Topical fluoride as a cause of dental fluorosis in children

Abstract

BackgroundFor many years, topical use of fluorides has gained greater popularity than systemic use of fluorides. A possible adverse effect associated with the use of topical fluoride is the development of dental fluorosis due to the ingestion of excessive fluoride by young children with developing teeth. ObjectivesTo describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis. Search strategyElectronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, EMBASE, BIOSIS, Dissertation Abstracts and LILACS/BBO. Reference lists from relevant articles were searched. Date of the most recent searches: 9th March 09. Selection criteriaRandomised controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies and cross-sectional surveys, in which fluoride toothpastes, mouthrinses, gels, foams, paint-on solutions, and varnishes were compared to an alternative fluoride treatment, placebo or no intervention group. Children under the age of 6 years at the time topical fluorides were used. Data collection and analysisData from all included studies were extracted by two review authors. Risk ratios for controlled, prospective studies and odds ratios for case-control studies or cross-sectional surveys were extracted or calculated. Where both adjusted and unadjusted risk ratios or odds ratios were presented, the adjusted value was included in the meta-analysis. Main results25 studies were included: 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias. Studies were included in four intervention/exposure comparisons. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months odds ratio 0.70 (random-effects: 95% confidence interval 1 Topical fluoride as a cause of dental fluorosis in children (Review)

Topical fluoride for caries prevention

“…There is less of a concern about professionally applied topical fluorides for which there are longer intervals between applications. 94 Fluoride varnish dispensed in unit doses has lower potential for harm than do other forms of high-concentration topical fluoride agents, because the amount of fluoride that is placed in the mouth by means of fluoride varnish is approximately one-tenth that of other professionally applied products. 95 …”

Pediatricians’ oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany

“…In contrast, the majority of our responders recommended the start of tooth-brushing and the use of toothpaste after the 1st birthday. Pediatricians and dentists are in agreement that young children swallow the majority of toothpaste until they can spit out and that it is necessary to limit the consumption of toothpaste with dose recommendations [1-5,13,20-22]. Additionally, parents should assist and supervise tooth-brushing [3-5,21,22].…”

“…Pediatricians and dentists are in agreement that young children swallow the majority of toothpaste until they can spit out and that it is necessary to limit the consumption of toothpaste with dose recommendations [1-5,13,20-22]. Additionally, parents should assist and supervise tooth-brushing [3-5,21,22]. The AAPD recommends that children less than 2 years of age should use a smear layer of fluoride toothpaste (≥1000 ppm) twice a day, and children up to 5 years of age should use a pea-sized amount [4].…”

A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary care dental services: the Northern Ireland Caries Prevention In Practice (NIC-PIP) trial

“…Research shows that fluorosis risk is related to an elevated fluoride intake for all of the first 3 years of life, 46 but that the first 2 years of life are the period with greatest risk. 47 A Cochrane review 48 that assessed fluorosis risk associated with use of fluoride-containing toothpaste in early childhood included 25 studies of different designs. There was weak, unreliable evidence that brushing a child's teeth with a toothpaste containing fluoride, before the age of 12 months, may be associated with an increased risk of developing mild fluorosis.…”

“…There was a small number of ARs with a possible link to the varnish; all of these were minor in nature and self-limiting, which suggests that fluoride-containing varnish in this young age group is safe. There is a potential increased risk of fluorosis, 48 which will only be apparent when the permanent incisor teeth erupt at 8-9 years of age and, therefore, assessment of this outcome is outside the scope of the trial reported here.…”