The case for reducing the current council on dental therapeutics fluoride supplementation schedule

The milder forms of dental fluorosis have increased in prevalence since the original epidemiologic surveys of the 1930s. Most studies of fluorosis hav e identified the use of supplements as a major risk factor. Fluorosis could be prevented, in part, by stopping the improper prescription of fluoride s upplements in optimally fluoridated areas and by lowering the dosage curren tly recommended by the Council on Dental Therapeutics supplemental fluoride schedule. At a 1991 workshop at the University of North Carolina, five alt ernatives to the present ADA Council on Dental Therapeutics schedule were s uggested; however, no consensus on dosage was reached. Recently, the Federa tion Dentaire international adopted a dosage schedule of 0.25 mg F from bir th to 3 years of age, 0.5 mg F from 3 to 5 years, and 1 mg F thereafter. At a 1992 Canadian workshop it was proposed that supplements should not be st arted until age 3, should be given only to those "at high risk" of caries, and only 0.25 mg F should be prescribed from 3 to 5 years of age. Similarly , in some European countries supplements are not recommended until 3 years, at which time 0.5 mg F is prescribed, but only "for children at risk." Aus tralia is considering a dosage schedule starting with 0.25 mg Fat 6 months, again only for those "particularly at risk of caries." Serious problems ex ist in limiting fluoride supplementation only to high-caries-risk children because they are not easily identifiable at a young age. Ideally, a dosage schedule should be based on body surface area or weight rather than simply age, and supplements should be in the form of lozenges for children over 2 years of age. A reduced fluoride supplement dosage schedule is proposed.