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Table 2 Summary of existing recommendations

From: Prophylaxis of caries with fluoride for children under five years

  Ref Date General recommendations for prophylaxis of caries with fluoride in children under five years
   Systemic (collective or individual) fluoride Topical fluoride
WHO [4]
[10]
[11]
2016
2017
“When feasible, access to national fluoridation schemes using water, salt and milk as vehicles should be promoted.”
“Community water fluoridation is safe and cost-effective and should be introduced and maintained wherever socially acceptable and feasible. The optimum fluoride concentration will normally be within the range 0.5–1.0 mg/L.”
Salt fluoridation should be considered where water fluoridation is not feasible for technical, financial or sociocultural reasons. It can be used for small groups or large populations, is very economical and, where necessary, provides freedom of choice.”
“Affordable and effective fluoride toothpaste should be available for all children. Policy-makers and dental professionals should advocate for, and promote, legislation conducive to the affordability, accessibility and quality of fluoride toothpaste. Strategies should include the elimination of taxes on fluoride toothpaste and designation of the toothpaste as a health product and not a cosmetic product.”
“Daily tooth brushing with fluoride toothpaste from the eruption of the first tooth must be regarded as the best clinical practice today” (moderate evidence).
“Fluoride varnish can, to some extent, decrease caries incidence in early childhood” (low evidence).
“Silver diamine fluoride can arrest dentine caries in primary teeth and prevent recurrence after treatment” (very low evidence).
  [12] 2018 “Confirm the use of community fluoride administration, such as water, salt or milk as primary prevention of early childhood caries” “Perform toothbrushing for children by a parent twice daily, using a soft toothbrush of age-appropriate size.”
“Use standard fluoride-containing toothpaste (1000–1500 ppm) in all children under the age of 6”
USPSTF [2] 2014 For children ≤5 years: “Oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride.” (B recommendation) For children ≤5 years: “Apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.” (B recommendation)
PrevInfad [16] 2011 Fluoride supplements
Only for children with risk factors for developing dental caries and depending on the fluoride to drinking water: oral fluoride supplement from 6 months of age.
For children aged between 0 and < 2 years: tooth brushing is recommended with toothpaste containing 1000 ppm of fluoride in a quantity of ‘craping’ or ‘stain’.
For children aged between 2 and 6 years: tooth brushing is recommended with toothpaste containing between 1000 and 1450 ppm of fluoride in a quantity of a pea.
AAP [17] 2014 Community water fluoridation: Recommended for both groups at low and high caries risk.
Dietary fluoride supplements: Recommended if drinking water supply is not fluoridated for both groups at low and high caries risk.
Toothpaste: recommended to start at tooth emergence (smear of paste until age 3 years, then pea-sized) for both groups at low ang high caries risk.
Fluoride varnish: recommended every 3–6 months starting at tooth emergence, recommended for both groups at low and high caries risk.
Over-the-counter mouth rinse: not applicable for groups at low caries risk; recommended to start at age 6 years if the child can reliable swish and spit in groups at high caries risk.
NICE [18] 2014 Not addressed “Ensure all early years services provide oral health information and advice”, including the “use of fluoride toothpaste as soon as teeth come through”
“Consider fluoride varnish programmes for nurseries and primary schools in areas where children are at high risk of poor oral health”
NHS [19] 2017 Not addressed In children aged 0 to 3 yearsa:
“As soon as teeth erupt in the mouth brush them twice daily with a fluoridated toothpaste” (Strength of the evidence I)
“Brush last thing at night and on one other occasion.” (Strength of the evidence III)
“Use fluoridated toothpaste containing no less than 1000 ppm fluoride.” (Strength of the evidence I)
“It is good practice to use only a smear of toothpaste” (Strength of the evidence GP).
In children aged 3 to 6 years:
“Brush at least twice daily, with a fluoridated toothpaste” (Strength of the evidence I)
“Brush last thing at night and at least on one other occasion.” (Strength of the evidence III)
“Use fluoridated toothpaste containing more than 1000 ppm fluoride.” (Strength of the evidence I)
“It is good practice to use only a pea size amount” (Strength of the evidence GP)
“Spit out after brushing and do not rinse, to maintain fluoride concentration levels” (Strength of the evidence III)
“Apply fluoride varnish to teeth two times a year (2.2% NaF-)” (Strength of the evidence I).
For children aged 0 to 6 years giving concern: all advice as above plus:
“Use fluoridated toothpaste containing 1350–1500 ppm fluoride.” (Strength of the evidence I)
“Apply fluoride varnish to teeth two or more times a year (2.2% NaF-)” (Strength of the evidence I)
  1. Abbreviations: AAP American Academy of Pediatrics, NHS National Health Service (UK), NICE National Institute for Health and Care Excellence, ppm parts per million, PrevInfad PrevInfad workgroup from the Spanish Association of Primary Care Pediatrics, USPSTF US Preventive Services Task Force, WHO World Health Organization
  2. aThe strength of the evidence was classified as follows [19]
  3. I: Strong evidence from at least one systematic review of multiple well-designed randomized control trial/s
  4. II: Strong evidence from at least one properly designed randomized control trial of appropriate size
  5. III: Evidence from well-designed trials without randomization, single group pre-post, cohort, time series of matched case-control studies
  6. IV: Evidence from well-designed non-experimental studies from more than one centre or research group
  7. V: Opinions of respected authorities, based on clinical evidence, descriptive studies or reports of expert committees
  8. GP for ‘Good practice’: specific evidence is not available but statements make practical sense