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Am Fam Physician. 2011;84(9):968

Author disclosure: No relevant financial affiliations to disclose.

Original Article: Health Maintenance in School-aged Children: Part I. History, Physical Examination, Screening, and Immunizations
Issue Date: March 15, 2011
Available at:

to the editor: I would like to commend Dr. Riley and colleagues for including oral health issues in their article. I was particularly impressed with their promotion of the dental home and advice about counseling to reduce the intake of sugary snacks and beverages.

The authors emphasized the use of fluoride supplements and toothpaste containing fluoride, two important tools in the fight against childhood caries. In addition, fluoride varnish is a service that family physicians can easily offer their patients. It has strong evidence of effectiveness in children with moderate to high risk of caries1 and is now a Medicaid reimbursable service for primary care physicians in 38 states.2

I would like to update the authors' recommendation to offer counseling on fluoride supplementation to families of children six months to 16 years of age living in areas with inadequate fluoride in the water supply. A report from the American Dental Association Council of Scientific Affairs recommends fluoride supplements only for “high-risk children.”3 The expert panel did not define high risk. Others have listed the following as markers for higher risk of caries: personal or family history of caries, enamel defects, visible plaque or white spots, low socioeconomic status, more than three sugary snacks between meals daily, or child is put to bed with a bottle with a drink containing sugar.4

Finally, carrying out the authors' recommendations for oral health maintenance may be difficult for some practicing physicians without additional training. The Society of Teachers of Family Medicine Group on Oral Health has created a seven-module oral health training program, which is available at This program includes childhood, adult, and prenatal oral health topics and can be completed for continuing medical education credit.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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