Systemic Fluorides

As fluorosis of the teeth has been associated with chronic ingestion of greater than recommended amounts of fluoride, when prescribing systemic fluorides it is important the dental professional take into account all the possible sources of fluoride that the patient ingests, to determine the correct level of supplementation. In areas where the community water supply is fluoridated, children may be exposed to amounts of fluoride in excess of the recommended levels because of ingestion of fluoride from swallowed toothpaste and concentrated fluoride reconstituted with fluoridated water. Conversely, in areas with optimal fluoridation, some families avoid the use community fluoridated water supplies for drinking and cooking because of fear of chemical and bacterial contamination. The bottled water the family uses may not contain optimal levels of fluoride and thus fluoride supplementation should be considered.

After investigation of the patient’s dietary intake of fluoride and a risk assessment for the patient’s proclivity for caries, the clinician can refer to the Dietary Fluoride Supplementation Schedule as recommended by the American Academy of Pediatric Dentistry and the American Academy of Pediatrics (Table 7).

Table 7. Dietary Fluoride Supplementation Schedule.
Age< 0.3 ppm F0.3-0.6 ppm F> 0.6 ppm F
Birth ‑ 6 months000
6 months ‑ 3 years0.25 mg00
3 ‑ 6 years0.50 mg0.25 mg0
6 years ‑ 16 years1.00 mg0.50 mg0

Practitioners should consider the following when discussing fluoride intact with patients and parents:

  • The preventive effects of fluoride are topical, not systemic
  • Fluoride intake for infants in concentrated or powdered formula must be monitored
  • Tooth brushing in children under three should be supervised
  • Use only a smear or pea sized amount of fluoridated toothpaste
  • Encourage the child to spit out excess toothpaste
  • Do not let the child eat toothpaste

Contraindications: Hypersensitivity to fluoride, tartizine or any component of the formulation; when fluoride content of water exceeds 0.7 ppm.

Warnings/Precautions: Prolonged ingestion of excessive doses may result in dental fluorosis and osseous changes.

Systemic fluoride supplements are available as liquid or chewable tablets. The fluoride in most dietary fluoride supplements is incorporated as sodium fluoride (NaF). One milligram of fluoride is equivalent to approximately 2.2 mg of sodium fluoride. When prescribing fluoride the clinician should specify the dose to be dispensed in terms of fluoride ion, sodium fluoride, or both. Fluoride drops and tablets are available as sodium fluoride 0.5mg (0.25 mg fluoride), 1.1 mg (0.5 mg fluoride, and 2.2 mg (1mg fluoride). When prescribing chewable tablets it is recommended that the child suck on the tablets before chewing and swallowing to maximize the contact time of the fluoride with the tooth enamel. Samples of supplemental fluoride prescriptions are:

12-month-old whose drinking water contains less than 0.2 ppm fluoride:

Rx: Sodium fluoride solution 0.5 mg/ml (0.25 mg fluoride)
Disp: 50 ml
Sig: Dispense 0.5 ml of liquid in mouth before bedtime

Four-year-old whose drinking water contains less than 0.2 ppm fluoride:

Rx: Sodium fluoride tablets 0.25 mg fluoride/tablet (0.55 mg NaF/tablet)
Disp: 180 tablets
Sig: Chew one (1) tablet, swish, and swallow after brushing at bedtime. Nothing to eat or drink for 30 minutes.