The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

THE FLUORIDE
DEBATE

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

DISEASES

Question 20.
Can fluorosis in children's teeth be prevented?

ADA's Fluoridation Facts Short Answer
Because risk factors have been identified and verified by generally accepted scientific knowledge, the occurrence of dental fluorosis in the United States can be reduced without denying young children the decay prevention benefits of community water fluoridation.

ADA's Fluoridation Facts Long Answer
During the period of enamel formation in young children (before teeth appear in the mouth), inappropriate ingestion of high levels of fluoride is the risk factor for dental fluorosis.52, 135 Studies of fluoride intake from the diet including foods, beverages and water indicate that fluoride ingestion from these sources has remained relatively constant for over half a century and, therefore, is not likely to be associated with an observed increase in dental fluorosis.104, 107

Dental decay has decreased because children today are being exposed to fluoride from a wider variety of sources than decades ago. Many of these sources are intended for topical use only; however, some fluoride is inadvertently ingested by children.109 Inappropriate ingestion of topical fluoride can be prevented, thus reducing the risk for dental fluorosis without reducing decay prevention benefits.

Since 1992, the American Dental Association has required manufacturers of toothpaste to include the phrase "Use only a pea-sized amount (of toothpaste) for children under six" on fluoride toothpaste labels with the ADA Seal of Acceptance. The rationale for choosing six years of age for the toothpaste label is based on the fact that the swallowing reflex is not fully developed in children of preschool age and they may inadvertently swallow toothpaste during brushing. In addition, the enamel formation of permanent teeth is basically complete at six and so there is a decreased risk of fluorosis. Because dental fluorosis occurs while teeth are forming under the gums, individuals whose teeth have erupted are not at risk for dental fluorosis.

Additional discussion on this topic may be found in Question 16 and Question 19.

Numerous studies have established a direct relationship between young children brushing with more than the recommended pea-sized amount of fluoride toothpaste and the risk of very mild or mild dental fluorosis.136-138 One study of 916 children residing in a fluoridated community revealed that an estimated 71% of identified fluorosis cases could be explained by a history of having brushed more than once a day with more than the recommended amount (only one pea-sized dab at each brushing) of fluoride toothpaste throughout the first eight years of life.139 Parents and caregivers should put only one pea-sized amount of fluoride toothpaste on a young child's toothbrush at each brushing. Young children should be supervised while brushing and taught to spit out, rather than swallow, the toothpaste.

Additionally, it has been shown that 25% of the fluorosis cases could be explained by a history of taking dietary fluoride supplements inappropriately (i.e., while also consuming fluoridated water) during the first eight years of life.139 Dietary fluoride supplements should be prescribed as recommended in the Dietary Fluoride Supplement Schedule approved by the American Dental Association, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry in 1994 (See Table 1.)12 Fluoride supplements should only be prescribed for children living in nonfluoridated areas. Because of many sources of fluoride in the diet, proper prescribing of fluoride supplements can be complex. It is suggested that all sources of fluoride be evaluated with a thorough fluoride history before supplements are prescribed for a child.73 Included in that evaluation is the testing of the home water supply if the fluoride concentration is unknown.

Parents, caregivers and health care professionals should judiciously monitor use of all fluoride-containing dental products by children under age six. As is the case with any therapeutic product, more is not always better. Care should be taken to adhere to label directions on fluoride prescriptions and over-the-counter products (e.g., fluoride toothpastes and rinses). The American Dental Association recommends the use of fluoride mouthrinses, but not for children under six years of age because they may swallow the rinse. In addition, these products should be stored out of the reach of children.

Finally, in areas where naturally occurring fluoride levels in ground water are higher than 2 ppm, consumers should consider action to lower the risk of dental fluorosis for young children. (Adults are not affected because dental fluorosis occurs only when developing teeth are exposed to elevated fluoride levels.) Families on community water systems should contact their water supplier to ask about the fluoride level. Consumers with private home wells should have the source tested to accurately determine the fluoride content. Consumers should consult with their dentist regarding water testing and discuss appropriate dental health care measures. In homes where young children are consuming water with a fluoride level greater than 2 ppm, families should use an alternative primary water source, such as bottled water, for drinking and cooking. Private wells should be tested at least yearly due to possible fluctuations in water tables. It is important to remember that the American Dental Association recommends dietary fluoride supplements only for children living in areas with less than optimally fluoridated water.

Additional discussion on this topic may be found in Question 9 and Question 32.

Repeat of Question 20.
Can fluorosis in children's teeth be prevented?

Opposition's Response

Yes; avoid fluoridated water and toothpaste containing fluoride.

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First Edition
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