The recommendations come from the U.S. Preventive
Services Task Force (USPSTF), a government-backed panel.
“Only one in four preschool children is seeing a dentist, but most
see a primary care clinician,” Dr. Michael LeFevre told Reuters
Health. “Primary care clinicians can play an important complementary
role in helping dentists keep children’s teeth healthy.”
A family physician from the University of Missouri School of
Medicine in Columbia, LeFevre chairs the USPSTF.
The panel declined to state how often doctors should apply fluoride
varnish to infants’ teeth, saying research is inconclusive.
Pediatric dentist Dr. Mary Hayes welcomed the help from
pediatricians, family doctors and nurse practitioners.
“It’s a good thing that dentistry and medicine are working hand in
hand trying to attack decay in kids’ mouths,” she told Reuters
Health. Hayes is an American Dental Association spokeswoman and was
not involved with the new recommendations.
In addition to applying fluoride varnish to all baby teeth, the task
force continues to urge doctors to prescribe oral fluoride
supplements to infants who have not had fluoride added to their
drinking water. Supplements come in daily doses of drops, tablets or
In an effort to prevent tooth decay, fluoride was first added to the
water supply in Grand Rapids, Michigan, in 1945. Since then,
communities throughout the U.S. have debated whether to add the
naturally occurring mineral to public water systems.
About two-thirds of Americans currently drink water from fluoridated
community systems, according to the Centers for Disease Control and
The task force last updated its recommendations on prevention of
tooth decay in preschool-aged children 10 years ago.
In 2004, it said primary care doctors should prescribe oral fluoride
to babies whose water had not been fluoridated starting at six
Evidence at the time showed the benefit of reducing the risk of
dental cavities with fluoride outweighed possible harms, including
fluorosis, a condition that discolors teeth and can pit the enamel.
LeFevre and Hayes both said the task force thoroughly examined
fluoride risks in formulating the new recommendations. But Dr.
Philippe Grandjean, from the Harvard School of Public Health in
Boston, told Reuters Health in an email that the panel appears not
to have considered brain-related risks from fluoride exposure.
In 2012, Grandjean found that 26 of 27 studies on intelligence tests
in fluoride-exposed children showed an IQ deficit linked to
increased fluoride. All but two of the studies were conducted in
China, where water fluoride levels were sometimes much higher than
is typical in the U.S.
LeFevre added in an email, “The Task Force recommendation for
supplements when the water supply is deficient in fluoride is based
on the benefits and harms found in trials of supplementation in
those selected circumstances. The Task Force did not examine the
epidemiologic studies related to fluoridation of water.”
“Dental varnish is not expected to have much systemic absorption,”
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Grandjean, who was not involved in the new
recommendations, said he could not assess possible risks of water
fluoridation in the U.S. and called for research to clarify
fluoride’s role in potential adverse effects on brain development.
In 2011, the U.S. Department of Health and Human Services lowered
recommended fluoride limits in water, saying too large a dose of the
mineral, which is also found in toothpaste and mouth rinses, may
have damaged some children’s teeth (see Reuters story of January 7,
2011 here: http://reut.rs/1nhv6k0).
The new task force report, published in Pediatrics, points out that
about 42 percent of children between two and 11 years old get
cavities in their baby teeth. That percentage decreased from the
early 1970s until the mid-1990s, when tooth decay began increasing
again, particularly in preschool-aged children.
Hayes said she regularly sees children with mouths full of unhealthy
teeth in her Chicago pediatric dental practice. Just this week she
said she treated a four-year-old girl with two front teeth that
needed to be extracted, six molars that needed crowns, two molars
that needed fillings and four that needed partial root canals.
The child had been drinking four cups of soda per day, Hayes said.
Now, at Hayes’ insistence, she drinks just milk and water.
Renee Sharp, research director for the Environmental Working Group,
a research and advocacy group, said she was more comfortable with
the new recommendation on professionally applied fluoride varnish
than she was with the recommendation on parent-administered fluoride
drops for infants.
She is based in Oakland, California, and was not involved with the
“We certainly have concerns with the drops because it’s so
imprecise, and it would be so easy to overexpose a child to
fluoride,” Sharp said.
The task force recommendations do not address educating parents
about optimal dietary and other health practices for their
children’s oral hygiene. The guidelines do call for more research on
The panel members also conclude there is not enough evidence to
recommend that primary care doctors routinely examine the mouths of
their preschool-aged patients.
SOURCE: http://bit.ly/1g5WzOb Pediatrics, online May 5, 2014.
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