Fluoride Action Network

Skip the Fluoride: Semiannual treatments pointless for many kids

SOURCE: HealthSCOUT | May 24, 2000 | By Julia McNamee Neenan

May 24 (HealthSCOUT) — Hundreds of millions of dollars may be wasted annually on children’s fluoride treatments by dentists, a new study suggests.

Typically given once or twice a year at routine checkups, the treatments do nothing to reduce cavities in kids, says a study of insurance records published in a recent issue of Journal of Public Health Dentistry. If you’re really interested in cutting your kids’ cavities, the study says choose a dentist who’s conservative in monitoring and filling cavities.

“There is a very clear pattern of quite regular use of topical fluoride among most children and most dentists, and there’s a very good reason: It was the standard; it was the right thing to do,” says lead study author Dr. Stephen Eklund, associate professor at the University of Michigan School of Public Health. But, he says because fluoride now is available to so many children in so many forms, including toothpaste, city water and canned goods, the effectiveness of the treatments has not been clear. “There is very little evidence,” he says.

Eklund and his colleagues studied the dental billing records of 15,190 Michigan kids from throughout the state and across many socioeconomic levels. The children, aged 4 to 14, had worked with a single dentist for at least three years. All were insured and, like most American children, most drank fluoridated water. Eklund found topical fluoride treatments were the norm: The children averaged slightly more than one treatment a year and had 0.67 fillings a year.

But it made no real difference in cavity count if the kids had fluoride treatments or not, the study found. For example, 4-year-olds who received less than half a fluoride treatment each year averaged 0.28 cavities a year in their baby teeth, compared with 4-year-olds who had more than one treatment a year and averaged 0.32 cavities a year. Similarly, 10-year-olds who received less than half a fluoride treatment a year averaged 0.12 cavities a year in their permanent teeth, compared with those who had more than one treatment a year and also averaged 0.12 cavities a year.

“It’s probably an unnecessary procedure” for the majority of children in the United States, who are insured, have few cavities and live in areas served by fluoridated water, Eklund says.

American Academy of Pediatric Dentistry spokeswoman Amy Johnson says $10 billion is spent nationally on children’s dentistry. Of the total, about 8 percent, or $800 million, is spent on topical fluoride treatments. Most dentists charge about $30 for fluoride treatments, Eklund says.

Fluoridation of water began about 50 years ago and serves more than half the United States, Eklund says. The number of cavities has been cut in half in the last half-century; most children have fewer than two cavities today and many have none at all, he says. When studies first showed the effectiveness of fluoride in preventing decay, Eklund says many insurance companies began paying for fluoride treatments in full, and dentists made them a routine part of checkups.

A topical fluoride treatment contains about 12,000 parts per million of fluoride and usually is applied twice a year. Fluoridated water, on the other hand, contains 1 part per million of fluoride and passes through your mouth every time you drink treated water; it’s also in many canned goods. Most toothpastes contain about 1,000 parts per million of fluoride, and many children use over-the-counter, yummy-tasting rinses with 500 parts per million of fluoride daily.

Serving the poor

Still, large areas of the U.S. water supply are not fluoridated, like San Antonio, Texas, where Dr. Kevin J. Donly practices. A professor of dentistry at the University of Texas Health Sciences Center, Donly says because the city’s water isn’t treated, topical fluoride treatments remain an important part of his practice. In addition, poorer, uninsured children who don’t regularly go to dentists or have reliable access to fluoridation may need topical fluoride when they do have an appointment, both Donly and Eklund say.

Choosing a dentist may be the easiest way to cut back on your children’s cavities, says Eklund whose study found that some dentists tended to fill a lot of cavities. The study found dentists have a wide range of attitudes towards what constitutes a cavity and requires filling.

“It is a pattern of care. The data are very clear. Some dentists are more aggressive, and some are more conservative,” Eklund says.

Since so few children have cavities today, Eklund says the difference among dentists usually is how they treat “borderline” cases in which a tooth shows some signs of decay. One dentist might fill it immediately; another might choose to wait, hoping the tooth will “remineralize,” or repair itself.

Donly says a dentist must consider many factors in deciding whether to fill a tooth beginning to decay. A child whose parents haven’t been diligent in dental appointments might need to have the tooth filled rather than risk serious decay later, Donly says, and a child whose older siblings have mouths filled with cavities similarly might need an immediate filling.

“It’s risk assessment,” Donly says.

What To Do

Children have different vulnerabilities to cavities. Take this study into account the next time your dentist wants to charge you for a fluoride treatment, but don’t dismiss your child’s need for the treatment.