The prevention of child tooth decay

Fluoride supplements to prevent tooth decay is necessary in children older than six months and at risk for cavities, in addition to the daily brushing teeth with a fluoride toothpaste, according to the French Agency of Health Security Health Products (AFSSAPS).

The Afssaps presented Wednesday during a press conference an update of its major recommendations dated from 2002 on the use of fluoride in preventing tooth decay before the age of 18.

From a debate between experts from different backgrounds, these new recommendations are part of an overall plan for prevention of dental caries established in 2005 by the Ministry of Health, for which the High Authority of Health (HAS) should make public the recommendations in 2009 for direction of this policy.

The Afssaps now recommends not to give fluoride to children aged under six months. While its 2002 recommendations included the systematic prescription of fluoride through systemic (drops, tablets) from birth and up to two years, it now seems unnecessary before the age of six months.

After six months of age, either from the thrust of the first teeth, fluoride intake should be adjusted according to the risk of cavities in children.

One expert working group, Professor Michel Goldberg, a biologist and dentistry at the University of Paris-Descartes, said during the press conference that it concerned only 15% of children. These are children born to mothers of a socio-economic status with a low diets, poor oral hygiene and little or no going to consult a dentist.

Anne Castot, head of the assessment and monitoring of risk and drug information to Afssaps, added that the criteria for screening children at risk were being identified with the HAS .

For children with a reduced risk of dental caries, the AFSSAPS recommends brushing teeth with a fluoride toothpaste at least twice a day, toothpaste having a fluorine content tailored to the age of the child.

In children with a higher risk, a fluoride intake is recommended from the first appearance of teeth, in addition to brushing with a fluoride toothpaste containing appropriate for their age.

But first, a review customized daily intakes of fluoride should be done. It is necessary to take into account other sources of fluoride (drinking water, salt, for example) to avoid excessive fluoride can lead to child dental fluorosis characterized by the irreversible appearance of white patches on the teeth.

The supplemental fluoride can take the form of solutions / drinkable drops and tablets (systemic administration), varnishes, gels or mouth (topical administration).

Health products containing fluoride have several statutes (drug, cosmetic, medical device). There are about fifty specialty pharmaceutical form of tablets and solutions / drinkable drops.

Some toothpaste, mouthwash, chewing gum and gels Fluor (for professionals) have the status of medicine. Varnishes gases, which are only professional, have the status of the drug or medical device.

The recommendations of the Afssaps come from an analysis of the scientific literature that has evolved since 2002, especially in terms of knowledge about the mechanism of action of fluoride.

In the early 1980s, the action of fluoride considered major was linked to the contribution by General (tablets, drops: action during any phase of mineralization crowns). Local action (use of toothpaste, chewing gum, dental after the shoot) was seen as complementary.

Today, the experimental data, clinical and epidemiological data show that fluorides have superior efficacy when administered after the outbreak of teeth (mostly local). In addition, the maximum protective efficacy is obtained by means of small but regular contributions fluoride in the mouth on the surface of the email.