Abstract
OBJECTIVE: To prevent fluorosis caused by excessive fluoride ingestion by revising recommendations for fluoride intake by children. OPTIONS: Limiting fluoride ingestion from fluoridated water, fluoride supplements and fluoride dentifrices. OUTCOMES: Reduction in the prevalence of dental fluorosis and continued prevention of dental caries. EVIDENCE: Before the workshop, experts prepared comprehensive literature reviews of fluoride therapies, fluoride ingestion and the prevalence and causes of dental fluorosis. The papers, which were peer-reviewed, revised and circulated to the workshop participants, formed the basis of the workshop discussions. VALUES: Recommendations to limit fluoride intake were vigorously debated before being adopted as the consensus opinion of the workshop group. BENEFITS, HARMS AND COSTS: Decrease in the prevalence of dental fluorosis with continuing preventive effects of fluoride use. The only significant cost would be in preparing new, low-concentration fluoride products for distribution. RECOMMENDATIONS: Fluoride supplementation should be limited to children 3 years of age and older in areas where there is less than 0.3 ppm of fluoride in the water supply. Children in all areas should use only a "pea-sized" amount of fluoride dentifrice no more than twice daily under the supervision of an adult. VALIDATION: These recommendations are almost identical to changes to recommendations for the use of fluoride supplements recently proposed by a group of European countries. SPONSORS: The workshop was organized by Dr. D. Christopher Clark, of the University of British Columbia, and Drs. Hardy Limeback and Ralph C. Burgess, of the University of Toronto, and funded by Proctor and Gamble Inc., Toronto, the Medical Research Council of Canada and Health Canada (formerly the Department of National Health and Welfare). The recommendations were formally adopted by the Canadian Dental Association in April 1993.
Full text
PDF






Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Beltran E. D., Burt B. A. The pre- and posteruptive effects of fluoride in the caries decline. J Public Health Dent. 1988 Fall;48(4):233–240. doi: 10.1111/j.1752-7325.1988.tb03204.x. [DOI] [PubMed] [Google Scholar]
- Burt B. A. The changing patterns of systemic fluoride intake. J Dent Res. 1992 May;71(5):1228–1237. doi: 10.1177/00220345920710051601. [DOI] [PubMed] [Google Scholar]
- Clarkson J. A European view of fluoride supplementation. Br Dent J. 1992 May 9;172(9):357–357. doi: 10.1038/sj.bdj.4807866. [DOI] [PubMed] [Google Scholar]
- Clarkson J. Review of terminology, classifications, and indices of developmental defects of enamel. Adv Dent Res. 1989 Sep;3(2):104–109. doi: 10.1177/08959374890030020601. [DOI] [PubMed] [Google Scholar]
- Clovis J., Hargreaves J. A. Fluoride intake from beverage consumption. Community Dent Oral Epidemiol. 1988 Feb;16(1):11–15. doi: 10.1111/j.1600-0528.1988.tb00545.x. [DOI] [PubMed] [Google Scholar]
- Driscoll W. S., Horowitz H. S., Meyers R. J., Heifetz S. B., Kingman A., Zimmerman E. R. Prevalence of dental caries and dental fluorosis in areas with negligible, optimal, and above-optimal fluoride concentrations in drinking water. J Am Dent Assoc. 1986 Jul;113(1):29–33. doi: 10.14219/jada.archive.1986.0141. [DOI] [PubMed] [Google Scholar]
- Evans R. W., Stamm J. W. An epidemiologic estimate of the critical period during which human maxillary central incisors are most susceptible to fluorosis. J Public Health Dent. 1991 Fall;51(4):251–259. doi: 10.1111/j.1752-7325.1991.tb02223.x. [DOI] [PubMed] [Google Scholar]
- Heifetz S. B., Driscoll W. S., Horowitz H. S., Kingman A. Prevalence of dental caries and dental fluorosis in areas with optimal and above-optimal water-fluoride concentrations: a 5-year follow-up survey. J Am Dent Assoc. 1988 Apr;116(4):490–495. doi: 10.14219/jada.archive.1988.0309. [DOI] [PubMed] [Google Scholar]
- Holm A. K., Andersson R. Enamel mineralization disturbances in 12-year-old children with known early exposure to fluorides. Community Dent Oral Epidemiol. 1982 Dec;10(6):335–339. doi: 10.1111/j.1600-0528.1982.tb00405.x. [DOI] [PubMed] [Google Scholar]
