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Appropriate Fluoride Exposure in Toddlers

Children age 18 months to 36 months are most susceptible to cosmetically objectionable fluorosis of their developing permanent dentition. As always, the risk-benefit ratio must be weighed.

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Fluorosis Risk

The risk of fluorosis for a toddler vs the benefits of a topical fluoride application to prevent the early lesions from progressing to cavitated lesions and possibly causing pain must be considered.

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Recommendations from the ADA

In 2013, the American Dental Association (ADA) Council on Scientific Affairs published evidence-based clinical recommendations regarding professionally applied and prescription-strength home-use topical fluoride agents for caries prevention.

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Professional Application

The recommendations include two types of professionally applied fluorides: 5% neutral sodium fluoride (NaF) varnish and 1.23% acidulated phosphate fluoride (APF) gel. However, for children younger than 6, only the 5% NaF varnish is recommended. This is due to the risk of adverse effects (particularly nausea and vomiting) associated with swallowing excess amounts of fluoride gel.

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Varnish Vs Gel

Even though 5% NaF varnish contains a much higher concentration of fluoride (22,000 ppm) compared with the APF gel (9,000 ppm)—overall, less fluoride is used for a full-mouth application. This is because the varnish is painted on the teeth in a thin layer. In addition, evidence suggests that 5% NaF varnish can arrest active pit and fissure caries in primary teeth.

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This information is from the article Addressing Precavitated Lesions in Toddlers by Durinda Mattana, RDH, BSDH, MS. To read the article, click here.

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