Subj:   Fluoride Supplements
Date:   Fri, 28 Apr 2000 2:18:54 PM Eastern Daylight Time
From:   "Euan Swan" <>
To:   "Dental Public Health Listserv" <>
The Canadian Dental Association (CDA) has recently approved a new policy on

the use of fluoride supplements in the form of lozenges or chewable tablets.
This new policy document is provided below for the interest of listserv

The new CDA policy is a significant change from previous policies of the
1990's. Fluoride supplements (lozenges or chewable tablets) are now generally
not recommended for children before the eruption of the first PERMANENT
tooth. If they are used at all, the total daily fluoride intake from ALL
sources should not exceed 0.05-0.07 mg F / kg body weight in order to
minimize the risk of dental fluorosis. Dosage is now related to body weight
and the old tables or dose schedules relating age and water fluoride
concentration are gone.

Euan Swan

Canadian Dental Association
Considerations re: Fluoride Supplementation

The Canadian Dental Association supports the appropriate use of fluorides in
the prevention of dental caries as one of the most successful preventive
health measures in the history of health care. The availability of fluorides
from a variety of sources, however, is a current reality which the practising
dentist needs to take into account in dealing with patients. This is
particularly true of children under the age of six, where exposure to more
fluoride than is required simply to prevent dental caries can cause dental
fluorosis. There is no evidence of any health problems being created by such
exposure, but it is prudent to attempt to limit exposure to the optimal
levels required for continuing dental caries protection. Current levels of
fluoride intake from all sources are difficult to establish for any given
area, but the dentist should consider general intake to the extent possible
in recommending fluoride supplementation.

The following suggestions are consistent with these principles:

1. Fluoride supplements are only required for high dental caries risk
patients and may be unnecessary if the patient is receiving adequate fluoride
from other sources.

2. Before prescribing fluoride supplements, a thorough clinical examination,
dental caries risk assessment and informed consent with patients/caregivers
are required.

3. The Canadian Consensus Conference on the Appropriate Use of Fluoride
Supplements for the Prevention of Dental Caries in Children, held in November
1997 suggested that high caries risk individuals or groups may include those
who do not brush their teeth (or have them brushed) with a fluoridated
dentifrice twice a day or those who are assessed as susceptible to high
caries activity because of community or family history, etc.

4. The estimation of fluoride exposure from all sources should include use of
fluoridated dentifrice and all home and child care water sources. Dentists
should be aware of the average fluoride exposure in their area. The possible
impact of fluoride reducing factors within the home such as the use of
unfluoridated bottled water of some reverse osmosis devices should be taken
into account.

5. Lozenges or chewable tablets are the preferred forms of fluoride
supplementation. Drops may be required for individual patients with special

6. The use of fluoride supplements before the eruption of the first permanent
tooth is generally not recommended. When, on an individual basis, the
benefit of supplemental fluoride outweighs the risk of dental fluorosis,
practitioners may elect to use these supplements at appropriate dosages on
younger children. In doing so, the total daily fluoride intake from all
sources should not exceed 0.05-0.07 mg F / kg body weight in order to
minimize the risk of dental fluorosis.

7. Following the eruption of the first permanent tooth and the associated
decrease in the risk of dental fluorosis at this stage of development,
fluoride supplements in the form of lozenges or chewable tablets may be used
to deliver an intra-oral fluoride dose. A lozenge or chewable tablet
containing 1 mg fluoride delivers the same amount of fluoride intra-orally as
brushing with an average load (1 gm) of a 1000 ppm fluoride dentifrice.

Approved by Resolution 2000.06
Canadian Dental Association Board of Governors
March, 2000