CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2019; 55(01): 054-059
DOI: 10.1055/s-0039-1694083
Original Article
National Academy of Medical Sciences (India)

Use of Fluoridated Dentifrices among Children: Are We in the Right Direction?

Aditi Kapur
1   Pediatric Dentistry Unit, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
J. S. Thakur
2   Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
K. Gauba
3   Department of Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
A. Goyal
1   Pediatric Dentistry Unit, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
K. Mohit
4   Department of Community Dentistry, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
J. Manoj
1   Pediatric Dentistry Unit, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Further Information

Publication History

Publication Date:
02 October 2019 (online)

Abstract

Introduction Use of topical fluorides in dentifrices has always been an important tool in prevention of dental caries in young children. Due to the easy availability of various low and high fluoride dentifrices, the parents have no clear understanding about their correct age-appropriate use in children. This study was undertaken to evaluate and understand the trend and current practices among the end user.

Materials and Methods A total of 173 children aged 4 to 6 years were enrolled in the study from schools located in two different geographical areas of the Chandigarh city; group 1 (n = 90) from a peri-urban slum cluster: (Govt. Primary School, Indira Colony, Mani Majra, n = 51); Govt. Middle School, Mani Majra (n = 39); group 2 (n = 83) from an urban private city school (Ankur, Punjab University, Sector 14) using cluster sampling method. Two examiners using type IV examination examined all the children aged 4 to 6 years present using a preinstructed close-ended questionnaire. Data were analyzed using SPSS Software Version 25 (SPSS Inc., Chicago, IL, United States).

Results The data regarding the knowledge of fluoride in pastes showed that 85% of the children were using high fluoride pastes, 10% were using nonfluoride pastes, and 5% were using low fluoride pastes. In group 1, none of the users were aware about the benefits/risk of using fluoride toothpastes and only 22% were aware in group 2. Only 27% of children in group 1 dispensed the correct amount of dentifrice for this age group i.e., a pea head size versus 67% in group 2; a half brush length was dispensed by 61.5% in group 1 and 28% in group 2, and just a smudge by 11.5% in group 1 and 5% in group 2. Forty one percent children in both the groups had a history of having intentionally consumed the toothpaste. The toothpaste was dispensed to the child by parent in 89% of cases in group 2 and only 50% in group 1 and 88% parents claimed to always supervise the child while tooth brushing versus only 53% in group 1. Majority of the respondents’, i.e., 97% in group 1 and 63% in group 2 had never been explained about the correct method of use of fluoride paste in children.

Conclusion Knowledge about fluoridated toothpastes is low among the population. The children in peri-urban slums areas are exposed to the high fluoride pastes from very early in life and there is no other toothpaste which is brought home except for those which are commonly used among the members. In the city schools; however, a small percentage of population uses low fluoride pastes in children, possibly due to a greater awareness and access to information, but has no clear idea about their limitations and benefits of age-appropriate use. Till appropriate guidelines are available for the country, a safe practice to follow is tailoring individual need based protocol. The children in peri-urban slums areas need to be educated more on the health practices and importance of use of fluoride dentifrices and the children in the city schools need to be guided more on the age appropriate use of high and low fluoride dentifrices.

