How to use fluoride to prevent tooth decay

Press release Afssaps AFSSA-1 in August 2002

The value of systematic prescription fluoride in preventing tooth decay in infants and pregnant women is the subject of much debate. In particular, current recommendations in the United States and Canada warn against the risk of dental fluorosis and advocate to begin fluoride supplements until the age of 6 months. It was reported that the Belgian Ministry of Health plans to withdraw from certain fluorinated products, medicines fluoride on medical prescription would not be covered. .

Dental fluorosis is due to an overdose of fluoride for several months or years occurring during the period of mineralization of teeth. This period begins the third month of life in utero and ends around 12 years. Fluorosis is characterized by an aspect of mottled tooth enamel. Intakes of fluoride from some foods (mostly table salt), water (bottled or distribution) and drugs (tablets, drops, toothpaste).

In 2000, the French Agency for the Safety of Health Products (AFSSAPS) has set up an expert group to reassess the interest of prescription fluoride in preventing tooth decay in infants and pregnant women, and consider the various therapeutic strategies developed in other countries. The French Agency for Food Safety (AFSSA) was also associated with this reflection.

The Afssaps draws attention to the need to control inputs fluorinated to prevent tooth decay from birth to 12 years.

To this end, to avoid dental fluorosis, doctors and dentists must establish a customized inputs (water distribution and bottled fluoridated salt, medicines in the form of tablets, drops, chewing gum or toothpaste) before any prescription


prophylactic optimal dose is 0.05 mg of fluoride / kg / day within 1 mg / d, all inputs fluorinated confused. In areas where drinking water contains more than 0.3 mg / l of fluoride, no supplementation is necessary,

in infants and young children from 0 to 2 years in the absence of other sources of fluoride intake represented by drinking water or preparing bottles, prescription fluoride in the form of drops or tablets is systematic. For the preparation of bottles, use of fluoridated water or very low fluoride content (less than or equal to 0.3 mg / l in case of supplementation)

in children 2 to 6 years, we must adjust the prescription based on family food habits and hygiene. Fluoride can be provided through drinking water, table salt fluorinated (maximum concentration of 250 mg of fluoride / kg) and toothpaste. Children under 6 should use toothpaste concentration less than or equal to 45 mg fluor/100g: the amount of toothpaste used must be the size of a pea and children need to rinse the mouth and spit toothpaste,

in children 6 to 12 years, fluoride can be made only by water and salt fluoride.
Toothpastes dosed more than 150 mg of fluoride / 100g can be used.

in pregnant women, fluoride supplementation during pregnancy offers no benefit in children for its provisional and permanent teeth.


These recommendations were incorporated in March 2002, the leaflet and summary of the characteristics of all medicines containing fluoride.

The French Agency for Food Safety (AFSSA) has, meanwhile, made recommendations (1) on the fluoride content of natural mineral waters according to their consumption. Thus, for infants and children, it can be consumed without restriction a natural mineral water with less than 0.5 mg / L fluoride when no drug supplementation and less than 0.3 mg / L if supplementation combined drug.

For adults, a reference value of 3 mg / L fluoride has been proposed.

These values are based on the safety limits set in 2001 Recommended dietary allowances (0.4 mg / day for infants and 4 mg / day for adults) and data on water consumption. AFSSA also drew attention to the need for consumer information by appropriate labeling.

Moreover, AFSSA reported in January 2001 an opinion (2) on a sweetened chewing gum containing sodium fluoride for children over 6 years and adults, recommending a consumer information by appropriate labeling on the risks of fluorosis in the event of excessive daily consumption of fluorine (due to increased catches of sugared almonds or other sources of fluoride, especially through water).