Advice to parents has changed in recent years. Whereas it was thought that fluoride worked best if given by mouth as drops or tablets, dentists now think that topical application, in toothpaste, is preferable. Most dentists today recommend supplementation only for children at high risk of decay – for example, those with decay in their milk teeth. Children who are not at particular risk should get all the fluoride they need from toothpaste.
If a child has too much fluoride when the permanent front teeth are developing – around the second birthday – it can lead to the discoloration known as fluorosis. But working out how much a child is getting can be difficult. It is the total intake – from supplements, toothpaste and the water you drink – that matters.
All water contains some fluoride (including bottled water), but you cannot tell how much unless you call your water company to ask. If you live in an area with more than 0.7 parts per million of fluoride in the drinking water, do not give your child extra fluoride.
Young children often swallow toothpaste and this can pose a problem. There is evidence of a connection between swallowing fluoride toothpaste and enamel mottling (fluorosis) in children. it has been suggested that young children may swallow up to half the paste on the brush, so children up to six who are caries-free should just use a pea-sized amount of low-fluoride toothpaste (around 500 parts per million).
You can check the fluoride content of toothpaste in the list of ingredients – it’s listed as ppmF. Children over six and those at high risk should use a pea-sized amount of adult-strength fluoride toothpaste (1,000 or 1,4500 ppmF), rather than ‘baby’ toothpaste, which contains less fluoride.
According to the latest evidence, it is best to spit out toothpaste but not to rinse. The more frequently children rinse and the more water they use, the quicker the fluoride is cleared from the mouth. Not rinsing means fluoride is retained in the mouth longer, giving better benefit.
The mottling caused by fluoride – fluorosis – is permanent, but there are ways of cosmetically whitening the teeth using either micro-abrasion, a porcelain veneer/crown, or a white filling material.
A slow-release fluoride implant developed by Jack Toumba at Leeds Dental Institute releases fluoride continuously into the mouth. The implant is made of glass, is about 6mm and is attached by the dentist to the back tooth with dental cement. One study showed that after two years, children with this implant had 76 percent fewer cavities than those without the implant. The device may be available in about five years’ time. It will not completely eliminate cavities, but it is expected to reduce them dramatically.
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