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Cochrane for Clinicians

Topical Fluoride as a Cause of Dental Fluorosis in Children

Alvin Soto-Soto, MD,
Alexis B. Reedy-Cooper, MD, MPH,
Penn State Health St. Joseph Medical Center, Reading

American Family Physician. 2026;113(3):219-220.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

  1. 1.Wong MCM, Zhang R, Luo BW, et al. Topical fluoride as a cause of dental fluorosis in children. Cochrane Database Syst Rev. 2024(6):CD007693.
  2. 2.US Environmental Protection Agency. Fluoride (soluble fluoride): CASRN 7782-41-4. Integrated risk information system (IRIS) chemical assessment summary. EPA; 2010. Accessed January 20, 2026. https://iris.epa.gov/ChemicalLanding/&substance_nmbr=0053
  3. 3.Choi AL, Sun G, Zhang Y, et al. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environ Health Perspect. 2012;120(10):1362-1368.
  4. 4.Warren JJ, Levy SM, Broffitt B, et al. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes— a longitudinal study. J Public Health Dent. 2009;69(2):111-115.
  5. 5.Chankanka O, Levy SM, Warren JJ, et al. A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health–related quality of life. Community Dent Oral Epidemiol. 2010;38(2):97-109.
  6. 6.Do LG, Spencer AJ. Risk-benefit balance in the use of fluoride among young children. J Dent Res. 2007;86(8):723-728.
  7. 7.National Institutes of Health. Fluoride. Health professional fact sheet. Accessed March 16, 2025. https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/
  8. 8.Walsh T, Worthington HV, Glenny AM, et al. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019(3):CD007868.
  9. 9.National Institute of Dental and Craniofacial Research. Tooth decay. Last reviewed January 2026. Accessed January 20, 2026. https://www.nidcr.nih.gov/health-info/tooth-decay
  10. 10.Joseph BK, Kullman L, Sharma PN. The oral-systemic disease connection: a retrospective study. Clin Oral Investig. 2016;20(8):2267-2273.
  11. 11.American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. J Am Dent Assoc. 2014;145(2):190-191.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

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