Government policies on fluoride utilization in the Nordic countries

In most but not all the Nordic countries, the National Boards of Health have issued guidelines governing the utilization of fluoride. The purpose of this paper is to outline the process of policy formation, describe the current fluoride guidelines in the Nordic countries, and discuss compliance with and appropriateness of the guidelines. The fluoride guidelines summarize current knowledge and make recommendations on choice of fluoride preparations (supplements, toothpaste, and varnish) and doses. Fluoride policies in the Nordic countries in the late 1990s state that use of fluoride toothpaste twice a day is the preferred and sufficient source of fluoride for the majority of the population. The policies of the Nordic countries are similar, but there are differences, some of them self-explanatory others not so obvious. In the case of supplements, for example, there are differences in the recommended dosage schedules. In the case of toothpaste, it is unclear what concentrations of fluoride are recommended both for children and for adults. Starting time for the use of fluoride, whether toothpaste or supplements, varies between countries. The clinicians' compliance with fluoride guidelines has not been systematically evaluated. Comparing the advice and treatments offered by dentists in the Nordic countries with current guidelines suggests that national policies influence the practice of clinicians. For government policy to be appropriate, it is imperative that the guidelines are based on sound scientific evidence. It is thus concluded that if nonevidence-based elements are included in national guidelines, this should be clearly stated to prevent confusion and enhance compliance from professionals and the public.