APPROPRIATE USES OF FLUORIDES FOR CHILDREN - GUIDELINES FROM THE CANADIAN WORKSHOP ON THE EVALUATION OF CURRENT RECOMMENDATIONS CONCERNING FLUORIDES

Objective: To prevent fluorosis caused by excessive fluoride ingestion by revising recommendations for fluoride intake by children. Options: Limiting fluoride ingestion from fluoridated water, fluoride suppleme nts and fluoride dentifrices. Outcomes: Reduction in the prevalence of dental fluorosis and continued prevention of den tal caries. Evidence : Before the workshop, experts prepared comprehensive literature revie ws of fluoride therapies, fluoride ingestion and the prevalence and ca uses of dental fluorosis. The papers, which were peer-reviewed, revise d and circulated to the workshop participants, formed the basis of the workshop discussions. Values: Recommendations to limit fluoride intak e were vigorously debated before being adopted as the consensus opinio n of the workshop group. Benefits, harms and costs: Decrease in the pr evalence of dental fluorosis with continuing preventive effects of flu oride use. The only significant cost would be in preparing new, low-co ncentration fluoride products for distribution. Recommendations: Fluor ide supplementation should be limited to children 3 years of age and o lder in areas where there is less than 0.3 ppm of fluoride in the wate r supply. Children in all areas should use only a ''pea-sized'' amount of fluoride dentifrice no more than twice daily under the supervision of an adult. Validation: These recommendations are almost identical t o changes to recommendations for the use of fluoride supplements recen tly proposed by a group of European countries. Sponsors: The workshop was organized by Dr. D. Christopher Clark, of the University of Britis h Columbia, and Drs. Hardy Limeback and Ralph C. Burgess, of the Unive rsity of Toronto, and funded by Proctor and Gamble Inc., Toronto, the Medical Research Council of Canada and Health Canada (formerly the Dep artment of National Health and Welfare). The recommendations were form ally adopted by the Canadian Dental Association in April 1993.