___________________________________ DCA06DT Dental Treatment of Pediatric and Adolescent Patients
Fluoride’s preventive effects are principally topical, rather than systemic, as was previously thought. Fluoride disrupts the activity of cariogenic bacteria (e.g., Streptococcus mutans ) by decreasing its metabolism of carbohydrates in dental plaque, the action responsible for acidification of the oral environ- ment that causes the demineralization [27]. Acid excreted by cariogenic bacteria stimulates the release of fluoride that is then incorporated into enamel that has undergone initial demineralization. However, mutated strains of Streptococcus bacteria resistant to fluoride are known to inhabit the oral cavity (and the environment) in response to fluoride exposure [70]. Fluoride is nonselective and also kills many species of beneficial bacteria. Topical fluoride inhibits the demineralization of sound enamel and promotes the remineralization of damaged enamel, particularly in the context of dietary fluoride, calcium, and phosphorus deficiency [26]. Fluoride, calcium, and phosphate strengthen the crystal structure of enamel [28]. Beyond a topi- cal effect, ingested fluoride will become incorporated into the enamel and dentin of unerupted teeth and thus increase their resistance to susceptible cariogenic bacteria [22]. New research indicates another important caries-preventing action of topi- cal fluoride is to weaken the ability of bacteria to adhere to tooth enamel [73]. Fluoride concentrations in community water supplies in the United States are not standardized, and some communi- ties have opted not to include fluoride in their water at all. The American Academy of Pediatric Dentistry recommends age-dependent fluoride supplementation only if the fluoride concentration in a child’s water supply is less than 0.6 parts per million (ppm) [31]. No fluoride supplement is recommended for children from birth to 6 months, even if community water fluoridation is unavailable. A 0.25-mg fluoride supplement is advised for children 6 months to 3 years of age if the fluoride concentration in available water is less than 0.3 ppm. Chil- dren 3 to 6 years of age should receive 0.50 mg fluoride if the water fluoride concentration is less than 0.3 ppm or 0.25 mg fluoride if the concentration range is 0.3–0.6 ppm. Children 6 to 16 years of age should receive 1 mg fluoride supplement if the fluoride concentration in the community water supply is less than 0.3 ppm or 0.50 mg if the fluoride concentration is 0.3–0.6 ppm [31]. The American Dental Association Coun- cil on Scientific Affairs encourages healthcare providers to evaluate all potential fluoride sources and to conduct a caries risk assessment before prescribing fluoride supplements [74]. Parents should consult with their pediatrician, pedodontist, or general dentist to determine if fluoride supplementation is needed for their child. Due to increasing research and public awareness of the neu- rotoxic effects of many chemicals, including fluoride, some parents will not want to administer fluoride supplement or fluoride toothpastes. These parents should be advised regard- ing proper nutritional intake of calcium, phosphorus, and vitamin D and the importance of regular tooth brushing and preventative dental visits [74].
The Scottish Intercollegiate Guidelines Network asserts that resin-based fissure
sealants should be applied to the permanent molars of all children as early after eruption as possible. (https://www.scottishdental.org/wp- content/uploads/2014/04/SIGN138.pdf. Last accessed January 16, 2026.) Grade of Recommendation : A (At least one meta- analysis, systematic review, or randomized controlled trial rated as high quality and directly applicable to the target population; or a body of evidence consisting principally of studies rated as well-conducted, directly applicable to the target population, and demonstrating overall consistency of results) FLUORIDE TREATMENT Fluoride is the negatively charged ionic form of the element fluorine, and it is able to form stable bonds with positively charged ions, such as sodium and calcium, to promote reminer- alization of teeth. Virtually all water naturally contains fluoride, but usually at a concentration that is not sufficient to prevent tooth decay. The use of community water fluoridation began in late 1940s [25]. In 2010, the U.S. Department of Health and Human Services decreased the recommended optimal concentration of fluoride in drinking water for reduction of dental caries from 0.7–1.2 mg per liter of water to 0.7 mg per liter [30]. This change was the result of the widespread avail- ability of fluoride-containing foods, water, beverages, tooth- pastes, and mouth rinses and to some degree was a response to concerns of overexposure to fluoride, which is neurotoxic at higher doses and can also cause dental and skeletal fluorosis [72]. This recommendation was finalized in 2015, with stud- ies showing that 0.7 mg per liter of fluoride in drinking water maintained decreases of up to 35% of caries in children, while minimizing the risk of skeletal fluorosis [30; 81]. Fluoride is slightly more toxic than lead and slightly less toxic than arsenic and has a narrow therapeutic window that can be difficult to control when all potential sources are considered [74]. Exces- sive ingestion of fluoride can cause dental fluorosis, a condition in which the enamel exhibits subtle changes (e.g., white spots) and potentially extensive areas of pitting and discoloration. Swallowed fluoridated toothpaste and drinking water are the primary sources of excessive fluoride intake and are considered the leading causes of fluorosis [71]. To prevent this, parents should receive instructions regarding toothbrushing technique and tvhe amount of toothpaste that is appropriate for children to minimize the unnecessary ingestion of fluoride.
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