Oral fluoride supplementation for children in areas with inadequately fluoridated water and the application of fluoride varnish to all children’s teeth can help prevent dental caries in children aged 5 and under, according to updated recommendations from the U.S. Preventive Services Task Force.
The moderate benefits of both fluoride treatments were determined to outweigh the potential harms of fluorosis, Dr. Virginia A. Moyer reported on behalf of the USPSTF (Pediatrics 2014 [doi:10.15425/peds.2014-0483]).
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The moderate benefits of both fluoride treatments were determined to outweigh the potential harms of fluorosis.
Meanwhile, the task force found no studies that addressed improved clinical outcomes or possible harms of oral screenings by children’s primary care doctors and therefore issued no recommendation regarding routine oral screening exams.
The new statement updates the previous recommendations issued in 2004, when only the oral fluoride supplementation was recommended for children in areas with fluoride levels below 0.6 ppm in the local drinking water. That recommendation remains, with the fluoride varnish recommendation added based on new research. Both interventions received B recommendations and therefore are required by the Affordable Care Act to be covered by insurers without out of pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.
Approximately 42% of children aged 2-11 years old have dental caries in their primary teeth, according to the 1999-2004 National Health and Nutrition Examination Survey, making dental caries the most common chronic disease among U.S. children. Risk factors for increased dental caries include frequent snacking or sugar consumption, inappropriate bottle feeding, low socioeconomic status, being an ethnic minority, poor dental care access, failure to use fluoride toothpaste, a history of previous caries in the child or family, dry mouth, and developmental defects of the tooth enamel.
The task force did not recommend limiting fluoride varnish application only to children at higher risk for dental caries because no validated tools exist for assessing which children are at highest risk, and "a risk-based approach to fluoride varnish application will miss opportunities to provide an effective dental caries preventive intervention to children who could benefit from it," Dr. Moyer, USPSTF chairwoman, wrote.
The oral fluoride supplementation recommendation is based on the same six trials assessed for the 2004 recommendations. Those trials showed a 32%- 72% reduction of decayed, missing and filled teeth and a 38%- 81% reduction of decayed, missing, or filled tooth surfaces, compared with no supplementation or placebo.
The fluoride varnish recommendation relies on three recent studies that found a decreased risk for dental caries (from 1 to 2.4 fewer caries) after 2 years among children receiving a fluoride varnish every 6 months, compared with children not receiving the varnish. It’s unclear, however, how often the varnish should be applied: three other studies found no clinical differences with application multiple times in 2 weeks, once every 6 months or once a year.
The task force also considered the use of xylitol to reduce caries but found insufficient evidence to make a recommendation. The Community Preventive Services Task Force already recommended in April 2013 both community water fluoridation and school-based dental sealant delivery programs to prevent caries in children.
The Agency for Healthcare Research and Quality supports the independent, voluntary U.S. Preventive Services Task Force, as mandated by Congress. The authors reported no conflicts of interest.