The incorporation of fluoride into tooth structure is especially important during the phases when tooth development is taking place i.e. from birth when the primary teeth are mineralising to approximately 12 years of age when the permanent teeth have developed.

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Fluoride can be obtained in two ways, namely by swallowing (for example through water and diet) and by topical application (for example by using fluoridated toothpastes, gels and mouth rinses).

Fluoride in SA
South Africa’s water supplies are not fluoridated. In Cape Town, the levels of fluoride in the water are much lower than the optimal level required to prevent the formation of cavities.

In such cases where fluoride levels in the drinking water are low, fluoride supplements can be of value. These supplements are an effective way of reducing the incidence of cavities in children who are at high risk.

However, before fluoride supplements are prescribed, other factors have to be taken into consideration. Nowadays, most toothpaste brands and mouth rinses contain fluoride. Parents should strictly monitor their children to ensure that they do not swallow toothpaste. Flavoured children’s toothpastes that are good enough to eat are plentiful and extra caution should be exercised when a child uses such a toothpaste.

Studies have shown that children cannot rinse without swallowing. Up to half of the toothpaste placed on the brush can be swallowed. Children younger than five years have not yet learnt to spit when they brush. This, together with the ingestion of additional fluoride supplements, increase the risk of developing fluorosis. For this reason, fluoride mouth rinses are also not recommended in children under six years of age, as they are more likely to swallow it. Toothpaste should be stored out of reach of children.

What is fluorosis?
Fluorosis refers to the white “mottled” appearance seen in permanent teeth in cases where excessive amounts of fluoride were ingested while the teeth were still forming. The critical period for the development of fluorosis is five years and below as the crowns of the permanent teeth are only calcified around the age of four years.

Other hidden sources of fluoride can also be found in the diet. Salt, some vitamin supplements and milk (including some infant formulas) are often fluoridated. The total fluoride exposure has to be taken into account before supplements are considered.

Other factors that should be considered before prescribing fluoride supplements include: present and previous cavities (i.e. is the child at high risk of developing cavities), special needs children (i.e. disabled or medically compromised) who are unable to maintain an adequate standard of oral hygiene.

Fluoride tablets and drops have been shown to be effective in the prevention of cavity formation. In Cape Town, the recommended dosages would be as follows:

• 0 to 6 months: none
• 6 months to 3 years: 0.25mg
• 3 to 6 years: 0.5mg
• 6 to 12 years: 1 mg

Zymafluor: 4 drops = 1 tablet = 0.25mg
Listerfluor: 5 drops = 0.25mg

It is better for the child to suck or chew the tablet instead of swallowing it. In young children, however, the tablet should be finely crushed and dissolved in water. The longer the tablet is in contact with the teeth, the more beneficial the effect.

Fluoride drops would be the better option in very young children, as they are unable to chew or swallow tablets. There is always a possibility of overdosage with these supplements and with this there is a risk of developing fluorosis of the permanent teeth. Parental supervision is therefore essential.

As mentioned previously, fluoride supplements should only be recommended in children with a high caries risk. The decision to prescribe supplements is based on the child’s individual need. It is therefore advisable to consult your dentist before the decision is made to give children fluoride supplements. - Dr Nadia Mohamed, B.Ch.D, BSc Hons/ MSc Dent Sc.

South African Dental Association (SADA)
 

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