The Case for Retaining the Current Supplementation Schedule

Abstract

Following ingestion of dietary fluoride, microquantities of fluoride return to the mouth in saliva, but in quantities large enough to facilitate the maintenance and reparative functions of enamel. Dietary fluoride supplements alone are unlikely to be the cause of the reported increase in fluorosis. Compliance continues to be extremely poor and few children use supplements for more than a year and a half. The amount of background fluoride resulting from dietary fluoride supplements appears to be very small. Considering the almost ubiquitous presence of fluoride dentifrice and the strong possibility of additional unintentional fluoride ingestion from many sources, the present fluorosis data is too amorphous to use as a basis for making reasonable risk/benefit evaluations. Very mild and mild fluorosis is not a serious problem for either the clinician or the patient. By altering the present recommended dosage we may deprive children from receiving a proven effective dose. One cannot make a risk/benefit decision concerning an esthetic problem without involving the patient's perception as well as the caries score. The apparent severity of the milder forms of fluorosis lessens with age and a community fluorosis index should be used only on populations who are older than 15 years.

Fluorose dental: ficção epidemiológica?

“…Há autores que consideram imprópria a suplementação de flúor (26) e outros que a defendem (27). Este último autor argumenta que a presença quase onipresente de dentifrício fluoretado e a forte possibilidade de ingestão de fluoreto adicional, não intencional, oriundo de muitas fontes, tornam os dados sobre fluorose atualmente relatados na literatura muito inconsistentes.…”

Fluoride Knowledge and Prescription Practices Among Dentists

“…Addressing educational issues among professional students including residents in pediatric dentistry is important, particularly at a time when uncertainties about the general use of fluorides exist among researchers. [10][11][12] The dental curriculum should emphasize the importance of caries risk assessment as well as comprehensive preventive regimens for dental caries. Instruction on caries risk assessment should include fluoride history, fluoride analysis of drinking water, diet history, and comprehensive clinical investigations.…”

“…In their secondary analyses of data from 1930 to 1980, researchers found the highest increase in the prevalence of fluorosis among children living in suboptimally fluoridated areas from 6.5 to 15.5 percent. Lack of consensus exists among researchers: some support the retention of the existing fluoride schedule, 10 while others feel strongly about reducing 11 or completely eliminating 12 the fluoride supplement as a caries prevention agent. As lifelong learners, dentists are bound to pay attention to the equivocal evidence for fluoride supplementation.…”