Flouride

I have been thinking of this topic for a month now.
I will get right to it.

I had this patient who had a 3 month old and wanted to know if I recommended fluoride supplements.
I said, "I don't know. I will make some calls and I have a JADA magazine in the back that is taking about this very subject. I will make the calls and I will read the article and get back to you."

I called my friend who is a pediatric dentist.
And this is where this story starts getting crazy.
I asked him what he does.
He says, "I don't recommend fluoride supplements."
WHAT?!!!
I said, "What do you mean?"
He repeated, "I don't recommend fluoride supplements"
I asked if this was an AAPD (American Academy of Pediatric Dentists) recommendation or was this your issue.
He said, "There is too much concern with Fluorosis to do any recommending."
His point was that if they get decay he is there to fix it.
If he recommends fluoride and they get Fluorosis he is to blame.
He is not saying that he wants them to get decay but his is saying that he doesn't want to be the scapegoat to problems that come with fluoride supplements.
I was shocked but I understood his philosophy.

As I was still spinning from this conversation I called another pediatric dentist and he didn't say the same thing but I could tell there was also some reservation to giving me a recommendation. He said something like, "I really try to get the parents to start drinking bottled water with fluoride in it."
Again, this is getting the kid fluoride but releasing any responsibility.
Hmmm?

So I went to the article and this is where it all blows up.
Okay the article is called Fluoride Supplements, Dental Caries and Fluorosis.
I got this out of the JADA magazine Volume 139, November 2008.

I am going to give you the cliff notes.
This article was basically an articles review. They did an article search from 1966-2006.
They found 988 articles. Some of them were repeats. Some of them didn't fit the criteria so basically they widdled it down to 85 articles that were "right on" for what they were looking for.
They were looking for if fluoride worked. They were checking in three different age groups.
6 months to 3 years, 3 years to 6 years old, then children older than 6.

Okay the first sentence I highlighted was...In 2006 (yes, that is two years ago) the Australian
Research Centre for Population Oral Health's workshop on the use of fluorides in caries prevention concluded that "fluoride supplements in the form of drops,or tablets to be chewed and/or swallowed should not be used."
WHAT??!!!
I thought "let me just read some more".
So a couple of paragraphs later..."This study (talking about another study) did NOT find statistically significant reduction in caries in permanent teeth."
Then a couple of paragraphs later..."The study (talking about yet another study) concluded that the prenatal fluoride supplements had no benefits."
Then it goes on to say that in another study involving 12 year olds that in a five year period there was no significant differences in the kid that took fluoride supplements and the kid that received topical varnish and the kid that just got oral health education.
And last but not least, "...expectant mothers used fluoride supplements from the fourth month of pregnancy until the delivery and their children used the supplements until reaching the age of 3 years, showed no caries-preventive benefit."
The article was littered with more and more of this.

Am I shocking everyone?
At this time my head is about to explode.

Then the article goes on to say..."the odds of dental flourosis increased by 84% for each year of use of fluoride supplements between the ages of younger than 6 months and 7 years.

What the heck is going on here?
Am I the only one that thought fluoride was good for children. I am the only one that when the kid comes in with alot of decay, I ask the parents where they live. If they live in an area without fluoride in the water they get vitamins with fluoride.
I thought everyone was doing this.
Don't tell me I am out of the look again?

The article does go on to say "In permanent teeth, the daily use of supplements prevents dental decay.

Okay so what did we learn?
Fluoride supplements are not any good from pre-birth to 6 years old. But have a place in preventing decay in permanent teeth.
But don't use too much because you can get fluorosis.

Last thing....
On the front of the article it lists the Clinical Implications to this article.
"The current recommendations for use of fluoride supplements during the first six years of life should be re-examined."
WELL YEAH!!!

Okay, who picks up the ball. Who is responsible to let everyone know? Is it the AGD? Is is the ADA, I mean they published this thing?
Is it the AAPD? Is it you?
Who?
Do we ignore this?
Do we brush it under the table? Do we just keep doing what we were doing?
Don't rock the boat.


I would like to know what you think.
Did you know about this?
Are you giving supplements?
Is this making your head spin?

Let me know,
john

ps Think of me tomorrow at 9am...my first basketball game with my 4th graders.
I finished Get Smart. Very good. I was pleasantly surprised. I really like Steve Carell.