Systemic Fluoride Delivery

A primary method of fluoride delivery is systemic, being artificially provided in water, milk, salt, or supplements, which must be ingested to be able to have any effect on teeth. In all of these applications, the primary action of fluoride in promoting remineralization and reducing demineralization is due to the presence of fluoride in a beneficial amount and at the right time. What follows is a brief discussion of the main forms of systemic fluoride delivery employed by dental professionals worldwide today:

Water Fluoridation – Water fluoridation is the primary systemic method of fluoride delivery to the American population. Fluoride occurs naturally in water supplies, usually at very low concentrations of 0.1 ppm. Community water studies have uncovered a few key findings: Overall, there is a 50% reduction in dental caries rates among children with 1 ppm fluoride in the community drinking water.12 However, this caries protection occurs only with consistent fluoride exposure. This is evident in studies that found that children who move to a nonfluoridated water community experience an increase in caries rates. In addition, adults also benefit from fluoride, with reduced coronal and root caries rates among those residing in fluoridated water communities.1

In the United States, it is estimated that more than 204 million people (approximately 75% of the population) are served by fluoridated water supply systems. This is a relatively inexpensive endeavor: The annual cost of fluoridating the drinking water for a community larger than 20,000 people in this country averages 50 cents per person. Just $1 invested in this preventive measure yields approximately $38 savings in dental treatment costs. The CDC monitors the progress of the country, as well as each individual state, toward meeting the Healthy People 2020 objective on community water fluoridation – that by the year 2020, 79.6% of people on community water systems will receive water that has to optimal level of fluoride recommended for preventing tooth decay.

Salt Fluoridation – This is a method of fluoride delivery used primarily in Europe, as well as Costa Rica, Columbia, and Jamaica. A landmark Swiss study found that fluoridating table salt reduced children’s caries levels by 50% over a 10-year period.13 An additional study, in Jamaica, reported similar results in a 10-year study in that country.14 There are concerns about excessive fluoride intake and the emergence of dental fluorosis, as well as concerns about increased salt intake.1

Milk Fluoridation – Adding fluoride to liquid, powdered, and long-life milk has been implemented in Eastern Europe, China, the UK, and South America. It has the advantage over water fluoridation in that it can be targeted directly at certain segments of the population, and intake can be controlled.15 However, well-controlled studies have not yet been conducted, and this is necessary before this method can be recommended for implementation in the United States.1

Fluoride Supplements – Both the US Centers for Disease Control (CDC) and the American Dental Association (ADA) currently recommend that oral fluoride supplements be used only in high-risk children residing in nonfluoridated areas. The recommended Supplemental Fluoride Dosage Schedule is as follows (Table 1):16

Table 1. Recommended Supplemental Fluoride Dosage Schedule.
Age of childLess than 0.3 ppm water fluoride concentration0.3 ppm to 0.6 ppm water fluoride concentrationGreater than 0.6 ppm water fluoride concentration
Birth to 6 months000
6 months to 3 years0.25 mg liquid drops00
3 to 6 years0.5 mg drops or tabs0.25 mg0
6 to 16 years1 mg0.5 mg0