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Fluoride Gels Reduce Decay

Professionally Applied Topical Fluoride Works Wonders

A Consultation with Dr. Martin Sinai Rayman

Dear Doctor,
My child's pediatric dentist wants to apply concentrated fluoride gel to his teeth to reduce his decay rate. How helpful are they and are there any downsides?

Dentist applying topical fluoride.

Dear Hadley,
You have raised an important question. Fluoride is widely used in oral products like toothpastes and added to drinking water to prevent tooth decay. Yet another recognized preventive measure is to apply it topically — directly to your child's teeth in the dental office. Professionally applied topical fluoride in gel form is frequently recommended for young children, but there are concerns about possible side effects.

Parents may worry because the concentrations of these topical fluorides are much higher than in toothpastes, and they are applied for a longer period of time (usually four minutes). However, the bottom line is that the benefits of fluoride applications far outweigh any potential harm. If your child is at a high risk for dental decay, fluoride gel applications can not only reduce the risk of new cavities, but also reverse very early decay. Let's discuss how and why, but as importantly, how to avoid side effects.

What The Science Says

The Cochrane Oral Health Research Group recently reviewed all the evidence on the safety and effectiveness of fluoride gel for the prevention of tooth decay in children and adolescents. They found favorable results for topical treatment. The review assessed evidence from 28 scientific studies in which over 9000 children (aged 2 to 15 years) were included. On average there was a 28% reduction in decayed, missing and filled tooth surfaces for children who received topical fluoride treatment. Studies that looked specifically at first or baby teeth showed a 20% reduction. The authors of the review concluded that the application of fluoride gel results in a large reduction in tooth decay in both permanent and baby teeth.

Current Pediatric Dental Practice

Children typically receive fluoride applications after a professional cleaning. Your pediatric or general dentist can offer these applications in the form of a gel, foam, or varnish. Varnishes are painted onto the teeth, foams are administered in a tray (similar to a mouth guard), and gels can either be painted or applied via a tray. All of these provide a temporary and high dose of fluoride. Sometimes, children can accidentally swallow some of the fluoride agent being used and there have been reports of sickness, vomiting, headache and stomach pain as a result. These are the main risks associated with topical fluorides, but since they are administered professionally, they are easy to avoid.

An expert panel from the American Dental Association (ADA), recommends that children at a high risk for decay should receive a 2.26 percent fluoride varnish or 1.23 percent fluoride gel, or a prescription-strength, home-use 0.5 percent fluoride gel or paste or 0.09 percent fluoride mouthrinse. These recommendations are for children who are six or older and only 2.26 percent fluoride varnish is recommended for children younger than 6 years.

How Fluoride Works

Fluoride plays a key role in making teeth more resistant to tooth decay, not only developing teeth, but also after they have erupted into the mouth. Tooth enamel is comprised of calcium and phosphate minerals, in a highly crystalline form called hydroxyapatite. Fluoride gets incorporated into the enamel structure replacing hydroxyapatite as fluorapatite, which is stronger and more resistant to acid attack. Fluoride applied topically, in toothpastes and gels for example, can also help reverse early decay by aiding "re-mineralization" — adding mineral back into tooth surfaces damaged by acid attack.

The ADA panel also found that the benefits outweigh any potential harm from fluoride applications for all age groups except for children younger than 6 years. In these children, the risk of experiencing adverse events associated with swallowing professionally applied topical fluoride agents outweighed the potential benefits of using all of them except for 2.26 percent fluoride varnish. Following a fluoride foam or gel application, your child should be cautioned not to eat for 30 minutes. Following a varnish application, your child may eat or drink immediately since the varnish sticks to the teeth and is released into the enamel over a longer period of time.

An Issue Of Balance

The ADA recommends that children at increased caries (tooth decay) risk should receive a professional fluoride treatment at least every six months and treatment should be adjusted as the child's risk changes. In children with Early Childhood Caries (ECC), or adolescents with a high decay rate, especially if undergoing orthodontic tooth movement, fluoride gel is often recommended every three months.

In that regard, decreasing your child's decay risk will also depend on making sure he or she has a low sugar diet, does not snack frequently, has good oral hygiene habits (teeth brushed and flossed at night by an adult), and has regular dental visits. Sealants, special filling materials applied to the nooks and crannies of the teeth most likely to decay, will also reduce risk of tooth decay.

Pediatric dentists are specialists in growth and development of the teeth and jaws, and deal exclusively with diseases and disorders of children's and adolescents' teeth. If you have concerns, talk to your pediatric dentist about the risks and benefits, and consider what's best for your child before making a decision. Ultimately the decision to administer fluoride gel is based on the unique needs of each child.