Fluoride use in pediatric dentistry: balancing benefits and risks
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20250048Keywords:
Fluoride, Pediatric dentistry, Dental caries prevention, Dental fluorosis, Oral health strategiesAbstract
Fluoride has been a critical component in pediatric dentistry, offering significant protection against dental caries, a prevalent issue among children globally. Its mechanisms of action include enhancing enamel resistance through remineralization, inhibiting demineralization, and reducing bacterial activity in the oral cavity. These processes contribute to strengthening teeth and reducing the risk of decay, making fluoride a cornerstone in both individual and community dental care. However, excessive fluoride exposure, particularly in early childhood, poses risks such as dental fluorosis and, in rare cases, systemic toxicity. Strategies to ensure safe and effective fluoride use involve a combination of public health measures and individualized approaches. Community water fluoridation remains a cost-effective solution, significantly reducing caries prevalence while requiring strict monitoring to maintain safe levels. Topical applications, such as fluoride toothpaste and varnishes, provide targeted protection and minimize systemic intake, especially in high-risk populations. Recommendations for parental supervision during toothbrushing and the use of age-appropriate fluoride toothpaste are critical in reducing the risk of overexposure. Localized therapies, such as fluoride varnish and supplements for non-fluoridated areas, further enhance protective effects while addressing regional disparities. Public education campaigns play an essential role in raising awareness about proper fluoride use, fostering healthier oral hygiene practices among children and their caregivers. Ongoing research and evidence-based guidelines remain fundamental in optimizing fluoride application and addressing emerging concerns. Balancing the benefits of fluoride in preventing caries with the risks of overexposure requires a comprehensive approach that integrates scientific advancements, public health initiatives, and community-specific strategies.
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References
Cate JMt. Current concepts on the theories of the mechanism of action of fluoride. Acta Odontol Scand. 1999;57(6):325-9. DOI: https://doi.org/10.1080/000163599428562
Featherstone JD. Prevention and reversal of dental caries: role of low level fluoride. Comm Dentistry Oral Epidemiol. 1999;27(1):31-40. DOI: https://doi.org/10.1111/j.1600-0528.1999.tb01989.x
Levy SM. An update on fluorides and fluorosis. J Canad Dent Assoc. 2003;69(5):286-91.
Burt BA. The changing patterns of systemic fluoride intake. J Dent Res. 1992;71(5):1228-37. DOI: https://doi.org/10.1177/00220345920710051601
McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, et al. Systematic review of water fluoridation. BMJ. 2000;321(7265):855-9. DOI: https://doi.org/10.1136/bmj.321.7265.855
Azarpazhooh A, Main PA. Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review. J Canad Dent Assoc. 2008;74(1).
Newbrun E. Mechanism of fluoride action in caries prevention. Fluorides Dent Caries. 1986;3:55-173.
Yang Z, Cai T, Li Y, Jiang D, Luo J, Zhou Z. Effects of topical fluoride application on oral microbiota in young children with severe dental caries. Front Cellular Infect Microbiol. 2023;13:1104343. DOI: https://doi.org/10.3389/fcimb.2023.1104343
Tenuta LMA, Cury JA. Fluoride: its role in dentistry. Braz Oral Res. 2010;24:9-17. DOI: https://doi.org/10.1590/S1806-83242010000500003
Hellwig E, Lennon A. Systemic versus topical fluoride. Caries Res. 2004;38(3):258-62. DOI: https://doi.org/10.1159/000077764
McDonagh M, Whiting P, Bradley M. A systematic review of public water fluoridation. University of York, NHS Centre for Reviews & Dissemination. 2000.
Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;2013(7):CD002279. DOI: https://doi.org/10.1002/14651858.CD002279.pub2
Twetman S, Axelsson S, Dahlgren H, Holm AK, Källestål C, Lagerlöf F, et al. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand. 2003;61(6):347-55. DOI: https://doi.org/10.1080/00016350310007590
Birkeland JM, Torell P. Caries-preventive fluoride mouthrinses. Caries Res. 1978;12(1):38-51. DOI: https://doi.org/10.1159/000260364
Dean HT. The investigation of physiological effects by the epidemiological method. Fluorine Dent health. 1942;23-31.
Levy SM. Review of fluoride exposures and ingestion. Community Dentistry Oral Epidemiol. 1994;22(3):173-80. DOI: https://doi.org/10.1111/j.1600-0528.1994.tb01836.x
Kragstrup J, Richards A, Fejerskov O. Effects of fluoride on cortical bone remodeling in the growing domestic pig. Bone. 1989;10(6):421-4. DOI: https://doi.org/10.1016/8756-3282(89)90073-2
World Health Organization. Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y. Fluoride in drinking-water. 2006. Available at: https://www. who.int/publications/i/item/9241563192. Accessed on 17 October 2024.
Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, Zentz RR. Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review. J Am Dent Assoc. 2014;145(2):182-9. DOI: https://doi.org/10.14219/jada.2013.37
Weintraub JA, Professor LH. Fluoride varnish for caries prevention: comparisons with other preventive agents and recommendations for a community‐based protocol. Special Care Dentistry. 2003;23(5):180-6. DOI: https://doi.org/10.1111/j.1754-4505.2003.tb00309.x
Centres for Disease Control and Prevention. Achievements in public health, 1900-1999: fluoridation of drinking water to prevent dental caries. MMWR. 1999;48:933-40.
Rozier RG, Adair S, Graham F, Iafolla T, Kingman A, Kohn W, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2010;141(12):1480-9. DOI: https://doi.org/10.14219/jada.archive.2010.0111