CDC releases new guidelines on fluoride use to prevent tooth decay

The Centers for Disease Control and Prevention (CDC) today issued new recommendations for fluoride use in the current day environment of widespread use of bottled waters and availability of a host of fluoride-containing products. Fluoride is a well-known preventative for tooth decay.

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States provides guidance to dental and health care providers, public health officials and the general public on the best practices in using fluoride to prevent tooth decay. A work group of fluoride experts evaluated the scientific evidence for the various fluoride products used in the United States.

"Fluoride is needed throughout the lifespan to prevent and control tooth decay. Better use of fluoride can lead to considerable savings in public and private resources and continue the tremendous advances we’ve made in reducing tooth decay," said CDC Director Dr. Jeffrey Koplan.

Fluoridation of community drinking water, which began in the late1940s, and use of other fluoride products, are credited for the dramatic reductions in tooth decay experienced by U.S. residents. In 1999, the CDC included water fluoridation in its list of 10 great public health achievements of the 20th century. Studies show that fluoride prevents the formation, slows the progression, and even reverses newly-forming cavities.

"Although these declines have been dramatic, there are still some areas of the country that are not receiving the benefits of water fluoridation," Koplan added.

Key recommendations for fluoride use include the following:

Continue and expand fluoridation of community drinking water. Water fluoridation in the proper amounts (0.7-1.2 parts per million [ppm]) has been accepted as a safe, effective, and inexpensive method of preventing tooth decay. Adding fluoride to municipal drinking water also is an efficient strategy to reduce the inequalities in dental disease among Americans of all social strata. All persons should know whether or not their primary source of drinking water has an optimal level of fluoride. Approximately 100 million Americans currently do not receive the benefit of fluoridation.

Frequent use of small amounts of fluoride. Daily and frequent exposure to small amounts of fluoride will best reduce the risk of tooth decay for all age groups. The recommendations strongly support drinking water with optimal levels of fluoride and following self-care practices such as brushing at least twice a day with fluoridated toothpaste.

Use supplements and high concentration fluoride products judiciously. Fluoride supplements for children may best be prescribed for those who are at high risk for decay and who live in communities that have a low fluoride concentration in their drinking water. High concentration fluoride products, such as professionally applied gels, foams, and varnishes, also may best benefit children who are at high risk of decay.

Parents should monitor the fluoride intake of children younger than six years old. The first six years of life are an important period for tooth development. Overuse of fluoride during this period can result in enamel fluorosis, a condition that may appear as white lines or spots on the teeth. Monitoring fluoride sources by parents can reduce the occurrence of white spots while preventing early tooth decay. Children under age six should use only a "pea-sized" amount of fluoride toothpaste; parents should consult their child’s doctor or dentist concerning use of fluoride toothpaste for children under age two.

Label bottled water with the fluoride concentration. Increased labeling of bottled waters on a voluntary basis will allow consumers to make informed decisions on their fluoride intake.

Educating health professionals and the public. Collaborative efforts by professional organizations, public agencies and suppliers of oral care products are needed to encourage behavior change to facilitate improved, coordinated use of fluoride products and regimens currently available.

Further research. Additional studies are needed to learn more about fluoride use and evaluate the current cost-effectiveness of fluoride modalities (i.e., toothpastes, mouth rinses, supplements, gels, and varnishes).

"With multiple sources of fluoride available to us, we want to ensure that every family member gets fluoride in the right amount, in the right place, and at the right time," stated Dr. William R. Maas, director of CDC’s Division of Oral Health (DOH). "These new recommendations will provide the framework for effective and efficient fluoride use in today’s environment of multiple sources of fluoride."

The complete report is available at the CDC Web site: www2.cdc.gov/mmwr/. For more information, please call CDC at the numbers listed above or visit the DOH Web site at http://www.cdc.gov/nccdphp/oh/.

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