Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document

Abstract

Aim To update the exisitng European Academy of Paediatric Dentistry (EAPD) 2009 fluoride guidelines. Methods Experts met in Athens, Greece duirng November 2018 for the following groups: I Fluoride toothpastes, II Fluoride gels, rinses and varnishes, III Fluoridated milk, fluoridated salt, tablets/lozenges and drops, IV Water fluoridation. Systematic reviews and meta-analyses were reviewed and discussed for each of the groups. The GRADE system was used to assess the quality of evidence which was judged as HIGH, MODERATE, LOW or VERY LOW based on the assessment of eight criteria which can influence the confidence of the results. Following the quality assessment, GRADE was then used to indicate the strength of recommendation for each fluoride agent as STRONG or WEAK/CONDITIONAL. Results Parents must be strongly advised to apply an age-related amount of toothpaste and assist/supervise tooth brushing until at least 7 years of age. The EAPD strongly endorses the daily use of fluoride as a major part of any comprehensive programme for the prevention and control of dental caries in children. Regardless of the type of programme, community or individually based, the use of fluoride must be balanced between the estimation of caries-risk and the possible risks of adverse effects of the fluorides. Fluoride use is considered safe when the manufacturer's instructions are followed. Preventive programmes should be re-evaluated at regular intervals and adapted to a patient's or population's needs and risks. Conclusions For the majority of European Countries, the EAPD recommends the appropriate use of fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen.

General dental practitioners’ approach to caries prevention in high-caries-risk children

“…It is encouraging that the majority of the dentists that took part in this study reported that they would use fissure sealants and fluoride varnish in high-risk children. Although these findings are self-reported and, therefore, do not necessarily guarantee that the participants use these treatments in their clinics, they show that GDPs in Jordan are aware of the importance of sealants (Ahovuo-Saloranta et al 2007) and fluoride varnish (Toumba et al 2019) in caries prevention. GDPs in this study cited parental awareness and child cooperation as barriers that hinder their delivery of preventive treatment.…”

“…In addition, only a few indicated that they would take a tailored approach to dietary counselling, including the use of diet diaries and practical advice on reducing sugar intake frequency or limiting it to mealtimes. Furthermore, none of the participants mentioned that they would advise the family on toothpaste fluoride concentration or spitting but not rinsing after brushing, despite those being evidencebased approaches to increasing fluoride exposure and reducing caries risk (Chestnutt et al 1998;Public Health England 2014;Toumba et al 2019). Previous studies in developed countries Pearce and Catleugh 2013) and other developing countries (Wagle et al 2017) noticed a similar trend in reported oral health education delivery.…”

Use of Fluoride Dentifrices for Children: Evaluation of General and Pediatric Dentists' Recommendations

“…The amount of 0.125 grams (grain of rice size) is recommended in babies and 0.25 grams (pea size) in children. The EAPD also suggests that children over 6 years old use toothpaste containing 1450 ppmF covering the length of the toothbrush (0.5-1.0 grams) [13].…”

Is it necessary for children to receive professional fluoride in addition to regular fluoride toothpaste? Protocol for a systematic review

“…2 Systematic reviews have shown that only toothpastes with fluoride concentrations of at least 1000 ppm can prevent caries effectively. 4 The typical fluoride concentration of regular toothpaste is approximately 1000-1500 ppm. 2 Unlike individual measures, PFA is usually carried out by professional dentists or participants, including forms of gel, foam and varnish.…”

“…Open access other fluorine-containing vehicles, care must be taken regarding the cumulative fluoride exposure of children under 6 years of age. 4 Additionally, cost-effectiveness must be considered for groups with low caries prevalence. 10 Regarding efficacy and adverse effects, is it necessary for children to receive PFA in addition to regular fluoride toothpaste?…”