Fluoride Toothpaste
Form
Concentrations of fluoride in toothpaste sold in the United States range from 1,000–1,500 ppm.
Use
Most people report brushing their teeth at least once per day, but more frequent use can offer additional protection. Fluoride in toothpaste is taken up directly by the dental plaque and demineralized enamel and also increases the concentration of fluoride in saliva.
Availability
Fluoride toothpaste is available over-the-counter and makes up more than 95% of toothpaste sales in the United States.
Recommendations
For most people (children, adolescents, and adults) brushing at least twice a day with a fluoride toothpaste—when you get up in the morning and before going to bed—is recommended.
Advice for Parents
For children aged 6 years and younger, some simple recommendations are advised to reduce the risk of dental fluorosis.
Supervise brushing to discourage swallowing toothpaste.
Place only a small pea-size amount of fluoride toothpaste on your child’s toothbrush.
For children younger than 2, consult first with your doctor or dentist regarding the use of fluoride toothpaste..
Learn more about oral health care for children.
Fluoride Mouth Rinse
Form
Fluoride mouth rinse is a concentrated solution intended for daily or weekly use. The most common fluoride compound used in mouth rinse is sodium fluoride. Over-the-counter solutions of 0.05% sodium fluoride (230 ppm fluoride) for daily rinsing are available for use by persons older than 6 years of age. Solutions of 0.20% sodium fluoride (920 ppm fluoride) are used in supervised, school-based weekly rinsing programs. Other concentrations also are available.
Use
Rinses are used daily or weekly for a prescribed amount of time. The fluoride from mouth rinse is retained in dental plaque and saliva to help prevent tooth decay.
Availability
Mouth rinses intended for home use can be purchased over-the-counter. Higher strength mouth rinses for those at high risk of tooth decay must be prescribed by a dentist or physician.
Recommendations
For children younger than 6, consult first with your doctor or dentist regarding the use of mouth rinse because dental fluorosis could occur if such mouth rinses are repeatedly swallowed. Because fluoride mouth rinse has resulted in only limited reductions in tooth decay among schoolchildren, especially as their exposure to other sources of fluoride has increased, its use should be targeted to individuals or groups at high risk for decay.
Fluoride Supplements
Form
Tablets, lozenges, or liquids (including fluoride-vitamin preparations) are available. Most supplements contain sodium fluoride as the active ingredient. Tablets and lozenges are manufactured with 1.0, 0.5, or 0.25 mg fluoride.
Use
Fluoride supplements can be prescribed for children at high risk for tooth decay and whose primary drinking water has a low fluoride concentration. To maximize the topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1–2 minutes before being swallowed.
Availability
All fluoride supplements must be prescribed by a dentist or physician.
Recommendations
For children aged less than 6 years, the dentist, physician, or other health care provider should weigh the risk for tooth decay without fluoride supplements, the decay prevention offered by supplements, and the potential for dental fluorosis. Consideration of the child’s other sources of fluoride, especially drinking water, is essential in determining this balance. Parents and caregivers should be informed of both the benefit of protection against tooth decay and the possibility of dental fluorosis.
Fluoride Gel and Foam
Form
Fluoride gel is often formulated to be highly acidic (pH of approximately 3.0). Products available in the United States include gel of acidulated phosphate fluoride (1.23% [12,300 ppm] fluoride), gel or foam of sodium fluoride (0.9% [9,040 ppm] fluoride), and self-applied (i.e., home use) gel of sodium fluoride (0.5% [5,000 ppm] fluoride) or stannous fluoride (0.15% [1,000 ppm] fluoride).
Use
In a dental office, fluoride gel is applied for 1–4 minutes. Home use follows instructions provided on the prescription.
Availability
Most fluoride gel and foam applications are delivered in a dental office by a dental professional. These higher strength products, if used in the home, must be prescribed by a dentist or physician.
Recommendations
Because these applications are relatively infrequent, generally at 3 to 12–month intervals, fluoride gel poses little risk for dental fluorosis, even among patients younger than 6 years of age. Routine use of professionally applied fluoride gel or foam likely provides little benefit to persons not at high risk for tooth decay, especially those who drink fluoridated water and brush daily with fluoride toothpaste.
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