Fluoride Supplementation

1. See Also
   1. Oral Health in Children
2. Indications
   1. Prevention of Dental Caries in children
      1. Use when water supply has inadequate fluoride
   2. Osteoporosis Prevention
      1. No longer recommended (previously recommended for adults at risk at 25 mg daily)
3. Precautions
   1. Narrow therapeutic index: Too high dosing effects
      1. See Fluorosis
      2. Increased Fractures from weak bone mineralization
      3. Fluorosis with mottling of dental enamel
   2. In areas with very high fluoride water concentration:
      1. Pregnant women and children should use bottled water
4. Dosing Schedule for children for Dental Caries prevention
   1. Ages 3 months to 3 years old
      1. Local Water Fluoride <0.3 ppm: Fluoride 0.25 mg qd
      2. Local Water Fluoride 0.3-0.7 ppm: No Fluoride
      3. Local Water Fluoride >0.7 ppm: No Fluoride
   2. Ages 3 to 6 years old
      1. Local Water Fluoride <0.3 ppm: Fluoride 0.50 mg qd
      2. Local Water Fluoride 0.3-0.7 ppm: Fluoride 0.25 mg qd
      3. Local Water Fluoride >0.7 ppm: No Fluoride Supplement
   3. Ages 6 to 16 years old
      1. Local Water Fluoride <0.3 ppm: Fluoride 1.00 mg qd
      2. Local Water Fluoride 0.3-0.7 ppm: Fluoride 0.50 mg qd
      3. Local Water Fluoride >0.7 ppm: No Fluoride
5. Efficacy
   1. Prevents Dental Caries
   2. Initially thought to prevent osteoporotic Fractures if started early and in low doses
      1. Found to increase bone density 10% per year
      2. However resulting bone is not thought to be as strong, and may not confer advantage in Osteoporosis Prevention
6. Preparations
   1. Drops: 0.125 mg, 0.25 mg and 0.5 mg per dropper
   2. Chewable tablets: 0.5 mg, 1 mg
   3. Tablets: 1 mg
   4. Multi-Vitamins (Tri-vi-flor and poly-vi-flor)
      1. Available as drops and chewable tablets
      2. Write specifically for older, generic formulation (another pharmaceutical switch to re-patent an old drug)
   5. Fluoride varnish (applied at dental visits, in addition to oral Fluoride Supplementation as needed)
      1. Fluoride varnish is also applied to teeth at each pediatric dental visits after Tooth Eruption (6 months)
      2. See Oral Health in Children
      3. Sievers (2016) Am Fam Physician 93(9):743-4 [PubMed]
7. References
   1. Pak (1995) Ann Intern Med 123:401-8 [PubMed]