 
  • References

  • 1 Adair SM. Evidence-based use of fluoride in contemporary pediatric dental practice. Pediatr Dent 2006; 28 (02) 133-142
  • 2 Ericsson SY. Cariostatic mechanisms of fluorides: clinical observations. Caries Res 1977; 11 (Suppl. 01) 2-41
  • 3 Duggal MS, Toumba KJ, Amaechi BT, Kowash MB, Higham SM. Enamel demineralization in situ with various frequencies of carbohydrate consumption with and without fluoride toothpaste. J Dent Res 2001; 80 (08) 1721-1724
  • 4 Ekambaram M, Itthagarun A, King NM. Ingestion of fluoride from dentifrices by young children and fluorosis of the teeth–a literature review. J Clin Pediatr Dent 2011; 36 (02) 111-121
  • 5 Wong MC, Glenny AM, Tsang BWK, Lo ECM, Worthington HV, Marinho VCC. Using a fluoridated supplement with a high fluoride concentration in children aged under 6 years may increase the risk of fluorosis. Evidence-based dentistry 2010; 11 (01) 6-9
  • 6 Kaminsky LS, Mahoney MC, Leach J, Melius J, Miller MJ. Fluoride: benefits and risks of exposure. Crit Rev Oral Biol Med 1990; 1 (04) 261-281
  • 7 Marinho VCC, Higgins JPT, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 2003; (01) CD002278
  • 8 Farkas CS, Farkas EJ. Potential effect of food processing on the fluoride content of infant foods. Sci Total Environ 1974; 2 (04) 399-405
  • 9 Naccache H, Simard PL, Trahan L. et al. Factors affecting the ingestion of fluoride dentifrice by children. J Public Health Dent 1992; 52 (04) 222-226
  • 10 Bentley EM, Ellwood RP, Davies RM. Fluoride ingestion from toothpaste by young children. Br Dent J 1999; 186 (09) 460-462
  • 11 Beltrán ED, Szpunar SM. Fluoride in toothpastes for children: suggestion for change. Pediatr Dent 1988; 10 (03) 185-188
  • 12 Horowitz HS. The need for toothpastes with lower than conventional fluoride concentrations for preschool-aged children. J Public Health Dent 1992; 52 (04) 216-221
  • 13 Pessan JP, Alves KMRP, Ramires I. et al. Effects of regular and low-fluoride dentifrices on plaque fluoride. J Dent Res 2010; 89 (10) 1106-1110
  • 14 Ekambaram M, Itthagarun A, King NM. Comparison of the remineralizing potential of child formula dentifrices. Int J Paediatr Dent 2011; 21 (02) 132-140
  • 15 Thaveesangpanich P, Itthagarun A, King NM, Wefel JS. The effects of child formula toothpastes on enamel caries using two in vitro pH-cycling models. Int Dent J 2005; 55 (04) 217-223
  • 16 dos Santos AP, Nadanovsky P, de Oliveira BH. A systematic review and meta-analysis of the effects of fluoride toothpastes on the prevention of dental caries in the primary dentition of preschool children. Community Dent Oral Epidemiol 2013; 41 (01) 1-12
  • 17 Rasines G. Fluoride toothpaste prevents caries in children and adolescents at fluoride concentrations of 1000 ppm and above. Evid Based Dent 2010; 11 (01) 6-7
  • 18 Ammari AB, Bloch-Zupan A, Ashley PF. Systematic review of studies comparing the anticaries efficacy of children's toothpaste containing 600 ppm of fluoride or less with high fluoride toothpastes of 1,000 ppm or above. Caries Res 2003; 37 (02) 85-92
  • 19 Freire IR, Pessan JP, Amaral JG, Martinhon CC, Cunha RF, Delbem AC. Anticaries effect of low-fluoride dentifrices with phosphates in children: A randomized, controlled trial. J Dent 2016; 50: 37-42
  • 20 Dos SantosAPP, de Oliveira BH, Nadanovsky P. A systematic review of the effects of supervised toothbrushing on caries incidence in children and adolescents. Int J Paediatr Dent 2018; 28 (01) 3-11
  • 22 Whitford GM. Fluoride toxicology and health effects. In Fejerskov O, Ekstrand J, Burt BA. eds. Fluorides in Dentistry. Hanover: International Society of Fluoride Research; 1996: 167-184
  • 23 Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, Zentz RR. Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review. J Am Dent Assoc 2014; 145 (02) 182-189
  • 24 American Academy of Pediatric Dentistry. Fluoride therapy. Pediatric Dentistry. Reference Manual 2018; 40 (06) 250-253
  • 25 European Academy of Paediatric Dentistry. Guidelines on the use of fluoride in children: an EAPD policy document. Eur Arch Paediatr Dent 2009; 10 (03) 129-135
  • 26 Lima CV, Pierote JJ, de Santana NetaHA, de Deus Mourade Lima M, de Deus MouraLdeF, de Moura MS. Caries, toothbrushing habits and fluoride intake from toothpaste by Brazilian Children according to socioeconomic status. Pediatr Dent 2016; 38 (04) 305-310