Clinical Evidence of the Role of Pre-eruptive Fluoride in Caries Prevention

Abstract

Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth.

The use of fluoride in infants and children

“…• The primary mechanism of the action of fluoride in preventing tooth decay is topical (evidence level II-3, recommendation B) (11,13,14) (Table 1). …”

Systemic versus Topical Fluoride

“…Clinical findings are supported by in vitro and in vivo studies demonstrating that the mode of action of fluoride can be mainly attributed to its influence on the de-and remineralization kinetics of dental hard tissues [Fejerskov et al,1981;ten Cate and Featherstone, 1991;ten Cate, 1999]. Thus, fluoride should be present in the oral cavity throughout life, particularly during the period when the teeth are erupting [Thylstrup, 1990]. However, in the clinical situation the optimum fluoride level to prevent caries development is not known.…”

Le recours au fluor chez les nourrissons et les enfants

“…• Le principal mécanisme d'action du fluor pour prévenir la carie dentaire est topique (catégorie II-3, recommandation B) (11,13,14) (tableau 1).…”