CLINICAL QUESTION

Is the use of topical fluoride during early childhood linked to the development of fluorosis in permanent teeth?

EVIDENCE-BASED ANSWER

Children aged 1 to 2 years who begin using toothpaste with higher fluoride concentrations (1,000 ppm or more vs less than 1,000 ppm) are at increased risk of developing dental fluorosis (mottling or discoloration) in permanent teeth.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

PRACTICE POINTERS

Fluoride in toothpaste and varnish is known to reduce the risk of tooth decay. Although not defined in this review, several health risk assessments and longitudinal studies indicate that a fluoride intake threshold of approximately 0.06 mg/kg body weight per day is associated with increased risk of dental fluorosis. The US Environmental Protection Agency's reference dose for fluoride is 0.06 mg/kg per day to protect against adverse effects in children, and observational studies have shown fluorosis prevalence rises significantly above this intake level.^2–4 In more severe cases of dental fluorosis, the enamel may become pitted and mottled with dark yellow or brown stains.⁵ The prevalence of dental fluorosis is approximately 11.3% in children aged 8 to 13 years.⁶ This Cochrane review examined the potential connection between early childhood use of topical fluoride and the development of dental fluorosis.