Overview
When daily tooth brushing with fluoridated toothpaste is not carried out or when the caries risk is increased, additional supplemental sources of fluoride may be recommended [1]. Fluoride supplements may come in the form of drops, lozenges, tablets or chewing gums. Most products contain sodium fluoride and are flavoured (mint or fruit) and sweetened by “tooth friendly” xylitol or sorbitol. The mechanism of action is local rather than systemic. The guidelines for fluoride supplements vary across the world.
Use and Application
Fluoride supplements should be used as prescribed by the dentist. The most common prescription for children is 1-2 tablets or lozenges per day containing 0.25 mg NaF. For adults, lozenges up to 0.75 mg NaF are available. The prescription is determined by age and by the level of fluoride in the local drinking water.
Effectiveness and Efficacy
Evidence of the effectiveness of fluoride supplements is inconsistent and confidence in the evidence available is very low. Practitioners are encouraged to conduct a caries risk assessment before prescribing fluoride supplements. When fluoride supplements are prescribed, they should be taken daily to maximize the caries prevention benefit [2].
Safety
The use of fluoride supplements in infants is controversial due to the risk of dental fluorosis and the total fluoride exposure from other sources must be considered. Fluoride supplements must be stored out of reach of small children. For patients aged 3 years and above, fluoride supplements are safe across the life course.
Cost Effectiveness
There are a lack of contemporary studies concerning the cost effectiveness of fluoride supplements and no current comparisons with other self-applied fluorides are available. The poor compliance with fluoride supplements is a serious drawback for its cost effectiveness.
Recommendations
Fluoride supplements are a preventive option for individual subjects with increased caries risk. In particular, elderly patients with impaired saliva functions, may benefit from fluoride lozenges and chewing gums which stimulate saliva secretion. Fluoride supplements are generally no longer a first choice treatment option in population-based programs.
Key Further Reading
1- Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children.
Tubert-Jeannin S, Auclair C, Amsallem E, et al. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD007592.
2- Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the ADA Council on Scientific Affairs.
Rozier, et al. Evidence-based clinical recommendations on the prescription of dietary fluoride supplements for caries prevention: a report of the ADA Council on Scientific Affairs. JADA 2010; 141:1480-1489
Guidance Document
ACFF Members can download the full reference document for Fluoride Supplements.