Circuit 3, station 9

There is a large consensus among researchers these days regarding fluoride’s main benefit to teeth, which usually comes from topical application to the outer surface of the teeth, such as when we brush and rinse, and not from direct ingestion. So, there’s typically no need for children to inject any form of fluoride, whether in drops or tablets. Swallowing fluoride is ineffective and dangerous, especially for small children. Fluoride is an endocrine-disrupting substance and a neurotoxin as well. Studies have shown that ingesting fluoride during childhood may cause several learning and behavioural problems.

A range of toothpastes are available containing different levels of fluoride. The amount of fluoride in the toothpaste can be found on the side of the tube and is measured in parts per million (ppm). Toothpastes containing 1,350 to 1,500ppm fluoride are the most effective. 

The optimal dose of fluoride is 0.05 mg per kilogram per day. Using a pea-sized amount of toothpaste versus a smear more than doubles the amount of fluoride potentially consumed by a child. Although the risk of developing fluorosis in the permanent dentition is associated with fluoride exposure beginning at 1 year of age, the risk to the permanent central incisors is greatest at approximately 2 years of age. 

Recommending fluoride therapy in children – whether it be fluoride supplements, toothpaste or professional topical applications – typically is tied to caries risk assessment, with fluoride therapies recommended for children who are at high risk of developing caries. All children should undergo a caries risk assessment before their dentists make recommendations associated with preventing or controlling dental caries.

Both adults and children should spit toothpaste out instead of rinsing with water after brushing.

Rinsing after brushing reduces the amount of fluoride and is not recommended. 

Fluoride supplementation is not mandatory as it depends upon whether they live in a water fluoridated area and whether they have risk factors for caries. 

The risk factors for poor oral health including caries – diet, smoking, alcohol use, hygiene, stress and trauma – are the same as those for many chronic conditions. Risk factors for severe dental caries in the UK include: living in a deprived area; being from a lower socioeconomic group or living with a family in receipt of income support; belonging to a family of Asian origin; or living with a Muslim family where the mother speaks little English. Other risk factors include substance misuse or having a chronic medical condition. 

If there is a low (0.3ppm) or no water fluoridation, then fluoride toothpaste is recommended

Toothpastes containing 1,350 to 1,500ppm fluoride are the most effective. 

• Children under 3 years old should brush twice daily, with a smear of toothpaste containing at least 1,000ppm fluoride.
• Children between 3 and 6 years old should brush at least twice daily with a pea-sized amount of toothpaste containing more than 1,000ppm fluoride.
• Children over 7 and adults should brush at least twice daily with a toothpaste containing 1,350-1,500ppm fluoride.