Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States Continuing Education Examination

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States Continuing Education Examination

August 17, 2001 / Vol. 50 / No. RR-14 Recommendations and Reports Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States Continuing Education Examination Inside: U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention (CDC) Atlanta, GA 30333 Continuing Medical Education for U.S. Physicians and Nurses Continuing Medical Education for U.S. Physicians and Nurses Continuing Medical Education for U.S. Physicians and Nurses Inside: Inside: Inside: The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. SUGGESTED CITATION Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR 2001;50(No. RR-14):[in- clusive page numbers]. Centers for Disease Control and Prevention .................. Jeffrey P. Koplan, M.D., M.P.H. Director The material in this report was prepared for publication by National Center for Chronic Disease Prevention and Health Promotion ................................................... James S. Marks, M.D., M.P.H. Director Division of Oral Health ............................................... William R. Maas, D.D.S., M.P.H. Director This report was produced as an MMWR serial publication in Epidemiology Program Office ..................................... Stephen B. Thacker, M.D., M.Sc. Director Office of Scientific and Health Communications ........................ John W. Ward, M.D. Director Editor, MMWR Series Recommendations and Reports ................................... Suzanne M. Hewitt, M.P.A. Managing Editor ....................................................................................................... Amanda Crowell ....................................................................................................... Elizabeth L. Hess Project Editors .......................................................................................................... Martha F. Boyd Visual Information Specialist ................................................................................................. Michele D. Renshaw Erica R. Shaver Information Technology Specialists Vol. 50 / No. RR-14 MMWR i Contents Introduction ......................................................................................................... 1 How Fluoride Prevents and Controls Dental Caries .......................................... 3 Risk for Dental Caries ......................................................................................... 5 Risk for Enamel Fluorosis .................................................................................. 6 National Guidelines for Fluoride Use ................................................................ 7 Fluoride Sources and Their Effects .................................................................... 8 Fluoridated Drinking Water and Processed Beverages and Food ............... 9 Fluoride Toothpaste ..................................................................................... 13 Fluoride Mouthrinse .................................................................................... 15 Dietary Fluoride Supplements ..................................................................... 16 Professionally Applied Fluoride Compounds ............................................ 17 Combinations of Fluoride Modalities ......................................................... 19 Quality of Evidence for Dental Caries Prevention and Control ....................... 19 Community Water Fluoridation ................................................................... 20 School Water Fluoridation .......................................................................... 20 Fluoride Toothpaste ..................................................................................... 20 Fluoride Mouthrinse .................................................................................... 20 Dietary Fluoride Supplements ..................................................................... 21 Fluoride Gel .................................................................................................. 21 Fluoride Varnish ........................................................................................... 21 Cost-Effectiveness of Fluoride Modalities ....................................................... 21 Community Water Fluoridation ................................................................... 22 School Water Fluoridation .......................................................................... 23 Fluoride Toothpaste ..................................................................................... 23 Fluoride Mouthrinse .................................................................................... 23 Dietary Fluoride Supplements ..................................................................... 23 Professionally Applied Fluoride Componds .............................................. 23 Combinations of Fluoride Modalities ......................................................... 24 Recommendations ............................................................................................ 24 Public Health and Clinical Practices ........................................................... 26 Self-Care ....................................................................................................... 27 Consumer Product Industries and Health Agencies .................................. 28 Further Research .......................................................................................... 29 Conclusion ........................................................................................................ 30 References ......................................................................................................... 30 Continuing Education Examination ............................................................. CE-1 ii MMWR August 17, 2001 Vol. 50 / No. RR-14 MMWR iii Fluoride Recommendations Work Group Steven M. Adair, D.D.S., M.S. R. Gary Rozier, D.D.S., M.P.H. School of Dentistry School of Public Health Medical College of Georgia University of North Carolina Augusta, Georgia Chapel Hill, North Carolina William H. Bowen, Ph.D. Robert H. Selwitz, D.D.S., M.P.H. Caries Research Center National Institute of Dental and Craniofacial University of Rochester Research Rochester, New York Bethesda, Maryland Brian A. Burt, B.D.S., M.P.H., Ph.D. John W. Stamm, D.D.S., D.D.P.H. School of Public Health School of Dentistry University of Michigan University of North Carolina Ann Arbor, Michigan Chapel Hill, North Carolina Jayanth V. Kumar, D.D.S., M.P.H. George K. Stookey, Ph.D., D.D.S. New York Department of Health School of Dentistry Albany, New York Indiana University Indianapolis, Indiana Steven M. Levy, D.D.S., M.P.H. College of Dentistry Gary M. Whitford, Ph.D., D.M.D. University of Iowa School of Dentistry Iowa City, Iowa Medical College of Georgia Augusta, Georgia David G. Pendrys, D.D.S., Ph.D. School of Dental Medicine University of Connecticut Farmington, Connecticut iv MMWR August 17, 2001 Fluoride Recommendations Reviewers Myron Allukian, Jr., D.D.S., M.P.H. David W. Johnston, B.D.S., M.P.H. Director of Oral Health School of Dentistry Boston Public Health Commission University of Western Ontario Boston, Massachusetts London, Canada John P. Brown, B.D.S., Ph.D. John V. Kelsey, D.D.S., M.B.A. Department of Community Dentistry US Food and Drug Administration University of Texas Health Science Center Rockville, Maryland San Antonio, Texas James A. Lalumandier, D.D.S., M.P.H. Joseph A. Ciardi, Ph.D. School of Dentistry National Institute of Dental and Craniofacial Case Western Reserve University Research Hudson, Ohio Bethesda, Maryland Stephen J. Moss, D.D.S., M.S. D. Christopher Clark, D.D.S., M.P.H. College of Dentistry Faculty of Dentistry New York University University of British Columbia New York, New York North Vancouver, Canada Ernest Newbrun, D.M.D., Ph.D. Stephen B. Corbin, D.D.S., M.P.H. School of Dentistry Oral Health America University of California, San Francisco Brookeville, Maryland San Francisco, California Michael W. Easley, D.D.S., M.P.H. Kathy R. Phipps, Dr.P.H. School of Dental Medicine School of Dentistry State University of New York Oregon Health Sciences University Buffalo, New York Portland, Oregon Caswell A. Evans, D.D.S., M.P.H. Mel L. Ringelberg, D.D.S., Dr.P.H. County Dental Director State Dental Director Los Angeles, California State of Florida Department of Health Tallahassee, Florida Lawrence J. Furman, D.D.S., M.P.H. National Institute of Dental and Craniofacial Jay D. Shulman, D.M.D., M.S.P.H. Research Baylor College of Dentistry Bethesda, Maryland Dallas, Texas Stanley B. Heifetz, D.D.S., M.P.H. Phillip A. Swango, D.D.S., M.P.H. Department of Dental Medicine Private dental consultant and Public Health Albuquerque, New Mexico School of Dentistry University of Southern California Gerald R. Vogel, Ph.D. Los Angeles, California ADA Health Foundation Paffenbarger Research Center Keith E. Heller, D.D.S., Dr.P.H. Gaithersburg, Maryland School of Public Health University of Michigan James S. Wefel, Ph.D. Ann Arbor, Michigan College of Dentistry University of Iowa Amid I. Ismail, D.D.S., Dr.P.H. Iowa City, Iowa School of Dentistry University of Michigan B. Alex White, D.D.S., Dr.P.H. Ann Arbor, Michigan Kaiser-Permanente,

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