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European Archives of Paediatric Dentistry
Published in: European Archives of Paediatric Dentistry 6/2019

Open Access 01-12-2019 | Caries | Invited Review

Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document

Authors: K. J. Toumba, S. Twetman, C. Splieth, C. Parnell, C. van Loveren, N. Α. Lygidakis

Published in: European Archives of Paediatric Dentistry | Issue 6/2019

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Abstract

Aim

To update the exisitng European Academy of Paediatric Dentistry (EAPD) 2009 fluoride guidelines.

Methods

Experts met in Athens, Greece duirng November 2018 for the following groups: I Fluoride toothpastes, II Fluoride gels, rinses and varnishes, III Fluoridated milk, fluoridated salt, tablets/lozenges and drops, IV Water fluoridation. Systematic reviews and meta-analyses were reviewed and discussed for each of the groups. The GRADE system was used to assess the quality of evidence which was judged as HIGH, MODERATE, LOW or VERY LOW based on the assessment of eight criteria which can influence the confidence of the results. Following the quality assessment, GRADE was then used to indicate the strength of recommendation for each fluoride agent as STRONG or WEAK/CONDITIONAL.

Results

Parents must be strongly advised to apply an age-related amount of toothpaste and assist/supervise tooth brushing until at least 7 years of age. The EAPD strongly endorses the daily use of fluoride as a major part of any comprehensive programme for the prevention and control of dental caries in children. Regardless of the type of programme, community or individually based, the use of fluoride must be balanced between the estimation of caries-risk and the possible risks of adverse effects of the fluorides. Fluoride use is considered safe when the manufacturer's instructions are followed. Preventive programmes should be re-evaluated at regular intervals and adapted to a patient's or population's needs and risks.