- Ismail A. I., Brodeur J. M., Kavanagh M., Boisclair G., Tessier C., Picotte L. Prevalence of dental caries and dental fluorosis in students, 11-17 years of age, in fluoridated and non-fluoridated cities in Quebec. Caries Res. 1990;24(4):290–297. doi: 10.1159/000261285. [DOI] [PubMed] [Google Scholar]
- Ismail A. I., Shoveller J., Langille D., MacInnis W. A., McNally M. Should the drinking water of Truro, Nova Scotia, be fluoridated? Water fluoridation in the 1990s. Community Dent Oral Epidemiol. 1993 Jun;21(3):118–125. doi: 10.1111/j.1600-0528.1993.tb00734.x. [DOI] [PubMed] [Google Scholar]
- Jenkins G. N., Edgar W. M. The distribution and metabolic effects of human plaque fluorine. Arch Oral Biol. 1969 Jan;14(1):105–119. doi: 10.1016/0003-9969(69)90025-9. [DOI] [PubMed] [Google Scholar]
- Koch G., Bergmann-Arnadottir I., Bjarnason S., Finnbogason S., Höskuldsson O., Karlsson R. Caries-preventive effect of fluoride dentifrices with and without anticalculus agents: a 3-year controlled clinical trial. Caries Res. 1990;24(1):72–79. doi: 10.1159/000261242. [DOI] [PubMed] [Google Scholar]
- Koch G., Petersson L. G., Kling E., Kling L. Effect of 250 and 1000 ppm fluoride dentifrice on caries. A three-year clinical study. Swed Dent J. 1982;6(6):233–238. [PubMed] [Google Scholar]
- Leverett D. Prevalence of dental fluorosis in fluoridated and nonfluoridated communities--a preliminary investigation. J Public Health Dent. 1986 Fall;46(4):184–187. doi: 10.1111/j.1752-7325.1986.tb03140.x. [DOI] [PubMed] [Google Scholar]
- Nakata M., Kuriyama S., Mitsuyasu K., Morimoto M., Tomioka K. Transfer of innovation for advancement in dentistry: a case study on pit and fissure sealants' use in Japan. Int Dent J. 1989 Dec;39(4):263–268. [PubMed] [Google Scholar]
- Newbrun E. Effectiveness of water fluoridation. J Public Health Dent. 1989;49(5 Spec No):279–289. doi: 10.1111/j.1752-7325.1989.tb02086.x. [DOI] [PubMed] [Google Scholar]
- Ophaug R. H., Singer L., Harland B. F. Dietary fluoride intake of 6-month and 2-year-old children in four dietary regions of the United States. Am J Clin Nutr. 1985 Oct;42(4):701–707. doi: 10.1093/ajcn/42.4.701. [DOI] [PubMed] [Google Scholar]
- Pendrys D. G., Katz R. V. Risk of enamel fluorosis associated with fluoride supplementation, infant formula, and fluoride dentifrice use. Am J Epidemiol. 1989 Dec;130(6):1199–1208. doi: 10.1093/oxfordjournals.aje.a115448. [DOI] [PubMed] [Google Scholar]
- Riordan P. J., Banks J. A. Dental fluorosis and fluoride exposure in Western Australia. J Dent Res. 1991 Jul;70(7):1022–1028. doi: 10.1177/00220345910700070101. [DOI] [PubMed] [Google Scholar]
- Segreto V. A., Collins E. M., Camann D., Smith C. T. A current study of mottled enamel in Texas. J Am Dent Assoc. 1984 Jan;108(1):56–59. doi: 10.14219/jada.archive.1984.0197. [DOI] [PubMed] [Google Scholar]
- Szpunar S. M., Burt B. A. Dental caries, fluorosis, and fluoride exposure in Michigan schoolchildren. J Dent Res. 1988 May;67(5):802–806. doi: 10.1177/00220345880670050101. [DOI] [PubMed] [Google Scholar]
- Thylstrup A. Clinical evidence of the role of pre-eruptive fluoride in caries prevention. J Dent Res. 1990 Feb;69(Spec No):742–823. doi: 10.1177/00220345900690S144. [DOI] [PubMed] [Google Scholar]
- Williams J. E., Zwemer J. D. Community water fluoride levels, preschool dietary patterns, and the occurrence of fluoride enamel opacities. J Public Health Dent. 1990 Summer;50(4):276–281. doi: 10.1111/j.1752-7325.1990.tb02135.x. [DOI] [PubMed] [Google Scholar]
- Woolfolk M. W., Faja B. W., Bagramian R. A. Relation of sources of systemic fluoride to prevalence of dental fluorosis. J Public Health Dent. 1989 Spring;49(2):78–82. doi: 10.1111/j.1752-7325.1989.tb02030.x. [DOI] [PubMed] [Google Scholar]
- de Liefde B., Herbison G. P. Prevalence of developmental defects of enamel and dental caries in New Zealand children receiving differing fluoride supplementation. Community Dent Oral Epidemiol. 1985 Jun;13(3):164–167. doi: 10.1111/j.1600-0528.1985.tb00435.x. [DOI] [PubMed] [Google Scholar]
