Fluoride.
Article Type: Report
Subject: Dental caries (Prevention)
Fluorides (Usage)
Fluorides (Health aspects)
Pedodontics (Standards)
Practice guidelines (Medicine) (Evaluation)
Author: Toumba, Jack
Pub Date: 09/01/2009
Publication: Name: European Archives of Paediatric Dentistry Publisher: European Academy of Paediatric Dentistry Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 European Academy of Paediatric Dentistry ISSN: 1818-6300
Issue: Date: Sept, 2009 Source Volume: 10 Source Issue: 3
Topic: Event Code: 350 Product standards, safety, & recalls
Geographic: Geographic Code: 4E Europe
Accession Number: 227281628
Full Text: The benefits of fluoride for dental caries prevention have now been known for over 65 years. Fluoride is one of the most researched topics in dentistry (5,920,000 hits on Google and 44,900 articles in PubMed/Medline). Originally fluoride was thought to work systemically but it is now acknowledged that the mode of action of fluoride is predominantly topical.

When fluoride levels in community drinking water were first adjusted to the optimum level of 1.0 ppm this was in an era with no other fluoride products available. Nowadays there are numerous dental fluoride products and dietary sources so that the optimum level of fluoride in drinking water has been lowered to 0.6-0.7 ppm. Clinicians and scientists try to optimise the benefits and minimise the risks of products for human use and for fluoride the following question still remains "how much is enough and how much is too much"?

As with any other product in medicine and pharmaceutics administering too little has no effect, too much leads to toxicity and side-effects whilst the correct amount leads to a beneficial therapeutic effect. Over the decades clinicians have varied the dose by the age or weight of the patient and more recently by caries-risk. Various professional bodies and societies have published guidelines to help and guide clinicians and this has been the case for fluoride, particularly for its use in children. It should always be borne in mind that guidelines are intended as a guide and are not mandatory.

This issue of the European Archives of Paediatric Dentistry contains the updated EAPD Fluoride Guidelines following a consensus workshop of 54 European experts in fluoride from 25 European countries. The fluoride workshop took place in Athens, Greece (as did the original fluoride workshop in 1997) in November 2008 organised by the European Academy of Paediatric Dentistry. Papers were presented by invited speakers who were knowledgeable on the various aspects of fluoride usage in dentistry at the symposium on "contemporary usage of fluoride in dentistry". These presentations have now been written up, reviewed, revised and are published herein. They serve to provide readers with up-dated reviews.

After the presentation papers had been given the workshop participants were divided into four groups:

1. Water fluoridation;

2. Fluoride tablets and drops, fluoridated milk and fluoridated salt;

3. Fluoride gels, rinses and varnishes; and

4. Fluoride toothpastes.

The SIGN format was employed for grading the levels of evidence statements (1++ to 4), recommendations (A to D) or as good practice points based on the workshop expert groups. The workshop groups each had two moderators, one of whom was asked to prepare a working paper as a starting point for the workshop and these papers were circulated to each participant in advance. The deliberations and statements of each group were reported back to everyone at the workshop. Following this review each group had three months to finalise their sections after which the draft updated fluoride guidelines were posted on the member's section of the EAPD website for comments from the membership. These comments have been considered and where appropriate modifications made to the guidelines. Finally after further review by the experts concerned, and editing, the EAPD Guidelines on Fluoride use in children are reproduced in this issue.

The final outcome was a consensus of participants throughout Europe and although they are a statement of current knowledge, it is recognized that these guidelines will obviously not comply fully with the fluoride guidelines of every country. Fluoride remains one of the cornerstones of prevention of dental caries with a number of different agents and methods of application available with good grades of evidence for their use. Novel agents and methods of delivery are still being developed for the future and the EAPD will continue to review progress in this field.
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