Conclusions

For the majority of European Countries, the EAPD recommends the appropriate use of fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen.
Literature
Bian JY, Wang WH, Wang WJ, Rong WS, Lo ECM. Effect of fluoridated milk on caries in primary teeth: 21-month results. Commun Dent Oral Epidemiol. 2003;31:241–5.
Burt BA. Prevention policies in the light of the changed distribution of dental caries. Acta Odontol Scand. 2008;195:7–63.
Buzalaf MA, Pessan JP, Honorio HM, ten Cate JM. Mechanisms of action of fluoride for caries control. Monogr Oral Sci. 2011;22:97–114.PubMed
Crystal YO, Marghalani AA, Ureles SD, et al. Use of silver diamine fluoride for dental caries management in children and adolescents, including those with special health care needs. Pediatr Dent. 2017;39(5):E135–45.
da Silva AM, Hegde S, Akudo Nwagbara B, et al. Community-based population-level interventions for promoting child oral health. Cochrane Database Syst Rev. 2016;15(9):CD009837.
DenBesten PΚ. Biological mechanisms of dental fluorosis relevant to the use of fluoride supplements. Community Dent Oral Epidemiol. 1999;27:41–7.PubMed
Dos Santos APP, deOliveira BH, Nadanovsky P. A systematic review of the effects of supervised tooth brushing on caries incidence in children and adolescents. Int J Paediatr Dent. 2018;28:3–11.PubMed
EAPD, Toumba KJ, Lygidakis N, Oulis C, et al. Guidelines on the use of fluoride in children: an EAPD policy document. Eur Arch Paed Dent. 2009;10:129–35.
Espelid I. Systemic fluoride supplements—milk, salt and tablets. A literature review. Eur Arch Paediatr Dent. 2008;10(3):149–56.
Fabruccini A, Alves LS, Alvarez L, et al. Comparative effectiveness of water and salt community-based fluoridation methods in preventing dental caries among schoolchildren. Commun Dent Oral Epidemiol. 2016;44:577–85.
Featherstone JD. Prevention and reversal of dental caries: role of low level fluoride. Commun Dent Oral Epidemiol. 1999;27:31–40.
Fejerskov O. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res. 2004;38:182–91.PubMed
Fejerskov O, Thylstrup A, Larsen MJ. Clinical and structural features and possible pathogenic mechanisms of dental fluorosis. Scand J Dent Res. 1977;85(7):510–34.PubMed
Fejerskov O, Thylstrup A, Larsen MJ. Rational use of fluorides in caries prevention. A concept based on possible cariostatic mechanisms. Acta Odontol Scand. 1981;39(4):241–9.PubMed
Gao S, Zhao I, Hiraishi N, et al. Clinical trials of silver di-amine fluoride in arresting caries among children: a systematic review. JDR Clin Transl Res. 2016;1(3):201–10.
Griffin SO, Regnier E, Griffin PM, Huntley V. Effectiveness of fluoride in preventing caries in adults. J Dent Res. 2007;86:410–5.PubMed
Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schünemann HJ, GRADE Working Group. Rating quality of evidence and strength of recommendations: going from evidence to recommendations. BMJ. 2008;336:1049–51.PubMedPubMedCentral
Hong L, Levy SM, Warren JJ, et al. Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars. Caries Res. 2006;40(6):494–500.PubMed
Ismail AΙ, Bandekar RR. Fluoride supplements and fluorosis: a meta-analysis. Commun Dent Oral Epidemiol. 1999;27:48–56.
Jürgensen N, Petersen PE. Promoting oral health of children through schools: results from a WHO global survey 2012. Commun Dental Health. 2013;30:204–18.
Kassebaum NJ, Smith AGC, Bernabe E, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 Countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96:380–7.PubMed
Ketley CE, West JL, Lennon MA. The use of school milk as a vehicle for fluoride in Knowsley, UK; an evaluation of effectiveness. Commun Dent Health. 2003;20:83–8.
Levy SM, Kiritsy MC, Warren JJ. Sources of fluoride intake in children. J Public Health Dent. 1995;55:39–52.PubMed
Marinho VC. Cochrane reviews of randomized trials of fluoride therapies for preventing dental caries. Eur Arch Paediatr Dent. 2009;10:183–91.PubMed
Mejàre I. Current guidance for fluoride intake: is it appropriate? Adv Dent Res. 2018;29:167–76.PubMed
Mejàre IA, Klingberg G, Mowafi FK, et al. A systematic map of systematic reviews in pediatric dentistry—what do we really know? PLoS ONE. 2015;10(2):e0117537.PubMedPubMedCentral
Network Scottish Intercollegiate Guidelines. Sign 50: A guideline developer’s handbook. Scotland: Scottish Intercollegiate Guidelines Network; 2008.
O’Mullane DM, Baez RJ, Jones S, et al. Fluoride and oral health. Commun Dental Health. 2016;33:69–99.
Oulis CJ, Raadal I, Martens L. Guidelines on the use of fluoride in children: an EAPD policy document. Eur J Paediatr Dent. 2000;1:7–12.
Pollick H. Salt fluoridation: a review. CDA J. 2013;41:395–404.
Poulsen S. Fluoride containing gels, mouthrinses and varnishes. An update of efficacy. Eur Arch Paediatr Dent. 2009;10(3):157–61.PubMed
Pretty IA. High fluoride concentration toothpastes for children and adolescents. Caries Res. 2016;50(Suppl 1):9–14.PubMed
Ran T, Chattopadhyay SK. Economic evaluation of community water fluoridation: a community guide systematic review. Am J Prev Med. 2016;50:790–6.PubMedPubMedCentral
Rolla G, Ogaard B, Cruz RDA. Clinical effect and mechanism of cariostatic action of fluoride- containing toothpastes: a review. Int Dent J. 1991;41:171–4.PubMed
Rugg-Gunn AJ, Do L. Effectiveness of water fluoridation in caries prevention. Commun Dent Oral Epidemiol. 2012;40(Suppl 2):55–64.
Scottish Intercollegiate Guidelines Network. Prevention and management of dental decay in the pre-school child. A national clinical guideline. No. 83. In, 2005: 44.
Slayton RL, Urquhart O, Araujo MWB, et al. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: a report from the American Dental Association. J Am Dent Assoc. 2018;149(10):837–49.PubMed
Stecksén-Blicks C, Sjöström I, Twetman S. Effect of longterm consumption of milk supplemented with probiotic lactobacilli and fluoride on dental caries and general health in preschool children: a cluster-randomized study. Caries Res. 2009;43:374–81.PubMed
Sutton M, Kiersey R, Farragher L, Long J. Health effects of water fluoridation - an evidence review. Ireland: Health Res Board; 2015.
Tomasin L, Pusinanti L, Zerman N. The role of fluoride tablets in the prophylaxis of dental caries. A literature review. Ann di Stomatol. 2015;VI(1):1–5.
Twetman S. Caries prevention with fluoride toothpaste in children: an update. Eur Arch Paediatr Dent. 2009;10:162–7.PubMed
Twetman S, Axelsson S, Dahlgren H, et al. Caries-preventive effect of fluoride toothpaste: a systematic review. Acta Odontol Scand. 2003;61:347–55.PubMed
Urquhart O, Tampi MP, Pilcher L, et al. Non-restorative treatments for caries: systematic review and network meta-analysis. J Dent Res. 2019;98(1):14–26.PubMed
Wennhall I, Hajem S, Ilros S, et al. Fluoridated salt for caries prevention and control—a 2-year field study in a disadvantaged community. Int J Paediatr Dent. 2014;24:161–7.PubMed
Wong MC, Clarkson J, Glenny AM, et al. Cochrane reviews on the benefits/risks of fluoride toothpastes. J Dent Res. 2011;90:573–9.PubMed
Wright JT, Hanson N, Ristic H, et al. Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review. J Am Dent Assoc. 2014;145:182–9.PubMed
Yengopal V, Chikte UM, Mickenautsch S, Oliveira LB, Bhayat A. Salt fluoridation: a meta-analysis of its efficacy for caries prevention. SADJ. 2010;65:60–7.PubMed
Metadata
Title
Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document
Authors
K. J. Toumba
S. Twetman
C. Splieth
C. Parnell
C. van Loveren
N. Α. Lygidakis
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
European Archives of Paediatric Dentistry / Issue 6/2019
Print ISSN: 1818-6300
Electronic ISSN: 1996-9805
DOI
https://doi.org/10.1007/s40368-019-00464-2

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