Supplements help prevent cavities in children where water quality and fluoride content is poor

Primary care clinicians who practice in areas where the water supply is deficient in fluoride should prescribe oral fluoride supplements to preschool children over the age of 6 months, according to a recommendation from the U.S. Preventive Services Task Force. The recommendation appears in the May 2004 issue of the American Journal of Preventive Medicine.

Dental cavities are a common childhood problem affecting as many as 19 percent of children between the ages of 2 and 5 years and more than half of children ages 5 to 9 years. “Preventing dental cavities in childhood is critically important to a lifetime of good oral health,” said Task Force Chair Ned Calonge, M.D., Chief Medical Officer and State Epidemiologist for the Colorado Department of Public Health and Environment. “We need to ensure that our very youngest patients are benefitting from fluoride supplements if they need them.”

The Task Force notes that primary care clinicians can play an important role in the prevention of cavities by prescribing fluoride supplements to those children whose water supplies are deficient in fluoride. Current dosage recommendations are based on the fluoride level of the local community’s water supply and are available online at http://www.ada.org/public/topics/fluoride/facts/tables.asp. Information on the fluoride content in a local community’s water supply can be requested from local health departments. It is important for clinicians to know the fluoride levels in their patients’ primary water supply before providing fluoride supplementation to avoid over-supplementation that can lead to fluorosis, which typically leads to mild discoloration of teeth.

The Task Force did not find adequate evidence that risk assessment for dental caries performed by primary care clinicians results in fewer cavities among young children. Therefore, it concluded that the evidence was insufficient to recommend for or against routine risk assessment for dental disease in preschool children by primary care clinicians.

The Task Force, sponsored by the Agency for Healthcare Research and Quality, is the leading independent panel of private-sector experts in prevention and primary care and conducts rigorous, impartial assessments of all the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services. The Task Force based its conclusion on a report from a team led by James Bader, D.D.S., at AHRQ’s RTI International-University of North Carolina Evidence-based Practice Center.

The Task Force grades the strength of the evidence from "A" (strongly recommends), "B" (recommends), "C" (no recommendation for or against), "D" (recommends against) or "I" (insufficient evidence to recommend for or against screening). The Task Force recommended that primary care clinicians prescribe oral fluoride supplements at currently recommended doses to preschool children over the age of 6 months whose primary water source is deficient in fluoride (“B” recommendation). It also found insufficient evidence to recommend for or against routine risk assessment of preschool children by primary care clinicians for the prevention of dental disease ("I" recommendation).

The recommendations and materials for clinicians are available online at http://www.ahrq.gov/clinic/3rduspstf/dentalchild/dentchrs.htm. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse by calling (800) 358-9295 or sending an e-mail to [email protected]. Clinical information also is available from the National Guideline Clearinghouse at http://www.guideline.gov.