Systemic fluorides are those that are ingested into the body and become incorporated into forming tooth structures. Systemic fluorides can also give topical protection because fluoride is present in saliva, which continually bathes the teeth. Systemic fluorides include water fluoridation or dietary fluoride supplements in the form of tablets, drops or lozenges.
Dietary fluoride supplements (tablets, drops or lozenges) are available only by prescription and are intended for use by children ages six months to 16 years living in nonfluoridated areas and at high risk of developing tooth decay. Your dentist or physician can prescribe the correct dosage. It is based on the natural fluoride concentration of the child's drinking water and the age of the child (see chart). For optimum benefits, use of dietary fluoride supplements should begin when a child is six months old and be continued daily until the child is 16 years old. The need for taking dietary fluoride supplements over an extended period of time makes dietary fluoride supplements less cost-effective than water fluoridation; therefore, dietary fluoride supplements are considerably less practical as a wide-spread alternative to water fluoridation as a public health measure. Fluoride supplements are recommended only for children living in non-fluoridated areas and at high risk of developing tooth decay.
It is important to note that fluoridated water may be consumed from sources other than the home water supply, such as the workplace, school and/or day care, bottled water, filtered water and from processed beverages and foods prepared with fluoridated water. For this reason, dietary fluoride supplements should be prescribed by carefully following the recommended dosage schedule (see chart). Dietary fluoride supplements are not recommended for children residing in a fluoridated community.
"There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries [cavities] in primary teeth," according to a systematic review of fluoride supplement research published in the November 2008 Journal of the American Dental Association.
The authors could find only one study, from China, showing any fluoride cavity-preventing benefit to primary teeth and that study was probably biased with a high withdrawal rate, the authors write.
Mild -to-moderate dental fluorosis (white spotted and/or yellow teeth) is a significant fluoride supplement side effect, they report.
Fluoride supplements, although a prescription drug, were never FDA [Food and Drug Administration] tested for safety or effectiveness because sodium fluoride was on the market pre-1938 before FDA testing laws were enacted.(1)
In 2007, the American Dental Association (ADA) reported on its website that fluoride supplements put children six and under at significant risk of permanently discolored teeth; but never shared that information with the American public, pediatricians or MD's who still prescribe fluoride supplements to toddlers. (2)
"This review confirmed that, in non-fluoridated communities, the use of fluoride supplements during the first 6 years of life is associated with a significant increase in the risk of developing dental fluorosis, write researchers Ismail & Bandekar and first published in Community Dentistry and Oral Epidemiology, February 1999, (3) but posted to the ADA's website July 2007.
Fluoride supplements sought to achieve a similar effect as fluoridation of the water supplies when it was believed that ingested fluoride reduced tooth decay. However, the Centers for Disease Control now reports that fluoride's purported beneficial effects are topical (4). Swallowing fluoride only exposes children to fluoride's adverse health effects, such as dental fluorosis.
