While brushing the teeth and flossing are important in prevention of tooth decay, they may not be enough. Research indicates that the use of fluoride, along with daily brushing and flossing, is most effective in preventing cavities.

Fluoride is a natural element found in rock, soil, water, and air. In the early 1900s, scientists discovered that children living in areas which naturally contained more fluoride in the drinking water had fewer cavities.

In the 1940s, communities began to add fluoride to their water supplies and in 1955, fluoride first appeared in toothpaste. Today, you can find fluoride in community drinking water, toothpastes, and mouth rinses.

What does Fluoride do?

Fluoride helps protect teeth in several ways. First, fluoride helps tooth development. Young children who ingest sufficient fluoride (usually through drinking water) during the period of enamel (outer coating) development can have stronger teeth, and the enamel is more resistant to acid attack.

Fluoride also can help strengthen teeth after they are formed. Just a small amount helps prevent tooth decay and cavities. Tooth decay occurs when acid attacks the surface of the tooth.
Fluoride works with saliva to protect tooth enamel by reducing the ability of plaque bacteria to produce this harmful acid. Fluoride also helps repair any damage before it becomes serious. Fluoride in your drinking water is like a constant "repair kit" for your teeth.

Where Is Fluoride Found?

Children and adults can get sufficient fluoride on a daily basis in several ways. In many communities, fluoride is added to the water supply so the child gets dental protection with every glass of water.

Most bottled water does not have fluoride. Some parents might choose bottled water over tap water, but inadvertently deprive their children of beneficial fluoride.

Most toothpastes contain fluoride. Just a tiny smear of toothpaste is enough to brush. Be sure children spit out the toothpaste after brushing.

Some mouthwashes contain fluoride, but young children should not use them. Mouthwash may contain fluoride and alcohol, both of which can be harmful to children if too much is ingested.

A dental health professional may recommend and apply topical fluoride treatments for some children. Special fluoride toothpastes can be brushed on their teeth. These usually come in fun flavors. The dentist may squeeze a fluoride "gel" into a plastic mouthpiece which the child holds in his mouth for a few minutes.

'Some dentists or pediatricians will "paint" the child's teeth with a clear sodium fluoride "varnish." It has a higher concentration of fluoride than current gel, foams, rinses and pastes, but is less toxic to children because less of the product is swallowed during application.

Too Much Fluoride

At proper levels, fluoride gives great benefits to the teeth during childhood and throughout life. However, dental fluorosis can occur if young children ingest too much fluoride for their size and weight during tooth development.

Fluorosis is a cosmetic problem, causing mottled, chalky, white spots on the surface of the teeth. It does not affect the function of the teeth.

Following these recommendations can help to avoid over ingestion of fluoride:

• Use plain water and a soft-bristled toothbrush for infants and toddlers. Toothpaste is not necessary.
• Fluoridated toothpaste should be introduced when a child is about two years of age. Choose a low-fluoride toothpaste that is "ADA Approved."
• Use only a tiny smear of toothpaste when brushing teeth.
• Teach children to spit out toothpaste after brushing. Some children like the taste and may want to swallow the toothpaste.
• Supervise children when they brush their teeth until you are sure they can do it well.
• Keep toothpaste out of children’s reach by storing it in a locked cabinet.
• If older children use mouthwash, teach them to "swish and spit."

In areas without fluoridated water, children’s physicians may prescribe fluoride supplements, such as drops or tablets. These should not be used unless advised by the child’s physician and generally will be given by the family at home. Refer to your program’s medication policy and procedures before giving fluoride supplements.

Toothbrushing in Childcare

Children and adults should brush their teeth at least twice a day, including just before bedtime. Here are some tips for tooth brushing in the childcare setting:

• Children should have their own age-appropriate toothbrushes, labeled with their names. Replace toothbrushes every three months, or more frequently if they show signs of wear. Toothbrushes should be replaced after a child has an infection.
• Rinse toothbrushes thoroughly after each use and allow to air dry. Toothbrushes must not touch one another, either during use or during storage.
• Children should have individually-labeled tubes of toothpaste. If toothpaste is from one large tube for all children, then the toothpaste should be squeezed onto individual pieces of paper; do not squeeze it directly onto the toothbrushes.
• Caregivers should wash their hands before and after helping a child with brushing.
• If a child’s gums are bleeding, the caregiver should wear gloves when helping with brushing and then recommend that the child be seen by a dentist.

Healthy Teeth Make Beautiful Smiles

Thorough tooth brushing takes time--about two minutes is recommended. One way to help children brush completely is to "time" the brushing by having other children sing a song while their classmates brush, such as the one below:

Helping children learn about how to keep their teeth healthy and learning appropriate dental care can help them start a lifetime of healthy dental habits.

Tania Cowling
Early childhood teacher resource books author, freelance writer, and former teacher

Internet Resources

American Academy of Pediatric Dentistry, www.aapd.org/publications/brochures/floride.asp

American Dental Association, www.ada.org/public/topics/fluoride/fluoride_article01.asp

Centers for Disease Control & Prevention, www.cdc.gov/fluoridation/fact_sheets/benefits.htm,
& www.cdc.gov/fluoridation/fact_sheets/fl_caries.htm
& www.cdc.gov/fluoridation/other/spplmnt_schdl.htm

Healthy Kids, Healthy Care: Dental Health (National Resource Center for Health and Safety in Child Care, www.healthykids.us/chapters/dental_pf.htm

Keep Kids Healthy, www.keepkidshealthy.com/WELCOME/treatmentguides/dental_health.html

Kid’s Health, www.kidshealth.org/parent/general/teeth/fluoride.html

Resources

The Centers for Disease Control & Prevention’s Brush Up On Healthy Teeth Program has available dental health resources including a quiz for parents, a poster, and a tip sheet. These can be downloaded from www.cdc.gov/OralHealth/factsheets/brushup.htm or by contacting the Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS F-10, Atlanta, GA 30341-3717; 770-488-6054