Riordan P J. Fluoride supplements for young children: an analysis of the literature focusing on benefits and risks. Community Dentistry and Oral Epidemiology: Vol 27; 72-83, 1999.

"The basis for the widespread acceptance of fluoride supplements in caries prevention is a large number of mostly small clinical trials in the late 1950's and 1960's. The early studies have been reviewed again recently in a series of publications and they have again been criticised (8, 13-15). The criticisms are serious and virtually none of the early fluoride supplement studies would be published today, because of methodological and other shortcomings. They present conclusions that are not supported by their data or consistent with their designs." (p 73, col 2)

"A clinical trial is usually conducted on a random sample. Within certain limits, such a sample is considered to be representative of the population. Samples consisting of dental students, dentists' children and persons attending private schools are unlikely to be representative, yet such groups are frequently used in fluoride supplement trials. Although Arnold et al. (33) had a large influence on the U.S. Public Health Service policy on fluoride supplements, their sample consisted of the children of dentists and other employees of the service." (Note: #33; Arnold FA, McClure FJ, et al. Sodium fluoride tablets for children. Dental Progress 1960;1: 8-12.) (p 78, col, 1)

"Fluorosis has long been accepted as a consequence of chronic toxic doses of fluoride, from whatever source. .and in recent years the association has consistently been reported in a series of studies (15, 43-46). In some of these studies, the effect of supplements has been difficult to isolate from that of other fluoride sources, but typically about 30-45% of regular supplement users developed fluorosis." (p 80, col 1,2)

"The public is generally not aware of dental fluorosis. This is changing; there have been attempts at litigation in several countries. Cosmetic issues related to teeth matter, witness the increasing proportion of dentists' time devoted to aesthetic care and the many articles in clinical journals about techniques to improve the appearance of moderate and severe fluorosis. It is only a matter of time until a case is brought that gets public attention. The risk is that noticeable fluorosis will be perceived by the public as a toxic consequence of fluoride ingestion - which, arguably, it is (57)." (p 81, col 1)

"Supplement use by children younger than 5 years entails a risk of fluorosis which, at the community level, becomes a certainty. A second factor is that the evidence in support of the effectiveness of fluoride supplements is poor. The benefits claimed for fluoride supplements are, in any case, available through regular toothbrushing with fluoride toothpaste and fairly minor and sensible lifestyle changes." (p 81, col 2)

"Given the absence of demonstrable benefits associated with non-lozenge supplements, and the frequent finding that lozenge or chewable supplements do have a slight caries preventive effect, there seems little reason to recommend supplements designed to be swallowed rather than chewed." (p 79, col 2)

"It seems likely that the difference in preventive effect between lozenges with 1.0 mg fluoride and 0.25 mg fluoride would be small, so that by standardising on the lower dose, the total fluoride intake could be reduced..There does not seem to be scientific evidence to support the widespread use of fluoride supplements by young children, even in the absence of fluoride in water." (p 82, col 1)

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The Case for Eliminating the Use of Dietary Fluoride Supplements Among Young Children

Dr. Brian A. Burt
Program in Dental Public Health
School of Public Health
University of Michigan

Abstract of paper presented at Dietary Supplement Conference, American Dental Association, Chicago, Illinois, January 31 - February 1, 1994

Fluoride supplements have been used for years to prevent dental caries, but there are three reasons why their use is inappropriate today among young children in the United States. They are (a) the evidence for the efficacy of fluoride supplements in caries prevention is not strong, (b) supplements are a clear risk for dental fluorosis, and (c) fluoride's pre-eruptive effects in caries prevention are weak.

There are many studies published on the caries-preventive efficacy of supplements, but few meet the standards for acceptable clinical trials. Well-conducted studies showing supplements to be efficacious have been conducted with school-age children in supervised programs, with chewable tablets or lozenges for slow dissolution to achieve topical effects. The evidence to show that supplements are a risk factor for enamel fluorosis is strong, and so is the evidence to show that fluoride prevents caries principally through post-eruptive effects. North American children are today exposed to fluoride from many sources: drinking water, toothpaste, gels, rinses, and a considerable amount in foods and beverages.

The additional cariostatic benefit would accrue from supplement use is marginal at best, while the risk of fluorosis is strong. There is evidence that the public is more aware of the milder forms of fluorosis than was previously thought, so dental policies should be aimed at reducing fluorosis. The risks of using fluoride supplements outweigh the benefit. Since there are alternative forms of fluoride to use in high risk individuals, fluoride supplements should no longer be used for young children in North America.

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(Note: The Food & Drug Administration has never approved fluoride supplements as being safe or effective. See www.fluoridealert.org/fda.htm)

(Quotes from Riordan compiled by Maureen Jones, Citizens for Safe Drinking Water (408) 297-8487 maureenj@pacbell.net