Other Fluoride Products
In the United States, water fluoridation is not the only form of
fluoride delivery that is effective in preventing tooth decay in people
of all ages. Use the information listed below to compare the other
fluoride products that may lower the risk for tooth decay, especially
for people who are at higher risk for decay:
Although all of these products reduce tooth decay, combined use with
fluoridated water offers protection greater than any of these products used
Additional information on these products and other topics can be found in
Recommendations for Using Fluoride to Prevent and Control Dental Caries
in the United States. MMWR, August 17, 2001;50(RR-14):1–42.
||Concentrations of fluoride in toothpaste sold in the United
States range from 1,000–1,500 ppm.
||Most people report brushing their teeth at least once per day, but more
frequent use can offer additional protection. Fluoride in toothpaste
is taken up directly by the dental plaque and demineralized enamel
and also increases the concentration of fluoride in saliva.
||Fluoride toothpaste is available over-the-counter and makes up
more than 95% of toothpaste sales in the United States.
||For most people (children, adolescents, and adults) brushing at
least twice a day with a fluoride toothpaste—when you get up in the
morning and before going to bed—is recommended.
Advice for Parents
For children aged 6 years and younger, some simple
recommendations are advised
to reduce the risk of dental
- Supervise brushing to discourage swallowing
- Place only a small pea-size amount of fluoride toothpaste on
your child's toothbrush.
- Seek advice
from a dentist or other health care professional before
introducing fluoride toothpaste to children under 2 years of age.
Learn more about
oral health care for children.
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Fluoride Mouth Rinse
||Fluoride mouth rinse is a concentrated solution intended for
daily or weekly use. The most common fluoride compound used in
mouth rinse is sodium fluoride. Over-the-counter solutions of 0.05%
sodium fluoride (230 ppm fluoride) for daily rinsing are available
for use by persons older than 6 years of age. Solutions of 0.20% sodium
fluoride (920 ppm fluoride) are used in supervised, school-based
weekly rinsing programs. Other concentrations also are available.
||Rinses are used daily or weekly for a prescribed amount of time.
The fluoride from mouth rinse is retained in dental plaque and saliva
to help prevent tooth decay.
||Mouth rinses intended for home use can be purchased
over-the-counter. Higher strength mouth rinses for those at high risk
of tooth decay must be prescribed by a dentist
||Children younger than 6 years of age should not use fluoride
mouth rinse without consultation with a dentist or other health care
provider because dental fluorosis could occur if such mouth rinses
are repeatedly swallowed. Because fluoride mouth rinse has resulted
in only limited reductions in tooth decay among schoolchildren,
especially as their exposure to other sources of fluoride has
increased, its use should be targeted to individuals or groups at high
risk for decay.
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||Tablets, lozenges, or liquids (including fluoride-vitamin
preparations) are available. Most supplements contain sodium
fluoride as the active ingredient. Tablets and lozenges are
manufactured with 1.0, 0.5, or 0.25 mg fluoride.
||Fluoride supplements can be prescribed for children at high risk
for tooth decay and whose primary drinking water has a low
fluoride concentration. To maximize the topical effect of fluoride,
tablets and lozenges are intended to be chewed or sucked for 1–2
minutes before being swallowed.
||All fluoride supplements must be prescribed by a dentist or
physician. The prescription should be consistent with the 2010
(PDF–756K) developed by American Dental Association (ADA).
For children aged less than 6 years, the dentist, physician, or
other health care provider should weigh the risk for tooth decay
without fluoride supplements, the decay prevention offered by
supplements, and the potential for
Consideration of the child's other sources of fluoride, especially
drinking water, is essential in determining this balance. Parents
and caregivers should be informed of both the benefit of protection
against tooth decay and the possibility of dental fluorosis.
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|Fluoride Gel and Foam
||Fluoride gel is often formulated to be highly acidic (pH of
approximately 3.0). Products available in the United States include
gel of acidulated phosphate fluoride (1.23% [12,300 ppm] fluoride),
gel or foam of sodium fluoride (0.9% [9,040 ppm] fluoride), and
self-applied (i.e., home use) gel of sodium fluoride (0.5% [5,000
ppm] fluoride) or stannous fluoride (0.15% [1,000 ppm] fluoride).
||In a dental office, fluoride gel is applied for 1–4 minutes.
Home use follows instructions provided on the prescription.
||Most fluoride gel and foam applications are delivered in a
dental office by a dental professional. These higher strength products,
if used in the home, must be prescribed by a dentist or physician.
||Because these applications are relatively infrequent, generally
at 3 to 12–month intervals, fluoride gel poses little risk for
dental fluorosis, even among patients younger than 6 years of age.
Routine use of professionally applied fluoride gel or foam likely
provides little benefit to persons not at high risk for tooth decay,
especially those who drink fluoridated water and brush daily with
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||Varnishes are available as sodium fluoride (2.26% [22,600 ppm]
fluoride) or difluorsilane (0.1% [1,000 ppm] fluoride) preparations.
||High-concentration fluoride varnish is painted by dental or
other health care professionals directly onto the teeth. Fluoride
varnish is not intended to adhere permanently; this method holds a
high concentration of fluoride in a small amount of material in
close contact with the teeth for many hours. Varnishes must be
reapplied at regular intervals with at least 2 applications per
year required for effectiveness.
||All fluoride varnish must be applied by a dentist or
other health care provider.
||No published evidence indicates that professionally applied
fluoride varnish is a risk factor for dental fluorosis, even among
children younger than 6 years of age. Proper application technique
reduces the possibility that a patient will swallow varnish during
its application and limits the total amount of fluoride swallowed as
the varnish wears off the teeth over several hours.
Although it is
not currently cleared for marketing by the Food and Drug
Administration (FDA) as an anti-caries agent, fluoride varnish has
been widely used for this purpose in Canada and Europe since the
1970s. Studies conducted in Canada and Europe have reported that
fluoride varnish is as effective in preventing tooth decay as
professionally applied fluoride gel.
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Date last reviewed: January 6, 2011
Date last modified: January 6, 2011
Division of Oral Health,
National Center for Chronic Disease
Prevention and Health Promotion