Fluoride supplements in caries prevention: a literature review and proposal for a new dosage schedule

Fluoride supplements have contributed significantly to caries prevention; however, better information about the dynamic nature of fluoride's effect on caries has made a reappraisal desirable. It seems, from a review of the literature, that the benefit from supplement use that can be expected today in populations in low-fluoride areas is small. Possible reasons include the low caries incidence in children of recent years. Few people are willing to use supplements with sufficient regularity to achieve an effect. The principal mode of action of fluoride in supplements, topical exposure of teeth to fluoride, can be achieved with toothpastes and other means. Supplement use has been associated with dental fluorosis in children. This is displeasing to look at and may put at risk the undoubted benefits of water fluoridation if the public associates fluoride with negative cosmetic effects. This reason alone should be sufficient to compel a reconsideration of existing recommendations. An appropriate new dosage schedule for fluoride supplements should be aimed only at identifiable high caries-risk individuals, not at groups defined by age or residence and should result in much lower fluoride intake in the age span birth-eight years than many current recommendations. It should start at six months or later, expressly recommend lozenges rather than tablets for swallowing to maximize the topical effect, stipulate that the maximum fluoride ion content of a tablet be 0.50 mg to reduce the chances of fluorosis and overconsumption, and have no upper age limit, as caries risk may occur at any age. A dosage schedule meeting these requirements is proposed.