEDLINE, the Cochrane Central Register of Controlled Trials, OVID Evidence-based Reviews and EMBASE. The authors agreed on the inclusion of 20 reports from 12 trials that met defined criteria. They also included five studies published since 1997 regarding the association between dental fluorosis and supplements.

Results. Eleven of the reports evaluated dosage schedules similar to that recommended by the American Dental Association. One potentially highly biased study of primary teeth of children during the first three years of life reported a 47.2 percent reduction in dental caries experience. Investigators in one trial involving 3- to 6-year-old children found a 43.0 percent difference, and another trial of children in this age group did not find a significant benefit. Researchers in several studies involving older children detected a significant reduction in caries increments in permanent teeth with the use of fluoride supplements. Fifteen of the studies had withdrawal rates of 30 percent or higher. All of the five included studies that evaluated the association between use of fluoride supplements and dental fluorosis found that use of the supplements increased the risk of mild-to-moderate fluorosis.

Conclusions. There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth. There is evidence that such supplements prevent caries in permanent teeth. Mild-to-moderate dental fluorosis is a significant side effect.

Clinical Implications. The current recommendations for use of fluoride supplements during the first six years of life should be re-examined.

Key Words: Fluoride; supplements; fluorosis; systematic review

Abbreviations: ADA: American Dental Association • APF: Acidulated phosphate fluoride • CSA: Council on Scientific Affairs • defs: Decayed, extracted because of caries and filled surfaces of primary teeth • deft: Decayed, extracted because of caries, filled primary teeth • dfs: Decayed and filled surfaces of primary teeth • DFS: Decayed and filled surfaces of permanent teeth • dmfs: Decayed, missing and filled surfaces of primary teeth • DMFS: Decayed, missing and filled surfaces of permanent teeth • F: Fluoride • NaF: Sodium fluoride

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