The Canadian Dental Association (CDA) has recently approved a new policy on

the use of fluoride supplements in the form of lozenges or chewable tablets.

This new policy document is provided below for the interest of listserv

members.



The new CDA policy is a significant change from previous policies of the

1990's. Fluoride supplements (lozenges or chewable tablets) are now generally

not recommended for children before the eruption of the first PERMANENT

tooth. If they are used at all, the total daily fluoride intake from ALL

sources should not exceed 0.05-0.07 mg F / kg body weight in order to

minimize the risk of dental fluorosis. Dosage is now related to body weight

and the old tables or dose schedules relating age and water fluoride

concentration are gone.



Euan Swan

Ottawa

Canada



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Canadian Dental Association

Considerations re:  Fluoride Supplementation





The Canadian Dental Association supports the appropriate use of fluorides in

the prevention of dental caries as one of the most successful preventive

health measures in the history of health care.  The availability of fluorides

from a variety of sources, however, is a current reality which the practising

dentist needs to take into account in dealing with patients.  This is

particularly true of children under the age of six, where exposure to more

fluoride than is required simply to prevent dental caries can cause dental

fluorosis.  There is no evidence of any health problems being created by such

exposure, but it is prudent to attempt to limit exposure to the optimal

levels required for continuing dental caries protection.  Current levels of

fluoride intake from all sources are difficult to establish for any given

area, but the dentist should consider general intake to the extent possible

in recommending fluoride supplementation.



The following suggestions are consistent with these principles:



1. Fluoride supplements are only required for high dental caries risk

patients and may be unnecessary if the patient is receiving adequate fluoride

from other sources.



2. Before prescribing fluoride supplements, a thorough clinical examination,

dental caries risk assessment and informed consent with patients/caregivers

are required.



3. The Canadian Consensus Conference on the Appropriate Use of Fluoride

Supplements for the Prevention of Dental Caries in Children, held in November

1997 suggested that high caries risk individuals or groups may include those

who do not brush their teeth (or have them brushed) with a fluoridated

dentifrice twice a day or those who are assessed as susceptible to high

caries activity because of community or family history, etc.



4. The estimation of fluoride exposure from all sources should include use of

fluoridated dentifrice and all home and child care water sources.  Dentists

should be aware of the average fluoride exposure in their area.  The possible

impact of fluoride reducing factors within the home such as the use of

unfluoridated bottled water of some reverse osmosis devices should be taken

into account.



5. Lozenges or chewable tablets are the preferred forms of fluoride

supplementation.  Drops may be required for individual patients with special

needs.



6. The use of fluoride supplements before the eruption of the first permanent

tooth is generally not recommended.  When, on an individual basis, the

benefit of supplemental fluoride outweighs the risk of dental fluorosis,

practitioners may elect to use these supplements at appropriate dosages on

younger children. In doing so, the total daily fluoride intake from all

sources should not exceed 0.05-0.07 mg F / kg body weight in order to

minimize the risk of dental fluorosis.



7. Following the eruption of the first permanent tooth and the associated

decrease in the risk of dental fluorosis at this stage of development,

fluoride supplements in the form of lozenges or chewable tablets may be used

to deliver an intra-oral fluoride dose. A lozenge or chewable tablet 

containing 1 mg fluoride delivers the same amount of fluoride intra-orally as

brushing with an average load (1 gm) of a 1000 ppm fluoride dentifrice.





Approved by Resolution 2000.06

Canadian Dental Association Board of Governors

March, 2000